For the past 20 years, Ryneal Medical Transport served West Virginians in the Eastern Panhandle when they were at their most vulnerable. 

If a Jefferson County resident was bed-ridden with end-stage liver disease, Ryneal could drive them to and from the hospital. If a Berkeley County senior citizen needed their oxygen tank managed on the way to a dialysis appointment, Ryneal could help.

“The first 15 years was great,” said Mary Helmick, Ryneal’s president and co-owner. “Actually, it was great up until COVID hit.”

That’s when staffing issues, paired with ride reimbursements that left little-to-no room for profits, began to cripple the organization, according to Helmick. She and her husband kept Ryneal alive for a while longer. But last January, they decided it was time to close, ending a service that in Helmick’s estimation would respond to 8,000 to 10,000 medical calls a year with their fleet of 24 specialized vehicles.

While there are a few other Eastern Panhandle organizations that provide the same types of services Ryneal did, none of them have the capacity to fully make up for the company’s absence. Many local health care workers understand why the organization shut its doors, but transporters and doctors alike say the change has made it even more difficult for some residents with life-threatening conditions to get to and from the hospital. 

“If there’s no Ryneal, they can’t safely leave the hospital because [staff] have no way to get them the continued care they need,” said Dr. Michael Londner, an emergency medicine physician and vice president of medical affairs at WVU Medicine Berkeley Medical Center. “They literally now are living in the hospital until we can sort out a solution.”

Problems related to health care transportation aren’t unique to the Eastern Panhandle; patients and providers have experienced problems accessing health care in other parts of West Virginia. 

But Ryneal’s closure highlights how West Virginians in the area rely on the medical transport system to get quick and effective health treatment — and how care suffers for all when one of those interdependent pieces goes away. 

“It’s its own ecosystem,” said Chad Winebrenner, the chief of operations for Berkeley County Emergency Ambulance Authority. “Even though we’re not directly tied in, that domino effect, it still gets to you.”

Needs unmet without Ryneal

There are many ways transportation issues can prevent patients from addressing their health needs. But in the Eastern Panhandle, Londner says the problem most exacerbated by Ryneal’s closure has been for patients who require special accommodations while in transit.

People who need this kind of trip range from those on dialysis who need stretchers to be transported to someone who needs oxygen administered on their way back from a chemotherapy session. It’s a population that requires either an ambulance or similarly-equipped vehicles to get from place to place.

Helmick remembers one of Ryneal’s last long trips, transporting a patient dying of cancer from Martinsburg to Emerald Isle, North Carolina, as one of these types of journeys. She said one of the woman’s dying wishes was to be at her home when she passed away. 

“We got her home at seven o’clock that night,” Helmick said. “She passed away at seven o’clock the next morning. We were very fortunate to get her home.”

In a post-Ryneal world, it’s becoming increasingly harder for Eastern Panhandle patients who need that kind of specialized medical transport to access it, even for trips that start and end within West Virginia’s borders. Londner said the region has struggled with these rides as long as he can remember, but the problem has expanded, first with an increased need from the COVID-19 pandemic and now with Ryneal’s closure.

There are other smaller companies in the area Ryneal served — primarily Berkeley, Jefferson and Morgan counties — that still offer specialized medical transportation services. The area’s two major hospital systems, Valley Health and WVU Medicine, each have a fleet of vehicles, as does a local private company called Patient Care Transport. 

But the region has seen large population growth over the past decade; it’s now home to over 200,000 people and has a higher-than-average disability prevalence. Even with the other service options, there is still a large unmet demand, according to Londner and Ali Hadavand, Patient Care Transport’s Chief Operating Officer. Hadavand said his company, plagued by the same staffing shortages felt by health care organizations across the country, is down to only three emergency medical technicians.

He thinks Patient Care could be shouldering more of the need left behind by Ryneal’s closure if it had more qualified employees.

