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Missouri Medicaid policy leaves Hepatitis C patients untreated

By Megan Liz Smith, Meg Cunningham, Michelle Stoddard and Cecilica Cao(Zhongqi Cao)

For Missouri Medicaid beneficiaries with hepatitis C, getting treated can be tricky. The state will only cover the treatment if a patient’s condition has reached a certain level of severity. They claim the cost of providing treatment is too high to treat everyone who has the disease. Three Missourians under Medicaid who have hepatitis C, are suing the Missouri Department of Social Services for refusing to provide treatment. The plaintiffs say that withholding treatment costs more because of what it leads to, like cirrhosis, liver transplants, cancer and even death.

In the United States, up to 3.9 million people are infected with chronic hepatitis C, according to the Centers for Disease Control and Protection. Fortunately, there are now drug treatments available with an almost 100 percent cure rate. In the past five years alone, new drugs have come to the market that treat all six types of the virus.

While more treatment options are becoming available, they come at a price of upwards of $95,000. A single pill of Harvoni, a leading hepatitis C treatment, costs $1,125. Competition is slowly driving prices down, but states are still having trouble affording the lifesaving treatment. In 2015, Missouri entered an agreement with Sovaldi, which reduced the price of the drug by 30 to 40 percent, according to the Department of Social Services.

Although the lower prices make the drug easier to afford, the Medicaid budget is tight.

“No one has an extra five or 10 percent of their budget just lying around,” Matt Salo, executive director of the National Association of Medicaid Directors, said.

Because of this, states set requirements for who they can and cannot treat. They do this by grading the severity of liver scarring.

“It’s called a Fibrosis Score, or F Score,” said Ghassan Hammoud, a hepatologist and gastroenterologist at the University of Missouri Hospital. “If you have a higher score, like F3 or F4, you’re on the verge of having your liver fail, getting liver disease, or even cancer. If the scarring is still in its early stages, like F0 or F1, that means there’s not much damage.”

The state tries to save money by only treating those with advanced scores. In Missouri, treatment is withheld until a patient has reached a score of F3, at which point severe liver damage has already occurred.

The Missouri Department of Social Services is being sued by three patients waiting for treatment under Medicaid. The plaintiffs argue that the state has an obligation to cover the cost of their treatment.

John Ammann, the attorney representing the plaintiffs, said it is proven that follow-up care is cheaper for the state if the disease is addressed early on. A recent study from Gilead Sciences, Inc. looked at this issue from a national level. They produce the hepatitis C drugs, Harvoni and Sovaldi, and wanted to find whether a “treat all” method really was cheaper. What they found was treating all eligible Medicaid patients with hepatitis C, regardless of the fibrotic stage, would result in 16,173 fewer hepatitis C related deaths and $3.8 billion in national savings.  

“Collectively, most states are definitely relaxing their criteria. Some of that is in response to lawsuits, some of it is in response to the fact that prices are coming down,” Salo said.

            The trial is set for February 2018. Many advocates hope the outcome of this case could change the status of thousands of patients waiting for treatment. 

Missouri Medicaid policy leaves Hepatitis C patients untreated -
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Festivals attract large crowds to small towns

By: Betsy Smith, Cecelia Cao (Zhongqi Cao), Molly Dove, Tana Kelley

HARTSBURG, Mo. -- On a warm Saturday fall morning, 50,000 people from across Missouri waited in their cars for two hours to enter Hartsburg, a town of 106 people.

Many in the crowd said the wait was worth it to experience the 26th annual Hartsburg Pumpkin Festival.

“This is small town USA at its finest,” said Cheri Buckner, an Ashland resident who attends the pumpkin festival almost every year with her kids and grandkids.

Hartsburg isn’t the only small town that has mastered the art of throwing a cherished festival. Rural towns across mid-Missouri are turning local gatherings rooted in history into an opportunity for community development and large crowds.

From parades to vendors selling food and crafts, these festivals bring townspeople together and provide real financial benefits for the small communities.

In Eldon, the turkey festival is planned by the Chamber of Commerce and serves as a way to cover the chamber’s operating cost, said Sandy Kilkenny, the office manager of the chamber. The turkey festival brings in up to $30,000 a year.

The Eldon chamber uses the proceeds from the turkey festival to host networking events. That helps local businesses strategically market themselves, something that can be a struggle in a small town.

The Olde Tyme Apple Festival in Versailles, Missouri also capitalizes on the up to 30,000 attendees it attracts. Over the past few years, the festival has drawn increased business and tax revenue to Versailles, said Brice Lake, the vice president of the Versailles Chamber of Commerce and the Olde Tyme Apple Festival chairman.

