Affordable Care Act bolsters the primary care workforce in medically underserved communities

Press Release

US Department of Health and Human Services

November 22, 2010

HHS Secretary Kathleen Sebelius today announced the launch of the new application cycle for the National Health Service Corps (NHSC) Loan Repayment Program, during a visit to Total Health Care, a community health center in Baltimore. The NHSC offers primary care medical, dental and mental health clinicians up to $60,000 to repay student loans in exchange for two years of service at health care facilities in medically underserved areas. This year's investment in the program, which includes $290 million from the Affordable Care Act, seeks to address shortages in the primary health care workforce and translates into greater access to healthcare for those who might otherwise go without.

"As we continue to seek ways to impact both the primary care workforce shortage and the increasing debt burden on new providers, NHSC serves as a model for addressing both challenges simultaneously," said Secretary Sebelius. "Increasing access to primary care physicians who can support the physical and mental well-being of individuals can help prevent disease and illness, and ensure everyone - regardless of where they live - has access to comprehensive, high quality care."

The Affordable Care Act also provides more flexibility in how the Corps administers the loan repayment program.  In addition to monetary awards that are higher than previous years, the Corps will give members the option of working half-time to fulfill their service obligation and provide credit for some teaching hours.

"The NHSC sites are located in some of the most geographically isolated and economically distressed areas of the country," said HRSA Administrator Mary K. Wakefield, PhD., RN. "The health care professionals who answer this call to serve in the NHSC will join thousands of dedicated primary care clinicians who bring quality health care to underserved communities and vulnerable populations."

"By the end of FY2011, we expect that over 10,800 clinicians will be caring for more than 11 million people, more than tripling the National Health Service Corps since 2008," said NHSC Director Rebecca Spitzgo. "By 2015, with the historic funding opportunities offered by ARRA and the Affordable Care Act, the Corps will support more than 15,000 new primary care professionals."

For the first time, providers may apply to the NHSC loan repayment program online where they will find tutorials and additional information to assist in the application process.

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Some states weigh unthinkable option: Ending Medicaid

By: Janet Adamy and Neil King Jr

The Wall Street Journal

November 22, 2010

Huge budget shortfalls are prompting a handful of states to begin discussing a once-unthinkable scenario: dropping out of the Medicaid insurance program for the poor. Elected and appointed officials in nearly a half-dozen states, including Washington, Texas and South Carolina, have publicly thrown out the idea. Wyoming and Nevada this year produced detailed studies of what would happen should they withdraw from the program. Wyoming found that Medicaid accounts for 63% of the state's nursing-home revenue.

The idea of abandoning Medicaid as a solution is so extreme that even proponents don't expect any state will follow through, but officials are floating the discussions because dire budgetary pressures have forced them to at least look at even the most drastic options. Medicaid, begun in 1965 and jointly funded by federal and state dollars, is the nexus of care for the neediest Americans, and a huge payer to hospitals, nursing homes and doctors. Medicaid enrollment totaled 62 million nationwide in 2007, the most recent data available.

But Medicaid has become one of the biggest items on state budgets, and states complain they don't have enough flexibility to pare it without losing their federal matching funds. The federal government, on average, covers 57% of the cost of the program for states. In exchange, states must keep Medicaid open to all who qualify. Some states, in particular those led by Republicans, are calculating whether they'd be better off giving up the federal funding and replacing Medicaid with a narrower program of their own. Texas Gov. Rick Perry has proposed that his state get out of Medicaid in favor of a state-run system unburdened by federal mandates-including the one that prohibits states from reducing eligibility for the program if they want to qualify for the federal matching funds.

"We feel very comfortable that we could come up with a more equitable, a more efficient, and obviously a more cost-effective way to deliver health care," he said. How to tackle the soaring cost of Medicaid was one of the big topics in the hallways at the Republican Governors Association gathering in San Diego last week. Mr. Perry said that in private discussions, most attendees agreed they wanted more freedom in choosing how to provide health care to the poor.

Officials at the federal Centers for Medicare and Medicaid Services dismiss the withdrawal discussions and say they're working to make the program more effective for states. "Medicaid's a strong program and it's getting stronger," said Donald Berwick, the agency's administrator. A new innovation center at the agency is looking for ways to tie Medicaid spending more to the quality of care, rather than quantity. In Washington state, which has a Democratic governor, Medicaid Director Doug Porter says he discussed the idea of dropping out of Medicaid with members of a citizen advisory committee the governor pulled together to tackle a $5.7 billion budget shortfall over the next two years.

