By Jocelyn Guyer
Say Ahhh! A Children's Health Policy Blog
May 1, 2012
It's easy to complain about state programs and service systems that are difficult to navigate. But what happens when states actually improve access to programs and supports? While there's no app for that, the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 included bonuses to reward states for implementing program features that simplify enrollment and retention in Medicaid and the Children's Health Insurance Program (CHIP) and reduce the number of uninsured children. (See a chart of the states that received CHIPRA Performance Bonus Awards for 2011.) In view of a proposal by the House Energy and Commerce Committee to eliminate CHIPRA performance bonuses, Jocelyn Guyer, the co-director at the Georgetown University Center for Children and Families, discusses the impact this will have on children's coverage. In addition, this committee proposes the repeal of the "maintenance-of-effort (MOE) requirement" and state grants for designing and establishing health exchanges. These are two provisions of the Affordable Care Act (ACA) meant to safeguard Medicaid and CHIP eligibility and benefits, and create marketplaces where individuals can shop for affordable health insurance.

By Sam Baker
Healthwatch: THE HILL's Healthcare Blog
May 3, 2012
On May 1, 2012, Republicans in the House and Senate introduced a bill to repeal the Maintenance of Effort (MOE) provision of the Affordable Care Act. MOE uses a "carrot or stick" approach to ensure states continue to provide the same access to Medicaid and the Children's Health Insurance Program (CHIP) as existed on March 23, 2010, when the ACA was signed into law. If a state reduces eligibility for mandatory eligibility groups, which includes children, they will lose the federal matching funds they receive for operating these programs. However, states can reduce provider payments. This blog reports that bill sponsors rationalize the repeal of MOE, stating cuts to provider payments will result in lack of access to care, and that maintaining current eligibility levels increases the financial burden to states.

Kaiser Commission on Medicaid and the Uninsured 
Henry J. Kaiser Foundation
May 2012
President Obama signed the Affordable Care Act (ACA) on March 23, 2010. In the past 26 months, many provisions of this national health reform legislation have been implemented, while others continue to roll out over time. Two provisions that ensure access to affordable care - the Medicaid expansion and the state health exchanges - won't go into effect until 2014. Until that time, the Maintenance of Effort (MOE) provision, which went into effect on the day the ACA was signed, acts as a stopgap measure to ensure states do not roll back eligibility for their Medicaid and Children's Health Insurance Programs (CHIP) for mandatory coverage groups. This fact sheet from the Kaiser Commission on Medicaid and the Uninsured (KCMU) explains the mandatory coverage groups for Medicaid, the MOE requirements for Medicaid and CHIP for children and adults, and exceptions to MOE for optional populations. This includes non-disabled adults whose income is more than 133% of the federal poverty level, or more than $14,868 for a family of one. KCMU also examines the impact of the U.S. House of Representatives proposal to repeal MOE. They cite the following Congressional Budget Office estimates if MOE is repealed: 

• About 300,000 people would lose coverage; 
• Subsidies for individuals that lost coverage and then have to purchase insurance through the health exchanges in 2014 would offset any federal savings for Medicaid and CHIP. 

In addition, states will receive fewer federal matching dollars for their Medicaid and CHIP programs.

By Phil Galewitz
Capsules: The KHN Blog
May 1, 2012
Almost 1,200 community health centers throughout the country provide care to about 20 million people. In 2009, community health centers received money from the American Reinvestment and Recovery Act (ARRA) to help them provide care. In 2014, when Medicaid expands and the health exchanges become operational, pending the decision of the U.S. Supreme Court, about 30 million additional people will have access to affordable health coverage options. In order to ensure their health needs are met, the Affordable Care Act (ACA) included money to "expand and modernize" community health centers. On May 1, 2012, 398 centers received a total of $728 million to expand their primary care services.

By Shefali S. Kulkarni
Kaiser Health News (KHN)
April 27, 2012
This story by Shefali Kulkarni, KHN staff writer and PBS (Public Broadcasting Service) Newshour provides an overview of the potential benefits and drawbacks of high-deductible health plans (HDPs). These plans have become increasingly popular, especially for small businesses (those with fewer than 199 employees), as a way to control the high cost of health insurance. HDPs are attractive because the average annual premiums, at $1,000 - $2,000 per year, are lower than standard health plan premiums. Additional financial incentives for some high-deductible plans include the option for enrollees to set aside pretax earnings in a Health Savings Account (HSA) that can be used to pay the deductible and other out-of-pocket medical expenses. Some employers also make tax-free contributions to their employees' HSAs. While high-deductible plans are required to provide vaccinations and well visits at no cost, beneficiaries must meet a high annual deductible, which starts at $2,400 per family, before the plan contributes to the cost of other health services. For this reason, these plans are also called "consumer-directed health plans" because enrollees weigh the benefit versus the cost of health services, as they pay the full cost of most services until they reach the annual deductible. The combination of high deductible, HSA, and annual out-of-pocket cap, which is $12,100 for families, can be a hardship for families with low income whose children, or other family members, have special health care needs and require many health services to treat and manage chronic conditions.

