Tag Archives: north carolina

Medicaid expansion may go to the ballot box in three states

Photo: joelip via Flickr

Advocates in three conservative states – Utah, Idaho and Nebraska – are trying to get Medicaid expansion on the ballot in November.

Organizers in Utah already have submitted signatures, which are now being verified. They have surplus signatures so odds are that they will make it. According to an article by Dylan Scott of Vox, a recent poll by the Salt Lake Tribune and the University of Utah found 62 percent of Utah voters support the ballot initiative. Continue reading

Supreme Court hears case over teeth whitening, professional board’s power

Photo by dbking via Flickr

Photo by dbking via Flickr

WASHINGTON — A long-running fight between the North Carolina State Board of Dental Examiners and a group of non-dentists who provide teeth-whitening services reached the nation’s high court today.

During an intense hour of oral arguments, the nine justices of the U.S. Supreme Court delved into whether the state board overstepped federal anti-trust laws in sending out threatening “cease and desist” letters to operators of teeth whitening salons in mall kiosks and salons.

Was the board, which is dominated by practicing dentists, unfairly obstructing competition from lower-priced providers? Or was the body fulfilling its obligation to protect the public health by acting as an arm of the state to shut down illegal practitioners of dentistry?

The court’s decision might have implications for teeth-whitening shops around the country, as well as for the state-established boards that regulate a wide range of professions, Emery Dalesio reported in an Oct. 13 story for The Associated Press

Dental whitening has grown into a multibillion dollar business and the struggle over who should be allowed to bleach teeth has been playing out in many states in recent years. Continue reading

N.C. hospital garnishes patient tax refunds to collect debts

Joseph Neff, reporting for North Carolina’s News & Observer, explains how UNC Health Care is taking advantage of “a little-known law, the Set Off Debt Collection Act, that allows state and local agencies to collect debts by seizing state tax returns and lottery winnings.

UNC is the only hospital in the state that qualifies to use the service and is, in fact, legally compelled to do so.

Last year, UNC Hospitals collected $5.7 million, while UNC Physicians and Associates collected $2 million. Together, that accounted for 11 percent of the $72 million of set off debt collected for all state and local agencies that year

Hoban compares N.C. mental health system to other states

WUNC’s Rose Hoban took advantage of an AHCJ fellowship to create far-reaching series on what state and local governments are doing to accommodate and treat residents with mental health disorders, particularly in terms of housing.

Rose Hoban

Rose Hoban

I recommend you start with Hoban’s honest and personal explanation of how the series came about. It was facilitated by an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund, but the initial impetus came from Hoban’s 12 years of nursing experience and firsthand experiences with treatment models for the mentally ill.

Her original plan for the fellowship, which called for a broad, systemic analysis, was to compare North Carolina’s health system to that of a an equivalent state elsewhere in the country. As she soon found, it’s not that simple.

… as I started digging, I learned that’s just not possible. States have so many varied ways of organizing mental health care delivery – Local-control or state-control? Combine with substance abuse services and developmental disabilities or not? Pull in lots of federal dollars or depend on state dollars? Rely on institutions or more on community-based services?

On top of that, states have many ways of paying for mental health services – Medicaid? State dollars? County dollars? Private dollars? Public-private-partnerships? Tax dollars? Insurance dollars? Fees?

With the insight provided by that false start, Hoban recalibrated by choosing to compare specific components of the North Carolina system with those of other relevant states. The results, along with some relevant past work and original blog posts, are available on Hoban’s NC Voices: Mental Health Disorder blog.

The centerpiece, a five-part radio series focusing on housing issues for those with mental health problems, aired on North Carolina Public Radio. The links below will take you to stories, transcripts and blog posts.

N.C. county’s mental health services overwhelmed

The one million people who live in North Carolina’s Mecklenburg County are served by a single 66-bed county mental health facility. Charlotte Observer reporter Ames Alexander found that, given those numbers, the math just doesn’t add up. Demand for mental health services has increased in recent years, while the supply of care has actually contracted. Problematic or dangerous patients are “given medicine and sent home,” and the percentage of critically ill patients actually admitted to the hospital is below past numbers as well as those of comparable facilities around the country.

In a 2003 study, the 66-bed hospital concluded that it would need up to 67 more beds in the coming decade – an expansion that was expected to cost as much as $49 million.

“The current facility can not meet the needs of existing volume, much less future needs,” the report said.

Since 2003, the needs have only intensified. Visits to the hospital’s emergency department have grown 25 percent.

In March, when Chapman sought help, emergency department visits jumped to the highest number in 10 months and the hospital’s adult units were running at 105 percent capacity. That same month, the number of calls to the hospital topped 24,000 – a record.

As you may have guessed, the needed expansion never materialized and, with budgets being cut in the county, it doesn’t seem likely any time soon. In addition to a number of well-chosen anecdotes and an exploration of the consequences of untreated mental illness, Alexander helps illuminate the problem by framing it as part of a larger discussion of who is responsible for public mental health treatment: The state or the county?