The National Conference of State Legislators reports that at least 29 states have autism mandates, which require health insurers to cover specific services for individuals with autism. An additional five states have laws that require insurers to cover a limited number of autism services as part of their plan's mental health benefits. This article reports the results of a survey conducted by Autism Speaks and MedClaims Liaison, a private, for-profit patient advocacy company. More than 25% of the 900+ families that participated in the survey - all with family members with autism and all living in states that require insurers to cover autism services - said they did not know about their states' requirements for coverage. Half of the families said the providers their family member needed did not accept their insurance. Disability Scoop reports Peter Bell, executive vice president of programs and services at Autism Speaks, as stating that autism legislation is not enough to ensure individuals receive needed services, and that there must be a focus on "implementation and enforcement."

In 2014, the Affordable Care Act (ACA) will require individual and small group private health insurance plans, in and out of the Exchanges, to provide essential health benefits and to conform to certain standards for cost-sharing. This article, from the Henry J. Kaiser Family Foundation Health Reform Source, provides an overview of recent guidance from the U.S. Department of Health and Human Services (HHS) about these two consumer protections. Read a synopsis of the HHS essential health benefits guidance issued on February 17, 2012. The following week, HHS released guidance about consumer cost-sharing, which explains the options health insurers have for determining "actuarial value (AV)," which is the percent of costs a plan will cover. Insurers can create up to four plan types, nicknamed the "heavy metal" plans. Platinum plans have a 90% AV; they will cover 90% of the costs of care and consumers will pay 10%. The AV for gold plans is 80%, silver is 70%, and bronze is 60% AV; consumers will pay 20%, 30%, and 40% of the costs, respectively. However, the guidance does not specifically prohibit plans from limiting medications or services for individuals with complex health needs, and is not clear about documentation that will make it easy for consumers to compare plans and cost-sharing.

The Medical Loss Ratio (MLR) is a provision of the Affordable Care Act (ACA) that requires health insurers to maximize the amount of consumers' premiums they spend on health care, quality improvement, and other activities, and minimize profits and money spent on administration and marketing. Even before this provision took effect in 2011, 70% of small group and 77% of large group insurers met the required 80/20 and 85/15 MLR ratio, respectively. The individual insurance market has a lot of catching up to do, as only 43% met the MLR requirement in 2010. With the exception of self-funded employers, who are not considered health insurers because they incur the liability for their employee's health services, the MLR provision applies to all health insurers, including grandfathered plans. If a health insurer did not meet the MLR in 2011, they must provide refunds to the employer and employees in 2012. In subsequent years, rebates will be calculated based on an insurer's performance over three years. This fact sheet from the Kaiser Initiative on Health Reform and Private Insurance provides details about the MLR equation and adjustments based on a plan's enrollment. There is also a list of states to which the U.S. Department of Health and Human Services (HHS) granted MLR waivers. HHS may require insurers to report MLR every year; currently they only have to report it for years when they are out of compliance.

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Visit Disenrollment Policies for Non-Payment of Premiums in Children's Coverage to see each state's policy about discontinuing a child's Children's Health Insurance Program (CHIP) eligibility due to non-payment of premiums. Find the most recent Federal Medical Assistance Percentage (FMAP), and learn how each state is integrating and upgrading its Medicaid and CHIP Eligibility Systems. These data, and more, collected during a national survey by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families are published in Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Practices in Medicaid and CHIP, 2011-2012.

Last month, the Catalyst Center announced the completion of its Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children's Health Insurance Program (CHIP). This user-friendly overview of Medicaid and CHIP coverage for children and youth with special health care needs (CYSHCN), specially written with Title V maternal and child health (MCH) staff and family leaders in mind, is available on our website. If you haven't had a chance to read it, in whole or in part, please check it out. And, when you're done, please take a short User Survey; your feedback will help us improve our materials.

If you have completed the tutorial, we invite you to test your knowledge by playing a game of Medicaid/CHIP Jeopardy or challenging yourself with a Medicaid Tutorial Crossword. Feel free to download the tutorial, games, and game instructions and answer keys for personal use or for use at workshops and other informational events.