“We’re doing our best,” Hadavand said. “I could definitely run two more trips a day at least.”

Now, the problem has become so severe that Berkeley Medical Center has held off from discharging some patients at all. Londner said that as of mid-June, one bed-bound patient who needs frequent dialysis treatments has been in the hospital for 158 days.

“He would need an ambulance three days a week to get him there,” Londner said. “And we don’t have any way to do that for him…We can’t safely discharge him knowing that he will not be able to receive care.”

The effects of this transportation gap are far-reaching. Emergency room wait times have risen for all patients, partly because hospitals can’t discharge people who are ready to either leave or be transferred but don’t have appropriate rides available, according to Winebrenner of the Berkeley County Emergency Ambulance Authority.

“It just becomes a pretty big backup when that chain gets broken,” he said. 

Mitigation possible with the right policies

Some of the factors that led to Ryneal’s closure, like health care workforce shortages, are problems that communities across the country struggle to address adequately. But others are issues that local policymakers could take steps to mitigate. 

In Ryneal’s January letter announcing its closure, Helmick and her husband cited low insurance reimbursement rates for rides as a major reason. While inflation raised the operational prices of goods like gas in recent years, the amount insurance providers like West Virginia’s Medicaid and Public Employee Insurance Agency paid Ryneal and other medical transport companies for their work didn’t keep pace. 

“This year it was going to hit harder,” she said.

While Ryneal may no longer exist, Londner thinks the only way future private companies can operate and succeed in the area is for insurance groups to raise their medical transportation reimbursement rates. It’s something he believes to be crucial for West Virginia’s Eastern Panhandle and, as it pertains to PEIA and Medicaid, something in West Virginia lawmakers’ power to address. 

“You need the reimbursement to be higher so that people can afford to make a living being a transport company,” he said.

It’s also not just private transportation. Despite some legislative action during the 2023 session, local emergency medical service agencies are also struggling with funding and retaining staff members. Some West Virginians have said making sure state lawmakers support these programs financially is crucial to creating robust local medical transportation systems.

To address staffing issues, Hadavand of Patient Care believes it’s important for local policy makers to think about ways to get kids interested in becoming paramedics and EMTs. Some parts of the country have EMS programs that engage kids in middle and high school, offering early exposure to the professions.

While programs like that may not completely reverse health care workforce shortages, Hadavand sees sparking a medical transportation interest in young people as important for his industry.

“I’m not sure how to do it,” he said. “But I think that would help, having more kids wanting to go down this path.”  

‘Domino effect’: Eastern Panhandle residents struggle to get vital health care after closure of a medical transport company appeared first on Mountain State Spotlight, West Virginia’s civic newsroom.

Mississippi politicians have long viewed being anti-abortion as a key to winning elections, working diligently for years to stretch the limits of the law and pass some of the nation’s most restrictive bans.

But based on a new Mississippi Today/Siena College poll, being anti-abortion may not be the key electoral issue that politicians – especially Republican politicians – have believed it to be.

A poll of Mississippians who say they will vote in the Aug. 8 Republican primary found that 45% support repealing the state’s “trigger law” that bans most abortions in the state. Another 44% of likely Republican voters oppose repealing the ban, and 11% said they were not sure.

Editor’s note: Poll methodology and crosstabs can be found at the bottom of this story. Click here to read more about our partnership with Siena College Research Institute.

Mississippi’s trigger law went into effect in 2022, when the U.S. Supreme Court overturned Roe vs. Wade. That decision effectively meant that abortion was no longer a national right and that the issue could be decided by each state.

It was a Mississippi case that led to the overturning of Roe. After the Supreme Court decision, the Republican leadership of the state proudly proclaimed Mississippi to be solidly pro-life, with some saying it was the nation’s “safest state for the unborn.”

The poll results are especially notable since the respondents are those who say they intend to vote in Republican primary in August. Generally speaking, it is believed that Republican primary voters tend to be staunchly anti-abortion while Democratic voters support abortion rights.