HARTSBURG, Mo. -- On a warm Saturday fall morning, 50,000 people from across Missouri waited in their cars for two hours to enter Hartsburg, a town of 106 people.“This is small town USA at its finest,” said Cheri Buckner, an Ashland resident who attends the pumpkin festival almost every year with her kids and grandkids.

“We’re getting back into economic development,” Lake said.

Like Eldon, Versailles uses the revenue from booth sales to fund the chamber, which holds job expos, résumé building activities and community events for residents. 

Amy Schneider, the director of the Columbia Convention and Visitors Bureau, said festivalgoers help bring new money into the town economy that businesses need.

Versailles has seen this firsthand. Lake said the local Sonic earns its highest profits all year during the weekend of the festival, and the town’s Mexican restaurant suddenly finds itself with a 45-minute wait.

In other cases, towns use festival proceeds to support local organizations. For the rural farming town of Olean, the Testicle Festival covers town operation costs and supports the local FFA chapter, said Gayle Bledsoe, treasurer of the Olean Jaycees. 

But making enough proceeds to fund these organizations and chambers is not an easy task. Festival chairmen plan for months to determine the best way to allocate resources and attract enough attendees to their normally quiet towns.

Planners must take into account visitor parking, bathrooms and trash. They also try to be considerate of residents’ needs, Kilkenny said.

Schneider said towns must decide for themselves whether the extra burden of the festival is worth the overall benefit. For the Hartsburg Pumpkin Festival, like many others, the burden is lessened by volunteer efforts. Local Boy Scouts clean up the town after the festival, and the Boone County Sheriff’s Department volunteers to control traffic.

For towns like Hatton, the residents never expected the festivals to attract so many people, but it is made possible by the effort of the whole community. Hatton Craft Day brings in almost 10,000 people to the small village.

            “If a community supports a festival either by ways of sponsorship or if the community supports a festival by way of volunteering, then you’re going to have a successful festival,” Schneider said.

The increased success of festivals is good for the town economy, but for most festivals, the origin was old-fashioned family fun. From there, residents watched the celebrations grow year after year as they attracted more people.

            “We had just seen a testicle festival happen somewhere in the paper, and we thought it’d be fun,” Bledsoe said of the origin of the Olean Testicle Festival 24 years ago. Now, families come from all over Missouri to try the turkey “mountain oysters.”

            In Eldon, a group of people thought it would be fun to have a turkey-themed festival because there were so many turkey farmers in the area 32 years ago when the tradition began, Kilkenny said. Although there are few turkey farmers now, the people of Eldon are still interested in maintaining their rituals and traditions.

For Hartsburg, the pumpkin festival started as a fun way to attract residents’ family members to their pumpkin farms, and it’s this family feel that makes these festivals special for the residents and people who come from all over the state.

“Festivals are a very important part of any and all communities regardless of what size, because it brings a community together, it’s something different, it’s something fun,” Schneider said.

So for many, a two-hour wait is well worth the chance to pick up some pumpkins and experience the charm of small town Missouri.   

For Missouri Medicaid beneficiaries with hepatitis C, getting treated can be tricky. The state will only cover the treatment if a patient’s condition has reached a certain level of severity. They claim the cost of providing treatment is too high to treat everyone who has the disease. Three Missourians under Medicaid who have hepatitis C, are suing the Missouri Department of Social Services for refusing to provide treatment. The plaintiffs say that withholding treatment costs more because of what it leads to, like cirrhosis, liver transplants, cancer and even death.

In the United States, up to 3.9 million people are infected with chronic hepatitis C, according to the Centers for Disease Control and Protection. Fortunately, there are now drug treatments available with an almost 100 percent cure rate. In the past five years alone, new drugs have come to the market that treat all six types of the virus.

Missouri Medicaid policy leaves Hepatitis C patients untreated

For Missouri Medicaid beneficiaries with hepatitis C, getting treated can be tricky. The state will only cover the treatment if a patient’s condition has reached a certain level of severity. They claim the cost of providing treatment is too high to treat everyone who has the disease. Three Missourians under Medicaid who have hepatitis C, are suing the Missouri Department of Social Services for refusing to provide treatment. The plaintiffs say that withholding treatment costs more because of what it leads to, like cirrhosis, liver transplants, cancer and even death.

In the United States, up to 3.9 million people are infected with chronic hepatitis C, according to the Centers for Disease Control and Protection. Fortunately, there are now drug treatments available with an almost 100 percent cure rate. In the past five years alone, new drugs have come to the market that treat all six types of the virus.

HARTSBURG, Mo. -- On a warm Saturday fall morning, 50,000 people from across Missouri waited in their cars for two hours to enter Hartsburg, a town of 106 people.

Many in the crowd said the wait was worth it to experience the 26th annual Hartsburg Pumpkin Festival.

“This is small town USA at its finest,” said Cheri Buckner, an Ashland resident who attends the pumpkin festival almost every year with her kids and grandkids.

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