By Dori Salcido, HHS Acting Assistant Secretary for Public Affairs
HealthCare Blog
April 25, 2012
Sami Wirtanen-Debenedet is a 9-year-old boy with a genetic disorder. He needs surgeries, chemotherapy, and follow-up care, which includes MRIs two-to-four times a year to prevent further complications. While Sami's diagnosis pre-dated the enactment of the Affordable Care Act (ACA), his family is grateful for the protections it provides for him now. Sami cannot be denied insurance due to his pre-existing condition, and despite the high cost of his care, his parents don't worry that he'll lose coverage because the ACA prohibits lifetime spending caps. Rather than worrying about paying for Sami's care, his parents can focus on "...finding the proper specialist, getting him to the MRIs, getting him to the doctors' appointments, keeping him healthy, you know, having him be a joyful child."

Visit MyCare to share your health care story and to watch videos and read more about how the ACA has helped others.

By Got Transition Staff with support from Tina Campanella, Quality Trust for Individuals with Disabilities
Got Transition? The National Health Care Transition Center
2012
Parents give their young children well-defined choices - do you want to read a book or color, do you want eggs or oatmeal for breakfast - to help them practice making decisions. As children get older, parents have less control over the choices their children face and can only hope they know enough about the possible outcomes to make a responsible decision. When a child has an intellectual disability, parents walk a fine line between making decisions for the child to ensure his or her safety and robbing the child of opportunities to build skills that will help him or her be as independent as possible. Once a child reaches the age of majority, (see summary age of majority by state and U.S. possession), parents cannot legally make decisions for a young adult without having the child's consent or without legal guardianship. This Got Transition? brief provides guidance for giving young adults with intellectual disabilities opportunities to make their own decisions and, depending on the type of decision such as health care or finances, for providing "the right support at the right time." This might be having friends or family discuss the decision with the young adult, who then makes the decision independently. There are different types of guardianship. If the young adult has a legal guardian, that person may have to document how they have helped the individual make decisions and, in emergencies, may be able to make decisions on the individual's behalf. For more information about guardianship, listen to a recording of the Got Transition webinar "Understanding Guardianship and the Alternatives for Decision Making Support."

Kaiser Commission on Medicaid and the Uninsured
Henry J. Kaiser Foundation
How much do you know about why there were almost (spoiler alert - this is one of the answers) 49 million Americans without health insurance in 2010? Test your knowledge with this interactive quiz from the Kaiser Commission on Medicaid and the Uninsured. The answer key sheds light on the provisions of the Affordable Care Act (ACA) that were designed to provide affordable coverage for all Americans and includes resources for learning more.

The Catalyst Center is hosting five webinars about our Medicaid/CHIP Tutorial 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). Each webinar will provide an overview of several sections of the tutorial. Guest speakers will highlight state partnerships that promote integration of Medicaid/CHIP and Title V programs. We welcome the participation of Medicaid, CHIP, Title V staff, health insurers, family leaders, and all interested others. Contact Meg Comeau if you'd like to share an example of a partnership between one or more of these stakeholder groups with the Medicaid or CHIP program in your state.

Save The Date: Medicaid/CHIP Tutorial Webinar Series
Webinar #3: What are the Pathways to Coverage and Covered Services for Medicaid and CHIP?
Date: Thursday, June 21, 2012
Time: 12:00 pm - 1:00 pm EDT
Learn about the pathways to Medicaid and CHIP eligibility and about the services these two public health insurance programs provide. We will send out an announcement when registration opens.

Access slides and recordings from past webinars on our website:
Webinar #1: What is the Medicaid/CHIP 101 Tutorial and What's In It For Me?
Webinar #2: Understanding the Basics--Medicaid & CHIP and Building Partnerships Among Stakeholders (slides available, recording to follow).

Date: May 23, 2012
Time: 3:00 - 3:30 pm EDT
Got Transition? National Health Care Transition Center
Josiah Barber of Portland, Oregon, attended the Association of Maternal and Child Health Programs (AMCHP) conference in February 2012 as the first recipient of the Ryan Colburn Youth Scholarship. Josiah was eligible for this award because he is a young man with a disability, has received services from his state Maternal and Child Health Title V program, has actively participated in community service activities, and is a youth leader. Join this radio show to learn about Josiah's health care transition experience and why it provided the incentive for him to become a leader in the field of Maternal and Child Health. He will also share how his experience at the AMCHP conference inspired his continuing interest in health care policy. Register for this event. Listen to past broadcasts.

The National Academy of State Health Policy (NASHP) is hiring a Program Director to lead teams working with states to help improve health coverage, access policies, and programs related to health reform implementation. This position is based in Washington, D.C. and will focus on meeting the needs of children and youth, including support for state Children's Health Insurance Programs (CHIP). Read the job description, responsibilities, qualifications, and how to apply.

If you have suggestions for news items related to coverage and financing of care for CYSHCN please email Beth Dworetzky Catalyst Center Coverage editor and Catalyst Center Assistant Director by 12 noon on Friday.