By Phil Galewitz
Kaiser Health News
July 11, 2012
As a result of the U.S. Supreme Court ruling on the Affordable Care Act (ACA), states are not obligated to expand Medicaid eligibility to legally residing residents, ages 19 to 65, whose incomes are less than 133% of the federal poverty level ($14,856 for a family of one). The Medicaid expansion is now an optional provision of the ACA. States that choose to expand Medicaid eligibility to 133% FPL will receive a 100% federal match to help pay for the cost of providing Medicaid to newly eligible enrollees for three years, beginning in 2014. Starting in 2017, the match rate will decrease until it levels out at 90% in 2020. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), in an effort to clarify the Court's decision, wrote a letter to the states' governors on July 10. She iterated in the letter that if a state elects not to implement the Medicaid expansion provision, it will not lose the entire amount of federal matching dollars (federal medical assistance percentage or FMAP) it receives to help fund its Medicaid program, as originally mandated in the ACA. Secretary Sebelius, concerned that states may be under the impression that the Court's "optional" ruling extends to the Maintenance of Effort (MOE) provision of the ACA also stated in her letter, "The Court's decision did not affect other provisions of the law." States may not reduce Medicaid eligibility or benefits for adults until 2014. MOE applies for children's eligibility and benefits for Medicaid and the Children's Health Insurance Program (CHIP) until 2019. States that are struggling with budget deficits may be able to roll back Medicaid eligibility for adults or charge premiums, changes that were recently approved for Illinois and Wisconsin. This summer, Secretary Sebelius will meet with state officials throughout the country to discuss ways states can move forward with implementation of the ACA.

By Jocelyn Guyer
Say Ahhh! A Children's Health Policy Blog
July 13, 2012
As noted above, Secretary of the U.S. Department of Health and Human Services (HHS) Kathleen Sebelius wrote a letter to the nation's governors on July 10. She clarified that the U.S. Supreme Court's ruling that the Medicaid expansion was optional applied only to that one provision of the Affordable Care Act (ACA). On July 13, Marilyn Tavenner, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS) wrote to the Republican Governors Association. In this blog post, Jocelyn Guyer, co-director at the Georgetown University Health Policy Institute Center for Children and Families, comments on that letter and praises the flexibility and generosity that HHS is extending to states while they decide whether or not to expand Medicaid eligibility to 133% of the federal poverty level (FPL). States do not have a deadline for notifying HHS if they will expand Medicaid eligibility. In addition, HHS will still reimburse 90% of a state's costs to improve their Information Technology (IT) systems to streamline eligibility determinations and enrollment even if they choose not to expand Medicaid.

By Sara S. Bachman, Margaret Comeau, Carol Tobias, Deborah Allen, Susan Epstein, Kathryn Jantz, and Lynda Honberg
Intellectual and Developmental Disabilities, Vol. 50, No. 3, pp. 181 - 189
June 2012
Citing data from the 2005-2006 National Survey of Children with Special Health Care Needs, the authors note that about 40% of families raising children with intellectual and developmental disabilities (IDD) report that their health insurance is not adequate to meet their children's needs and 34.6% of families experience financial hardship. Title V, Medicaid, the Children's Health Insurance Programs (CHIP), and state agency supports, which all vary from state to state, provide some additional services that may help reduce financial stress. These researchers from the Catalyst Center at Boston University, the Boston Public Health Commission, and the U.S. Department of Health and Human Services conducted structured interviews with staff from state Title V Children with Special Health Care Needs programs, Medicaid program staff, and family leaders to identify additional strategies to close benefit gaps and pay for additional services. They also discussed provisions of the Affordable Care Act (ACA) that may help reduce variability between states and alleviate the financial hardship many families experience.

Abstract: State Insurance Parity Legislation for Autism Services and Family Financial Burden
By Susan Parish, Kathleen Thomas, Roderick Rose, Mona Kilany and Robert McConville
Intellectual and Developmental Disabilities, Vol. 50, No. 3, pp. 190-198
June 2012
Previous research documents that children with autism spectrum disorders use more health services than children with other special health care needs. There is also evidence that Medicaid and families bear the primary financial responsibility for the cost of these services, as many private health insurers limit or deny services for children with this diagnosis. Using individual and state level data from the 2005-2006 National Survey of Children with Special Health Care Needs, the authors examined the association between states with autism mandates or parity legislation and family financial burden. Their preliminary analyses, which support the case of many advocates for creating autism mandates, found that families living in states with autism mandates or parity legislation had fewer out-of-pocket costs for their children's autism services than families living in states without these requirements for private health insurers.

