Money Follows the Person

North Carolina was awarded a Money Follows the Person Demonstration Grant in May 2007. It was intended to help individuals who are confined to institutions move back into the community. Most of these said people remain institutionalized, not out of willingness or preference, but because they must do so in order for Medicaid to cover their care. “Money Follows the Person,” a potential solution to the problem, is the term describing the practice of Medicaid allowing these people to move out of nursing homes and institutions and into their homes and communities to receive the assistance they need. Thus, the money for the care, along with the care itself, follows the person into their respective homes and communities.

Accomplishing this will be a long and grueling process. It involves shifting state policies, adjusting Medicaid funding streams, and supporting local communities so that elderly people living in nursing homes may come home. The MFP committee is working hard to achieve this goal. To learn more about MFP in North Carolina, please visit the hyperlinked article or www.ncmfp.com.

To Pay or not to Pay

Some people with MS have been finding that it is either one or the other. Pharmacy benefits manager Prime Therapeutics (Prime) assembled a team to examine the correlation between high out-of-pocket expenses for medication and those who decide not to fill their MS prescriptions. Research results showed that a daunting 1 out of 4 people with MS are not getting the medications they need due to high costs.

According to the study, the majority of individuals had an out-of-pocket expense of $150 or less and their decline to fill rate was 5.8 percent. For individuals with an out-of-pocket expense of greater than $150 the decline to fill rate was 27.0 percent.

Patrick Gleason, PharmD, FCCP, BCPS, lead author and Director of Clinical Outcomes Assessment at Prime Therapeutics, believes that, “Patients who aren't taking their medications face serious medical and health complications, which could result in substantial medical or hospitalization expenses for both the patient and health insurer.”

If you have previously experienced the dilemma of choosing between filling your medications and suffering from high expenses, or not filling and saving money, we would love to hear your story and any comments/concerns you may have.

“People First”

Ethics play a large role in all interactions and societal matters today. People are constantly striving to make sure they act in accordance with how they “should”, and if they’re not, they are usually still cognizant of what the norm is and how they are willingly disobeying it.

For this reason, it comes to some surprise that, up until recently, tons of bills were easily passed by NC State Legislature that used derogatory terms such as “dumb” and “crippled.” Senator Katie G. Dorsett recognized the inherent offense behind using these terms, and pushed for Senate Bill 208, entitled “People First.” The bill requires that the Legislative Services Office “incorporate into its drafting training of legislative drafters the preference to avoid language that implies a person as a whole is disabled, equates a person with his or her condition, or is regarded as derogatory or demeaning.”

Even though this is something that should have been done a long time ago, the victims of these formerly used harsh terms will probably appreciate Senator Dorsett’s identification and handle of the issue.

If you are thankful for the Senator's actions, please let her know at Katie.Dorsett@ncleg.net.

Time for Universal Health Care Coverage?

Harvard’s Dr. David Himmelstein certainly thinks so. A study done to discern the causes of U.S. personal bankruptcies revealed that medical bills make up a majority of the losses. Furthermore, the researchers, from Harvard Law School, Harvard Medical School, and Ohio University, found that more than 75% of these families had health insurance but still could not handle their medical debts. These findings confirmed for Himmelstein his belief that middle-class Americans are not adequately covered at all by health insurance.

Currently, the US is a mélange of several different public programs and employer-sponsored health insurance that neglects about 15 percent of the population. Himmelstein and others, such as Dr. Sidney Wolfe of the Health Research Group at Public Citizen, believe that the nation would be in better condition if they adopted a single-payer plan, where the government would coordinate health coverage.

Obama, although willing to consider making health insurance mandatory, does not feel the same way about the prospects of single-payer national health insurance coverage. There exist no signs of this kind of endorsement.

Nevertheless, health care reform has become a huge concern nationwide, potentially affecting millions of Americans for better or for worse. The current direction of reform has implications for all people with health care issues, including those living with multiple sclerosis. The study found that in 2007, patients with MS paid a staggering mean of $34,167 out of pocket. Whether it be through single-payer plans, or restructured health care plans, something must be done to mitigate these expenses. In what fashion, that cannot be determined at this time.

Breastfeeding a Newborn or Resuming MS treatment? Recent Studies Show that the Former May be the Better Choice

Because many MS medications involve a modification of the immune system, pregnant women are advised to discontinue use until they give birth. At this time, women face the choice of either nursing their child or resuming their MS treatment.

Annette Langer-Gould, M.D., Ph.D., along with her colleagues at Kaiser Permanente Southern California, Pasadena, studied the association between women with and without MS who breastfed and how many of those with MS were more likely to start formula feedings within the first two months after birth. "Of the 52 percent of women with MS who did not breastfeed or began regular supplemental feedings within two months postpartum 87 percent had a postpartum relapse, compared with 36 percent of the women with MS who breastfed exclusively for at least two months postpartum”, the authors write. "Women with MS and healthy women who breastfed exclusively had significantly prolonged lactational amenorrhea [absence of menstruation], which was associated with a decreased risk of relapse in women with MS."

From this study, it appears that it would be in the best interest of women with MS who have just given birth to breastfeed for at least the first two months rather than give formula feedings to their newborns. Nevertheless, the authors state that the implications of this study should be confirmed by further research before being conclusively taken as an accurate association.