By Jenny Gold
Kaiser Health News
April 30th, 2013
On October 1, 2013, the Health Insurance Marketplaces (formerly referred to as Exchanges) will open for enrollment. Consumers will use these online marketplaces, created as part of the Affordable Care Act (ACA), to shop for, compare, purchase, and enroll in health insurance plans that provide essential health benefits (EHBs). [For information about EHBs and children and youth with special health care needs (CYSHCN), read the Catalyst Center publication Your Questions on the Essential Health Benefits Bulletin Answered.] Individuals and families will enroll in a health insurance plan using a universal written or online application developed by the Centers for Medicaid and Medicare Services (CMS), which each state will customize with its Marketplace information. This single application will also screen applicants for eligibility for Medicaid, the Children's Health Insurance Program (CHIP), tax credits, and subsidies. The first draft of the application was 21 pages long. In response to concerns that it was too long, CMS made revisions. There are now three versions of the application. There is a  3-page form for individuals who do not have the option of employer-sponsored health insurance, a  12-page application for individuals and families who have employer-sponsored insurance, and an application for people who do not require financial assistance to purchase insurance. Despite these changes, consumers may still need to complete 21 pages. Parts of the original application have been included as appendices. Depending on family size and circumstances, this additional information may need to be submitted. The original draft included pages for up to six family members. The new one has pages for only two; families will have to copy those pages for additional family members, which will also add to the overall length of the application.

By Phil Galewitz
Kaiser Health News
May 5, 2013
One of the primary goals of the Affordable Care Act (ACA) is to close the gap between the number of individuals who have health insurance and those who do not by extending "affordable coverage to the uninsured." Non-pregnant, non-disabled, childless adults, ages 19 through 64, whose income is less than 138% of the federal poverty level (FPL) will be eligible for Medicaid in states that choose to implement this optional provision of the ACA. Individuals and families without access to employer-sponsored health insurance and those who are unable to afford their employer's plan will be able to purchase insurance through a Health Insurance Marketplace in each state. However, these new pathways to affordable coverage won't reduce the number of uninsured if people don't know about them. The April 2013 Kaiser Health Tracking poll found that 58% of people who are currently uninsured say they do not have enough information to know how the law will affect their family. The 17 states that plan to run a state-based Marketplace have federal grants to hire and train personnel to provide outreach and education to inform the public about the Marketplaces. They will also assist with the enrollment process. Maryland and Vermont are an example of two states that will supplement their federal funding with state dollars to ensure a robust public awareness campaign. However, in the 34 states where a partnership or federal Marketplace will operate there is significantly less money available for consumer assistance programs. Congress did not expect that so few states would run their own Marketplaces. These states will rely on a share of $54 million that was redirected to consumer assistance from the ACA's prevention fund. This funding will be given to community organizations to hire and train people to run consumer assistance programs. States such as Florida and Texas with large numbers of uninsured have opted for a federal Marketplace. Yet, they will have the smaller per capita budgets for hiring and training consumer assisters.

By Michelle Diament
Disability Scoop
May 10, 2013
The Social Security Administration and the U.S. Departments of Health and Human Services, Education, and Labor are working to understand the barriers to services and improve programs that support youth with disabilities in their transition to adult life. These three agencies have launched a Policy Works website (use of the site is free, but you must register). Between now and May 27, 2013, youth with disabilities, family members, service providers, advocates, policymakers and others can share their ideas to shape future policy and practice around transition.

Centers for Consumer Information and Insurance Oversight (CCIIO)
By Gary Cohen
May 13, 2013
Every health plan sold through the Health Insurance Marketplaces (state-run, state-partnership, or federally facilitated) must be a Qualified Health Plan (QHP). In order to be a QHP, a plan must be able to document the adequacy of its provider network, which must include a "sufficient number and geographic distribution of Essential Community Providers (ECPs) in [the plan's] service area." ECPs are providers who deliver care in medically underserved communities to people who may be uninsured, underinsured, have chronic health needs, or other circumstances that make it difficult for them to receive health services. The Centers for Medicaid and Medicare Services (CMS) will monitor plans for "network adequacy and ECP proficiency." This letter from the CCIIO Director to ECPs asks them to consider joining QHP provider networks. CCCIIO has developed a  Frequently Asked Questions on Essential Community Providers fact sheet with more information.

Massachusetts General Hospital (MGH) Center for Child & Adolescent Health Research and Policy
The Maternal and Child Health Bureau (MCHB) has six outcomes for children and youth with special health care needs (CYSHCN):

1. Families of CYSHCN partner in decision making at all levels and are satisfied with the services they receive;
2. CYSHCN receive coordinated ongoing comprehensive care within a medical home;
3. Families of CYSHCN have adequate private and/or public insurance to pay for needed health services;
4. CYCHSN are screened early and continuously;
5. Community-based services for CYSHCN are organized so families can use them easily;
6. Youth with special health care needs receive the services necessary to transition to all aspects of adult life, including adult health care, work, and independence.

MCHB established a cooperative agreement with the MGH Center for Child & Adolescent Health Research and Policy to document the evidence base for these six key components of systems of care for CYSHCN. The Center's findings, published in several peer-reviewed journals, are available on the MassGeneral Hospital for Children website (click on the tab for Research Projects).

Asian and Pacific Islander American Health Forum (APIAHF)
March 2013
The Health Care Law and You is a PowerPoint presentation that explains some of the consumer protections, insurance market reforms, and new coverage options available through the Affordable Care Act (ACA). This consumer-friendly resource, developed by the U.S. Department of Health and Human Services, includes speaker's notes and references. The Office of Public Engagement at the Centers for Medicare and Medicaid Services (CMS) has translated the slide set into: Bengali, Hindi, Hmong, Khmer, Samoan, Tagalog, Tongan, Traditional Chinese, and Vietnamese. Each translation, along with the English version, is available for download on the In-Language Resources page of the APIAHF website.

National Center for Medical Home Implementation Medical Home webinar: How to Incorporate Best Practices in Family Centered Care in Your Practice

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.

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 mcomeau@bu.edu.