Catalyst Center Quarterly  
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 The Catalyst Center is funded under grant #U41MC13618 from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. 
"What's in a name? That which we call a rose
By any other name would smell as sweet."

- William Shakespeare, Romeo and Juliet

Greetings!

What's in a name? The Catalyst Center is wondering the same thing as Romeo's Juliet and we've concluded that names do matter. Beginning with this issue, the quarterly eNewsletter, formerly known as Coverage, will now be called Catalyst Center Quarterly. It will continue to provide original content from the Catalyst Center, as well as articles, analyses, resources, announcements, and more.

We have also decided Week in Review was just not descriptive enough for our as-often-as-we-can-get-it-into-your-inbox roundup of news related to coverage and financing of care for children and youth with special health care needs. For this reason, starting next week, or as soon after as possible, Week in Review will be renamed Catalyst Center Coverage.

Sincerely,

The Catalyst Center Team
Article1The TEFRA Medicaid State Plan Option and Katie Beckett Waiver for Children

Making It Possible to Care for Children with Significant Disabilities at Home

The Chartbook Indicator: "TEFRA Medicaid State Plan Option/ Katie Beckett Waiver for children"

The Catalyst Center's online State-at-a-Glance Chartbook offers a comprehensive array of data from a variety of different sources on the coverage and financing of care for children and youth with special health care needs (CYSHCN). One of the data indicators found in the Chartbook under the topic area "Factors Influencing Health Insurance Coverage" tells users whether or not a specific state offers Medicaid eligibility to children either under the TEFRA state plan option or under a Katie Beckett home and community-based services waiver. There are differences between state plan options and waivers but we've grouped these two pathways to Medicaid coverage together as a single indicator because they both serve a group of children whose complex care needs are similar, at least on paper. In this article we provide an introduction to the two options and how they came into existence.

Katie Beckett and the Waiver Named After Her

The Katie Beckett waiver was created in the early 1980s. Katie Beckett was a three-year-old girl who contracted encephalitis, a viral brain infection, when she was just five months old.1
1Shapiro. J. (2010). Katie Beckett: Patient turned home-care advocate. Retrieved October 20, 2011 from the National Public Radio website: http://www.npr.org/templates/story/story.php?storyId=131145687
Article2Think You Know Medicaid and CHIP? Take the Challenge!

At the Association of Maternal and Child Health Programs (AMCHP) conference in February, the Catalyst Center announced the availability of a user-friendly Medicaid and CHIP tutorial, specially written for Title V staff, family leaders, public health/maternal and child health students, and interested others: 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).

Once you've checked it out and taken the quizzes at the end of each section, try your hand at our fun and games challenges. Think you know an acronym or two? Try our alphabet soup crossword puzzle. Or embrace your inner wonkiness with a stirring round of Medicaid Jeopardy. (Answer keys included for the faint of heart.) And, if you want to be totally fluent, read the Catalyst Center publication Medicaid as a Second Language: A Slightly Irreverent Guide to Common Medicaid Terms, Acronyms and Abbreviations. You'll be talking Medicaid in no time!

Love the tutorial? Hate it? Meh? Let us know by taking our user survey. Thanks!
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TopIN THIS ISSUE




Announcements...

Media Highlights...

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Article3"It's Not Hard, It Just Takes Time"
Community Clinic Closes Gaps in Health Care
for Children in Foster Care


Dr. Adrienne Carmack, Physician (right), 
Sandy Libby, RNC Pediatrics Care Manager (left)

Dr. Adrienne Carmack and her team at the Key Clinic are dedicated to providing comprehensive medical examinations and care management for children in foster care. Since starting the Key Clinic in 2009, this team has cared for over 250 patients. This is the story about how this clinic worked with state agencies, foster parents, and other providers to build a system of care for children and youth in foster care. To add some perspective, we've illustrated the narrative with a story of real patients who have received services at the Key Clinic.
______________________

Michael, 7, and Mary, 5, are siblings who have been in and out of foster care several times. This is the fourth time they've been removed from their biological parents and now they have been placed with a new foster family. Michael's stomach often bothers him and he frequently feels the urge to use the bathroom. There are times when he doesn't make it to the bathroom and has accidents at home and at school...

Children in foster care are an often unrecognized group of children and youth with special health care needs (CYSHCN). 
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Announcements

Event2Medicaid Matters for Kids Congressional Briefing Series

The first of a four-part series of briefings for congressional staff on the Fundamentals of How Medicaid Works for Kids took place on January 25, 2012. The briefing focused on the importance of Medicaid for children and how it works to keep kids covered in a tough economic climate. Meg Comeau, Catalyst Center director, discussed the critical role Medicaid plays for families raising children and youth with special health care needs. Read a summary of each speaker's presentation and view the slides on our blog posting Medicaid Matters for Kids: What We Told Them.

The second briefing, on Medicaid Innovations, took place last week. The series is sponsored by the Children's Hospital Association (formerly the National Association of Children's Hospitals), the American Academy of Pediatrics, Family Voices, First Focus, Georgetown Center for Children and Families, and the March of Dimes in collaboration with the Congressional Children's Health Care Caucus.
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Media Highlights

In honor of the second anniversary of the Affordable Care Act on March 23, all of this issue's media highlights relate to the ACA.