"It's not a serious consideration, but it's illustrative that people are even thinking about it," Mr. Porter said. "That I'm doing it is stunning." However, many elderly people rely on Medicaid to pay for long-term care at nursing homes, and that makes pulling out a "deal killer," Mr. Porter said. No good alternative currently exists to cover such nursing-home costs. Major cuts are in store for Washington's Medicaid program anyway. To plug the budget gap, the state is proposing eliminating coverage of prescription drugs, physical therapy and vision, dental and hearing treatments for adults next year.

Some policy experts say the most feasible scenario would be withdrawing from Medicaid in 2014 when the new health-care law overhaul is set to add 16 million Americans to the program's ranks. A quirk in the law passed in March suggests that a portion of the new Medicaid enrollees could instead qualify to get a tax credit to buy private insurance on state-run exchanges, although Democrats say that wasn't the intent of the law.

Indiana Gov. Mitch Daniels said he put a different proposal before the Republican governors assembled in San Diego: that they all band together to create a multistate insurance pool for the uninsured. But the states would do it, he said, only on the condition that the federal government agreed to eliminate some of the mandates embedded in the health overhaul. Wyoming's report said the 2014 Medicaid expansion would strain the state budget. "However, the strain that will ensue should Wyoming determine to opt-out of participating in Medicaid without a solid plan to replace it is truly immeasurable," the report said.

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California ranks last in U.S. on index measuring system of care for children with special health care needs, study finds (California)

Prepared By: The Child and Adolescent Health Measurement Initiative (CAHMI)

Lucile Packard Foundation for Children's Health

November 17, 2010

An estimated one in seven children in California has a special health care need, yet the state ranked worst in the nation on a composite index that measures whether these children have adequate health insurance, receive basic preventive care, and receive medical care that is comprehensive, ongoing and family-centered, according to a study released today. Children with special health care needs are those who have a chronic condition that requires health care beyond what is needed by most children. Conditions may range from mild, manageable asthma to highly complex conditions such as cerebral palsy or heart disease.

"These children are one of the most vulnerable segments of our society, and in many senses the system in California is not doing well for them," said David Alexander, a pediatrician who is president and CEO of the Lucile Packard Foundation for Children's Health, which commissioned the study.  Nearly all children with special health care needs in California experience some limitations in their daily lives. However, about one in four of the 1.4 million special needs children in California experiences difficulties severe enough that they are unable to do things other children their age can do. These children and their families usually have the most difficulty in finding medical and dental care, child care, transportation, educational assistance, medical equipment, consistent health insurance, and a range of other services.

"This is particularly concerning because advances in medical care mean that many children are surviving who previously would not have, and it will become increasingly difficult for our already overburdened system to care for them adequately," Alexander said. The composite index noted in the study does not evaluate the quality of the medical treatment that individual children receive, which is often excellent, Alexander said. Rather, it assesses adequacy of insurance, access to care, and other measures of how well the system functions, such as whether families are involved in the care. "We must make significant improvements in these areas," he said.

The study, Children with Special Health Care Needs: A Profile of Key Issues in California, analyzes the most recently available data from two surveys of parents sponsored in every state by the U.S. Maternal and Child Health Bureau: the 2007 National Survey of Children's Health and the 2006 National Survey of Children with Special Health Care Needs.  "Children with special health care needs in California have exceptionally complex conditions, and there is no question that many families are struggling to meet their basic requirements," said lead study author Christina Bethell, professor in the Department of Pediatrics at Oregon Health and Science University and director of the Child and Adolescent Health Measurement Initiative, where the study was conducted. "One of our significant findings was that nearly one in four of these children has parents who cut back or stopped working due to their child's health. This has a tremendous impact not only on families but also on employers."

In other key findings:

• Ethnic/racial and economic disparities in California are stark among children with special needs. Children of color and publicly insured children are much more likely to have poorer health status and sub-optimal health care.  
• Children with special needs are much more likely to repeat a grade and to miss more days of school than children without special needs.  
• California ranked 45th among states in addressing the transition from pediatric to adult care.   
• California had the nation's highest percentage of children whose parents reported stress from parenting their special needs child.