Abstract: Measuring the Impact and Outcomes of Maternal and Child Health Federal Programs
By Yhenneko Taylor and Mary Nies
Maternal and Child Health Journal
June 23, 2012
The authors conducted a meta-analysis of 20 peer-reviewed evaluations of Medicaid, Head Start, Healthy Start, and the WIC (Women, Infants, and Children) program. These four federal programs were designed to reduce health disparities and improve health outcomes among vulnerable populations. While the assessment of the impact of each program was inconclusive, the researchers' work establishes a baseline for identifying effective interventions and resources and improving future program evaluations.

State Health Insurance Exchange Laws: The First Generation
By Sara Rosenbaum, Nancy Lopez, Taylor Burke, and Mark Dorley
The Commonwealth Fund
July 2012
Affordable Health Insurance Exchanges (Exchanges) are a central component of the Affordable Care Act (ACA). These online marketplaces will allow individuals and families without access to employer-sponsored health insurance and small businesses to shop for, compare, and enroll in affordable health insurance plans that best meet their needs. The ACA provides a framework for establishing Exchanges and selecting Qualified Health Plans (QHP) that will be offered through the Exchanges, giving states options for developing Exchanges and associated policies. In this issue brief, supported by the Commonwealth Fund, the authors examine the variability in Exchange development and policy to date for 13 states and the District of Columbia. Differences include:

• Exchange governance
• Policies to avoid conflicts of interest
• Purchase of QHPs
• Creation of separate or merged Exchanges for individuals and small businesses
• Coordination with Medicaid and other state agencies to determine an applicant's eligibility for either tax credits to help defray the cost of health insurance premiums, or for Medicaid and the Children's Health Insurance Program (CHIP).   

In addition to this issue brief, the Commonwealth Fund has created State Action to Establish Health Insurance Exchanges. Use this interactive tool to see each state's progress towards Exchange development and its choices for governance, policy for avoiding conflicts of interest, tools for reducing adverse selection, coordination with Medicaid and CHIP, and more.

By The Advisory Board Company
July 10, 2012
Using a combination of lawmakers' public statements, press releases, and media coverage, editorial teams from the Daily Briefing and the American Health Line created an interactive map that shows where each state stands on the Medicaid expansion. Learn each state's position based on additional parameters, which include the number of uninsured, participation in the Affordable Care Act (ACA) lawsuit, and whether or not a state has established a Health Exchange. Click on one or more states to read legislators' remarks and related news, with links to the original media source.

By R. Barzel and K. Holt
National Maternal and Child Oral Health Resource Center
2012
This publication from the National Maternal and Child Oral Health Resource Center provides an overview of children's oral health by race, ethnicity, family income, and insurance status (private, Medicaid, uninsured). You can read about tooth decay (dental caries), access to care, oral health and children and youth with special health care needs (CYSHCN), and prevention. The report outlines innovative strategies states are using to make oral health care more readily available. These efforts improve children's overall health and reduce the costs associated with emergency department visits due to children's untreated and urgent oral health needs.

 Financing Home Visiting Programs with Medicaid
Voluntary home visiting programs where professionals provide support and information to pregnant women and young children (birth - 3 years old), including children with special health care needs, have the potential to improve health outcomes and reduce health costs later in life. The Pew Center on the States  is investigating ways to finance home visiting programs with Medicaid. The National Academy for State Health Policy (NASHP) reviewed the literature and state policies and practices. They also convened an expert panel to discuss the use of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, as well as Home and Community-based Services (HCBS) waivers, 1915 (b) Freedom of Choice waivers, benchmark plans, and other ways Medicaid might pay for home visiting. Read the report, Medicaid Financing of Early Childhood Home Visiting Programs: Options, Opportunities, and Challenges, and case studies from Illinois, Kentucky, Michigan, Minnesota, Vermont, and Washington State.

Date: August 1, 2012
Time: 3:00 - 4:00 p.m. EDT
Youth with special health care needs who are preparing for college have to do more than pack clothes and laptops. They need a transition plan to ensure they have access to health care providers, equipment vendors, pharmacies, emergency services, and other supports to manage their chronic health needs and stay healthy so they can successfully adjust to college life. Join Dr. Kitty O'Hare, a physician and Coordinator of Transition at the Martha Eliot Health Center of Boston Children's Hospital, and a panel of young adults to hear practical advice and learn from the experts.
Register for this event. Listen to recordings of prior broadcasts.

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.