But based on the new poll, abortion might not be any longer the hot-button social issue that Republicans use to attack Mississippi Democrats and link them to national Democrats.

That issue, according to the results of the poll, could become rights of transgender Americans. According to the poll, likely Republican primary voters by an overwhelming 70%-to-19% margin oppose “repealing the current ban on gender affirming healthcare for any trans person under 18 years of age.” The remaining 11% of the poll respondents were undecided.

Earlier this year during the 2023 legislative session, Republican leaders pushed through a bill banning gender affirming care for minors. The bill prohibits medical providers in Mississippi from providing the care and also appears to ban parents from seeking out-of-state care for their children, though it is unclear how that provision would be enforced.

In the 2023 session, Republican legislative leadership also attempted to take steps to ensure that laws in the state banning most abortions are not weakened.

The Legislature made an unsuccessful effort to revise the state’s ballot initiative process that was struck down in 2021 on a technicality by the state Supreme Court. The initiative process allows voters to gather signatures to bypass the Legislature and place issues on the ballot. The House leadership, led by Speaker Philip Gunn, wanted the new initiative process to ban efforts of placing abortion issues on the ballot. The Legislature ultimately was unable to pass a law restoring the initiative.

Of course, the one time that Mississippians voted on the issue of abortion under the old and now invalid initiative, they rejected the so-called “personhood amendment” by a 58% to 42% margin. The personhood proposal on the ballot in 2011 defined a person “to include every human being from the moment of fertilization, cloning or the equivalent thereof.” Then-Lt. Gov. Phil Bryant said at the time a vote against personhood would be “a victory for Satan.”

Since the U.S. Supreme Court overturned the national right to an abortion in 2022, six states have voted on abortion. In all of those states, the electorate voted — usually by large margins — to expand abortion rights. Some of those states, such as Kansas, Kentucky and Montana, are seen as conservative as Mississippi.

On other issues, likely Republican Party primary voters, according to the poll:

• Support eliminating the grocery tax 76% to 15%, with 9% undecided or not answering.
• Support eliminating the state personal income tax 71% to 18%, with 11% not sure.
• Support full funding of public education through the Mississippi Adequate Education Program 57% to 16%, with 26% having no opinion or not knowing.
• Support expanding Medicaid 52% to 35%, with 13% not sure.

The Mississippi Today/Siena College Research Institute poll of 646 registered voters was conducted June 4-7, 2023, and has an overall margin of error of +/- 4.8 percentage points. Siena has an ‘A’ rating in FiveThirtyEight’s analysis of pollsters.

Click here for complete methodology and crosstabs relevant to this story.

The post Poll: Mississippi Republican voters cool on abortion ban appeared first on Mississippi Today.

By Jaymie Baxley

North Carolina is in the process of reviewing Medicaid eligibility for more than 2.9 million residents amid the unwinding of a federal mandate that prevented states from kicking people off the rolls during the COVID-19 pandemic.

Known as the continuous coverage requirement, the mandate created by Congress in early 2020 protected Medicaid beneficiaries from losing coverage even if they no longer qualified for the program. It expired in April with the end of the public health emergency, allowing states to disenroll residents for the first time in nearly three years.

Terminations are not set to begin until July in North Carolina, but a top Medicaid official for the Biden administration has noticed a concerning trend among states that are further along in the process.

“What we’re seeing across the country for states that have started to disenroll people is that there are large numbers of terminations,” Daniel Tsai, director of the Center for Medicaid and CHIP Services at the U.S. Centers for Medicare and Medicaid Services, said during a videoconference with North Carolina reporters on June 9.

He said a lot of the people losing coverage was because of “procedural red tape,” rather than being over the income limits that determine eligibility. The issue is compounded by a lack of public awareness, according to Tsai. He said many at-risk enrollees do not know about the unwinding and the effect it could have on their benefits.

