Tricia Brooks
Say Ahhh! A Children's Health Policy Blog
August 29, 2012
As noted in the featured article above, states may choose to implement the Medicaid expansion provision of the Affordable Care Act (ACA), but they are not required  to do so.  However, due to a change in Medicaid program eligibility for children under the ACA, on January 1, 2014, states that currently cap Medicaid eligibility for children ages 6 to 19 at 100% of the federal poverty level (FPL) must expand it to 133% FPL (or 138% FPL after income adjustments are factored in). Many states already provide Medicaid to children with higher family incomes. However, 20 states set their income eligibility at the minimum currently allowed by Centers for Medicare and Medicaid Services (CMS) regulations. Once the income eligibility for Medicaid rises, children in this age group that were covered by the Children's Health Insurance Program (CHIP) will move from CHIP to Medicaid. See each state's current Medicaid and CHIP income eligibility guidelines for children.  

In this blog post, Tricia Brooks, a senior fellow at the Georgetown University Health Policy Institute's Center for Children and Families explains the benefits of the required Medicaid expansion to children, families, and the states. These include:

• States will continue to receive the enhanced Federal Medical Assistance Percentage (eFMAP) for children who move from CHIP to Medicaid;
• Aligning eligibility guidelines for all children reduces churn - the incidence of children losing public health coverage and having to reenroll. This will also decrease states' administrative burdens and make it easier for families to keep all of their children insured - regardless of the child's age;
• Children who move from CHIP to Medicaid will now have access to a more comprehensive benefit package, which includes the Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit;
• Families will have decreased cost-sharing for children covered under Medicaid.  

By Karen Davis and Kristof Stremikis
The Commonwealth Fund Blog
August 23, 2012
Research by the Commonwealth Fund compared the experiences of individuals with private health insurance, Medicaid, and the uninsured. Investigators found those with private insurance or Medicaid were significantly more likely to obtain needed medical services, follow-up care, and to fill prescriptions than those without insurance. In addition, individuals with public or private insurance had fewer unpaid medical bills and less medical debt. This research, coupled with findings in states that already extend Medicaid to nonelderly adults (ages 19 to 65) with income up to 133% of the federal poverty level (FPL) showed increased health, lower mortality rates, and in one state (Oregon) greater financial security for adults. In light of these findings, and despite the progress states are making to develop health benefits exchanges and implement other provisions of the Affordable Care Act (ACA), the authors of this blog discuss the positive aspects of the Medicaid expansion. They also wonder why some states are questioning whether to implement the Medicaid expansion, an optional provision of the ACA, while other states have already decided against it. Implementing the expansion will reduce the number of uninsured, promote health, and benefit both family and state budgets. With the 100% federal match, states can reduce expenses for uncompensated care and ensure individuals receive needed medical treatment, including mental health services. The authors also discuss the recurring proposal in the U.S. House of Representatives to convert Medicaid into a block grant program and the possible impact on states' budgets. They postulate that a block grant would shift costs to states, and without federal matching funds, pregnant women, individuals with disabilities, and children will lose coverage.

Find out where your state stands on implementing the Medicaid expansion.

By the Children's Hospital Association
August 2012
In May of this year, the Children's Hospital Association conducted a survey of children's hospitals to quantify the problem of shortages in pediatric specialists and children's access to timely care. The results, reported as area of shortage, burden on children and families, and barriers to recruitment, are based on responses from 69 children's hospitals. Children's hospitals have a two-week "benchmark" for wait times for appointments. However, due to a dearth of specialty providers, the average wait time for appointments with developmental pediatricians is 14.5 weeks. It can take up to 10.8 weeks to get an appointment with a geneticist, and 8.9 weeks to see a neurologist. Delays to see certain pediatric surgical teams for non-emergency procedures, which include urologists and orthopedics, also exceed the two-week standard. These long wait times mean children are not receiving "timely, appropriate care." Fewer physicians pursue pediatric specialties because of the cost and longer training time involved in caring for children and the noncompetitive salaries. Children's hospitals that are trying to recruit new specialty providers encounter multiple difficulties. These include increased recruiting costs and loss of patients who are opting to see adult providers rather than wait for pediatric specialists.