The barriers to creating a higher quality system are longstanding and complex, with no single solution, Alexander said. Ensuring that all children have adequate health insurance, and streamlining the way care is financed are two important steps, he said. Advocates and policymakers also need to press for treating children in an environment where their multiple health and social needs can be coordinated, and families can be involved in decision making, Alexander said. 

Although California ranks poorly on many indicators, the state is not alone, Alexander said. "Throughout the country, children with special needs receive care in a system that is poorly designed to meet their specific requirements. As health reform is implemented, we must be sure that the needs of this growing population finally are addressed."

ABOUT THE FOUNDATION: The Lucile Packard Foundation for Children's Health, a non-profit public charity, works to improve children's health by bringing public attention to key issues, particularly those related to children with  special health care needs. 

ABOUT CAHMI: The Child and Adolescent Health Measurement Initiatives a research and policy group based at Oregon Health & Science University that focuses on the development, implementation, and strategic dissemination of data based on measures of child and adolescent health and health care quality.

The full report and the executive summary are available at http://www.lpfch.org/specialneeds/press.html

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Issue Brief - Health Screening and Assessment for Children and Youth Entering Foster Care: State Requirements and Opportunities

Center for Health Care Strategies, Inc

November 2010

Issue Brief - Health Screening and Assessment for Children and Youth Entering Foster Care: State Requirements and Opportunities   

Early assessment and intervention are critical to the well-being of children and youth entering foster care - a population with a high prevalence of physical, behavioral, and oral health needs. This issue brief reports on a 50-state survey conducted by the Center for Health Care Strategies (CHCS) to understand child welfare agency requirements for health screenings and assessments upon a child's removal from the home.

The survey found:

•  Virtually all states require an initial physical, behavioral, or oral health screening, and more than half of states mandate all three;
•  State-required time frames for completion of health screenings vary significantly, and do not consistently reflect nationally recognized guidelines; and
• State mandates for follow-up health assessments are less rigorous than for initial screenings.

Findings suggest significant opportunities for states to strengthen screening requirements to more effectively guide care management and support better health outcomes for the high-risk foster care population.

 

Made possible through support from the Annie E. Casey Foundation and the Centers for Medicare & Medicaid Services.

 

Read the issue brief »

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Policy Statement: Principles of health care financing

By: Russell Libby

Pediatrics, Vol. 126, No. 5

October 25, 2010

The American Academy of Pediatrics advocates that all children must have health insurance coverage that ensures them access to affordable and comprehensive quality care. Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home.

Health insurance plans must be portable from state to state, with administrative procedures to eliminate breaks and gaps in coverage to ensure continuous coverage from year to year. Plans should ensure free choice of clinicians and foster coordination with public and private community-based programs for infants, children, and adolescents through the age of 26. The scope of services provided by all health plans must include preventive, acute and chronic illness, behavioral, inpatient, emergency, and home health care. These plans must be affordable and have cost-sharing policies that protect patients and families from financial strain and are without risk of loss of benefits because of plan design, current illness, or preexisting condition.

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Maximizing enrollment for kids program

Web-based Toolkit

NASHP

November 2010

This Self Assessment Toolkit is based on the diagnostic assessment that each of the eight state grantees participated in during the initial phase of the Maximizing Enrollment for Kids program, an initiative funded by the Robert Wood Johnson Foundation. This web-based interactive toolkit, developed by NASHP, is intended to guide states through an assessment of their enrollment and retention processes and procedures to identify strengths, weaknesses and opportunities for improvements. This diagnostic tool can help states determine where to target their limited resources to further reduce enrollment barriers and increase program efficiency.

The Self Assessment Toolkit is designed specifically for states, but does allow for engagement from interested stakeholders as a way to gain additional perspective during the assessment process. It seeks to provide states with access to available information on enrollment and retention simplifications, best practices and tools to help work toward meaningful improvements that can result in enrolling more eligible, but un-enrolled children.

Self Assessment Toolkit includes four modules that states can use with interested stakeholders either in combination or separately to identify issues and develop plans for improvement.

Features include:

• An online questionnaire that will provide states with a tailored report, highlighting workable best practices and strategies to improve enrollment and retention;
• Questionnaires that provide a vehicle for obtaining objective stakeholder feedback on areas for improvement; and
• Instructions on how to harness the information gleaned during the assessment process to develop improvement plans.

Please click here to access the Self-Assessment Toolkit.

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