“I would anticipate when terminations actually start, then you’re going to start to see a bunch of folks realizing for the first time that this is happening,” he said. “That’s of concern to all of us, and we really want to make sure that people get the word out.”

While the criteria for Medicaid varies from place to place, most states use the federal poverty level as a baseline for eligibility. This means the people at greatest risk of losing coverage should be those with incomes that now exceed the limit for their state, which in North Carolina is $24,860 in annual earnings for a family of three.

Several states are reporting worryingly high rates of terminations for what are essentially paperwork issues. A recent study by KFF, formerly known as Kaiser Family Foundation, found that more than 80 percent of unwinding-related terminations in Arkansas, Florida, Indiana and West Virginia involved residents who “did not complete the enrollment process and may or may not still be eligible for Medicaid.” 

“Millions of Americans’ health insurance and health care coverage is really at risk,” Tsai said. “We are urging every state across the country to do more and to take up many of the strategies we have put out on the table from a federal standpoint that really help make it easier for eligible people to stay covered.”

Resuming renewals 

One strategy the Biden administration is promoting, Tsai said, is automatically renewing coverage for people who continue to qualify for Medicaid. According to North Carolina’s unwinding plan, the state hopes to complete most renewals “without any contact with the beneficiary” using information collected from wage databases and other sources. 

Still, there will be cases where the state does not have all the information needed to confirm a Medicaid recipient’s eligibility and must reach out to the person by mail. If that beneficiary fails to respond within 30 days, their coverage could be terminated. 

“One of the really important messages for people is to not only update their contact information, but return the mail,” Tsai said.

Before the pandemic, Medicaid participants typically underwent annual or semiannual reviews to verify that they continued to qualify for coverage. But people who were added to the rolls while the federal mandate was in place have never gone through that process. Statewide enrollment grew 36 percent during the pandemic, with over 797,000 people newly qualifying for coverage from March 2020 until April of this year.

“What we find is a lot of people have no idea that Medicaid renewals have started,” Tsai said. “Consumers were told for three years, ‘Don’t worry, your Medicaid coverage is protected.’ 

“All of a sudden federal law has changed. A renewal form comes but the average consumer doesn’t know what Congress has done and doesn’t even know they need to respond to something.”

In a statement to NC Health News, the N.C. Department of Health and Human Services said 300,000 people are expected to lose coverage over the next 12 months. The agency says it is working to “ensure people eligible for Medicaid do not lose coverage and those no longer eligible are transitioned smoothly to affordable health plans.”

For some North Carolinians, that may mean going through the federal health insurance marketplace.

People ordinarily have only 60 days to enroll in a marketplace plan after losing Medicaid, but CMS has created a special enrollment period for individuals affected by the unwinding. They can apply for marketplace coverage at any time through June 31, 2024.

Expansion overlap

The timing of the unwinding presents a unique challenge for North Carolina, which is set to become the 40th state to expand access to Medicaid. 

Medicaid expansion was signed into law by Gov. Roy Cooper mere days before the continuous coverage mandate expired. It is expected to benefit hundreds of thousands of North Carolinians with incomes that are less than 138 percent of the federal poverty level for their family size — $34,306 for a family of three — up from the state’s previous limit of 100 percent.

DHHS has confirmed that many residents who lose coverage during the unwinding will become eligible again once expansion officially goes into effect, likely this summer. That won’t happen until a state budget is approved, which still could be months away.

“When you start renewals with expansion still to come and you’ve got a gap, it just leads to people having a gap in coverage and some confusion and resource challenges,” Tsai said. “Hopefully folks will have every chance in North Carolina to, if they’re eligible for Medicaid expansion when that starts, be able to seamlessly transition into that.

“And of course, if they’re not eligible for Medicaid, we want to make sure they’re getting over to other forms of coverage.”

The post As NC begins Medicaid ‘unwinding,’ federal official warns of worrying trends appeared first on North Carolina Health News.