Study: Nearly a Third of Doctors Won't See New Medicaid Patients
By Phil Galewitz
Kaiser Health News
August 6, 2012
The Medicaid expansion is just one provision of the Affordable Care Act (ACA) that was created to decrease the number of uninsured Americans. If every state chooses to implement this optional provision of the ACA, it is estimated that 16 million people will be newly eligible for Medicaid in 2014. To help build the capacity of the health provider workforce to serve the newly insured, in 2013 and 2014, the ACA will increase reimbursement rates for primary care providers who treat patients covered by Medicaid.  Despite this forthcoming rate increase, a study of 2011 data from the National Ambulatory Medical Care Survey Electronic Medical Records Supplement found that 31% of physicians do not accept new Medicaid patients. (It appears that pediatrician participation in Medicaid is higher, as reported in the 2008 Health Tracking Physician Survey, which found that 42% of pediatricians accepted all Medicaid patients.) This article reports that many doctors currently do not accept patients with Medicaid because of the low reimbursement rate, administrative burdens, and payment delays. In addition, providers are concerned about the sustainability of the Medicaid rate increase after 2014. While the ACA has provisions to expand community health centers that will serve Medicaid patients, there are concerns that individuals enrolled in Medicaid will have problems accessing care.

States Crack Down On Mental Health Prescriptions
By Bara Vaida  
Disability Scoop
August 15, 2012
One fifth of Medicaid pharmaceutical costs are for behavioral health medications, and the Substance Abuse and Mental Health Services Administration estimates that 33% of Medicaid and Children's Health Insurance Program (CHIP) enrollees have at least one "mental health episode" a year. States are looking for strategies to reduce Medicaid spending for mental health prescriptions. Illinois expects to reduce Medicaid spending by almost $300 million by restricting access to prescription medications to treat mental and behavioral health disorders and by limiting the number of prescriptions patients can fill each month. Oklahoma saved $11 million by requiring prior approval for anti-psychotic medications. When Vermont implemented a pre-authorization process for an anti-psychotic that was being overprescribed, it saved the state money as well. Some states are cutting Medicaid costs for mental health medications by asking manufacturers for rebates in exchange for having their drugs put on "preferred drug lists." Other states, looking to trim their Medicaid budgets, are watching and weighing the costs of savings against the impact on quality of care. There are concerns that these cost-cutting measures create barriers that prevent people from getting their medications, which make it difficult for patients to follow treatment plans, and increases emergency room use and hospitalization. Alternative studies suggest that mental health medications are often overprescribed for children, especially children in foster care. Programs that require second opinions and prior authorization help ensure anti-psychotic medications are prescribed appropriately.

Health Insurer Refunds May Stall in Employers' Hands
By Nina Bernstein
The New York Times
August 9, 2012
If you have health insurance, whether or not you used any medical services during the 2011 plan year, you may be eligible for a different kind of benefit - a health premium rebate - compliments of the Affordable Care Act (ACA). In August, individuals and families who purchase their own health insurance received rebate checks if their health plan did not spend at least 80% of the total premiums they collected on medical services and quality improvement activities. If you and your family have employer-sponsored insurance that failed to meet this spending guideline for small group health plans (group health plans with 50 or more employees must have spent at least 85% on these activities), your employer received the rebate. Employers have three months and several options for dispersing each employee's share of the rebate. They can give employees checks for their share of the premiums, apply the rebate towards the employees' future premiums and reduce the amount deducted from their pay checks, or use the rebate to implement wellness programs. The U.S. Department of Labor issued FAQs About Medical Loss Ratio (MLR) Insurance Rebate where employers and employees can learn more about the Medical Loss Ratio provision of the ACA. Note: Employers who incur the financial liability for health services used by their employees and insured family members are called self-funded or self-insured. Self-funded plans are exempt from the Medical Loss Ratio provision of the ACA. Employers and their employees will not receive premium rebates for self-funded health plans.