By Dr. David Keller
Telegram.com
March 13, 2012
In acknowledgement of the second "birthday" of the Affordable Care Act (ACA), David Keller wrote this opinion piece about the national health reform law. Dr. Keller examined the law, comparing it to the developmental milestones one can expect for a two-year-old child, from his clinical perspective as a pediatrician and as a fellow who worked at the U.S. Department of Health and Human Services (HHS) during the law's passage. He charts its progress towards ensuring Americans have access to affordable health insurance. He discusses the doctor's responsibility for providing quality healthcare, notes how the use of health information technology will facilitate communication between a child's physicians so care will be coordinated, and emphasizes the importance of the family's active role in the health care process. Furthering the child development analogy, just as a child continues to grow and develop, diverse groups of stakeholders are working to develop payment reform systems that will help control health care costs while ensuring the health system meets the needs of children, including children and youth with special health care needs.

Medicaid.gov
Keeping America Health
March 16, 2012
In 2014, the Affordable Care Act (ACA) will expand Medicaid eligibility for all individuals, age 19 to 64 years old, whose income is less than 133% of the federal poverty level, which in 2012 is $30,656 per year for a family of four. On March 16, 2012, the U.S. Department of Health and Human Services (HHS) released the final rule for the Medicaid and Children's Health Insurance Program (CHIP), which describes the elements of this provision. In the seven months since this rule was proposed (August 17, 2012), HHS and the Centers for Medicare and Medicaid Services (CMS) provided many opportunities for public input about the proposed rule, and adopted many of those suggestions. The final rule says:
  • Children will continue to be eligible for Medicaid and CHIP based on the state's existing eligibility criteria;
  • From 2014 - 2016, states will receive a 100% federal match for newly eligible individuals. Thereafter, the match rate will decrease to 90% by 2020;
  • Applicants will be eligible based on one of four categories: adults, children, parents, and women who are pregnant, although individuals with disabilities can enroll in an existing Medicaid category to ensure they have a fast track to coverage;
  • A single Modified Adjusted Gross Income (MAGI) formula and use of state or federal electronic data sources to verify income will be used to streamline eligibility determinations;
  • States can use their Exchange to determine Medicaid/CHIP eligibility and eligibility for tax credits or have the Exchange screen for Medicaid/CHIP eligibility and then pass the final determination along to the appropriate state agency.
Young Invincibles
March 18, 2012
In the fall of this year, college health plans will have to provide students with many of the same consumer protections that individual health plans must provide under the Affordable Care Act (ACA). This blog by the Young Invincibles discusses the final rule, released by the U.S. Department of Health and Human Services (HHS) on March 16, 2012, about college health plans. By 2014, college health plans will no longer be able to refuse coverage to students with pre-existing conditions; must phase out annual and lifetime benefit caps; provide free preventative care; and must meet an 80/20 Medical Loss Ratio (MLR). Self-funded student health plans are exempt from these regulations. Read more about Student Health Plans and the Affordable Care Act.

Kaiser Health News
March 16, 2012
In this short video, Jackie Judd, Vice President and Senior Advisor for Communications at the Kaiser Family Foundation, interviews Kaiser Health News's Michelle Andrews about several provisions of the Affordable Care Act (ACA) that are expected to go into effect later this year. These include the rebates health insurers will have to pay consumers if they did not meet the 80/20 (small group) or 85/15 (large group) Medical Loss Ratio (MLR) in 2011 (read a synopsis about MLR). In September, with the exception of tiered plans, insurers and employers that are self-insured will have to use a template and plain language to explain coverage, deductibles, out-of-pocket expenses, and any costs for using out-of-network providers. In addition, there will now be a $2500 limit for flexible spending accounts (FSAs). This may affect how families plan for use of pre-tax dollars to offset qualified out-of-pocket medical expenses. The video concludes with a discussion about provisions of the ACA, for example the extension of young adult coverage through age 26 on a parent's health plan, that will go away if the U.S. Supreme Court decides the health reform law is unconstitutional.

By Nina Totenberg and Julie Rovner
SHOTS: NPR's Health Blog
March 26, 2012
Today the U.S. Supreme Court begins hearing three days of oral arguments about the constitutionality of the national health reform law. In this blog, Nina Totenberg, NPR's legal affairs correspondent, and Julie Rovner, NPR's health policy correspondent, provide an overview of the questions that the U.S. Supreme Court will hear. These include the constitutionality of the individual mandate that requires everyone to have health insurance, the Medicaid expansion, and whether or not the Affordable Care Act (ACA) will stand if the Court rules strikes down the individual mandate. Before these three questions can be considered, the Court will begin with arguments about whether or not they will continue with this case at this time. At issue is the 1867 Tax Anti-Injunction Act law, which says that a tax law cannot be challenged until individuals have actually paid the tax. The tax penalty for not having health insurance will first go into effect in 2014; if the Court decides the Tax Anti-Injunction Act applies to this case, the rest of the arguments will be tabled.

As Adam Liptak reports in his March 16, 2012 Health Law Hearings: Justices Plan Daily Tapes article in New York Times, due to "extraordinary public interest" about the constitutionality of the individual mandate and the Medicaid expansion, the Court will release the audio tapes and transcripts of the oral arguments at the end of each of the three days.

A March 16 press release from the Supreme Court of the United States indicates the Court will make audio recordings and unofficial transcripts of the morning session available by 2 pm each day; afternoon sessions should be public by 4 pm. Listen to the audio recordings. Read the transcripts.
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The Catalyst Center is a national center dedicated to working with states and stakeholder groups on improving health care insurance and financing for Children and Youth with Special Health 
Care Needs (CYSHCN). For more information please visit us at www.catalystctr.org 
or contact Meg Comeau, Program Director at [email protected].