Census: More Americans Have Disabilities
By Shaun Heasley
July 26, 2012
Disability Scoop
Using data from the 2010 U.S. Census, a July 2012 report by the U.S. Census Bureau, "Americans With Disabilities: 2010 Household Economic Studies" found that while the number of Americans with disabilities has increased by 2.2 million since 2005, overall, the percent of individuals with disabilities remains about the same, just below 20%. The report categorized disability for individuals, aged 15 and older into mental, physical, or communication domains. Using different domains for children younger than 15, the report estimates there are  5.2 million children with some type of disability. In his article for Disability Scoop, Heasley notes that the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration are just two of the agencies that use these data for planning purposes.

Resources

Medicaid: Its Role Today and Under the Affordable Care Act
By Rachel Garfield, Robin Rudowitz, Barbara Lyons, Anne Jankiewicz, and David Rousseau
The Journal of the American Medical Association
August 22/29, 2012
If you're looking for viewer-friendly graphics showing the percentage of children and adults who rely on Medicaid, the costs associated with care for individuals with disabilities, and a comparison of the growth in health care spending between Medicaid and private health insurance, look no further than this infographic. It's also a source for information about the role Medicaid will play as a component of the Affordable Care Act (ACA). More than 50% of the estimated 49 million adults currently without insurance will be eligible for Medicaid if their state of residence elects to implement the Medicaid expansion provision of the ACA.

Family Voices Welcomes New Executive Director Lynn Pedraza
The Catalyst Center extends a warm welcome to Lynn Pedraza, the new Executive Director for Family Voices. We look forward to continued collaboration with this premier national organization that works to keep families at the center of children's health care. We also extend our best wishes and thanks to outgoing Executive Director Sophie Arao-Nguyen. Learn more about Lynn.

Family Voices Announces the Release of the Bright Futures Family Pocket Guide
This resource, based on the third edition of the American Academy of Pediatrics (AAP) Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents, was developed for families by families, in partnership with the AAP and other professionals. This family-friendly guide has information about child development and resources to help promote and encourage health and wellness and family/provider partnerships. Read more about the pocket guide.

New Video Tutorials from the National Center for Medical Home Implementation
The National Center for Medical Home Implementation (NCMHI) has created two video tutorials. The  MedicalHomeInfo.org Tutorial, created for pediatric healthcare providers, families, and others, provides an introduction to the NCMHI website, with an overview of key resources, information about the monthly Medical Homes @ Work e-newsletter, and What's New section. The Building Your Medical Home Toolkit Tutorial provides instructions for setting up a free user account so visitors can learn about the six building blocks of the Medical Home toolkit and download the 25 tools designed to support, improve, and advance pediatric medical home practices.

Date: September 19, 2012
Time: 2:00 pm - 3:00 pm EDT, 1:00 - 2:00 pm CDT, 12:00 - 1:00 pm MDT, 11:00 am - 12:00 pm PDT
You are invited to participate in this final session of a five-part webinar series about the Catalyst Center's latest technical assistance tool 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 webinar will cover the following sections of the tutorial:

• Section 9: What's New Under the Affordable Care Act (ACA)?
• Section 10: Next Steps: Making the Case for Successful Partnerships in Your State  

This webinar is an opportunity to learn about some of the provisions of the Affordable Care Act (ACA) that were designed to protect both eligibility and covered services for the 35.9% of children with special health care needs (CSHCN) who rely on Medicaid or CHIP (NS-CSHCN 2009/10). Participants will also learn about building partnerships amongst Medicaid, CHIP, Title V, patients, families, and other stakeholders to identify improvement projects in their state to better serve all children, including CSHCN. Register for webinar 5. Download the slides and listen to recordings of the first four webinars in this series.

Got Transition Radio Show #12: From Maine to Massachusetts Health Care Transition in a New State!
Date: September 26, 2012
Time: 3 - 3:30 pm EDT
Got Transition, the national healthcare transition center continues its radio show series with a transition of its own. Join host Mallory Cyr to learn about her latest transition from Maine to Massachusetts to attend graduate school. Mallory will share her experiences about locating accessible housing and building relationships with new health care providers. She looks forward to hearing about listeners own "moving" experiences. Register for this radio show. Listen to archives of past radio shows and webinars.

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.