Catalyst Center Coverage
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 Sept. 13, 2013
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"Competence without compassion is a delusion; compassion without competence is a fraud."
-Harvey Fineberg, President of the Institute of Medicine 
Featured Article
 
By Jenny Gold
Kaiser Health News
August 26, 2013
 
This article, about one family's efforts to coordinate care for their child with a rare disorder, provides insight into the difficulties families experience in navigating the health care system, coordinating care, and paying for health services for children with special health care needs. It also highlights why Medicaid and alternate pathways to Medicaid (waivers or state plan amendments) are so important for children with complex health needs. For 15-year-old Katie Doderer, even though she has private health insurance through her mother's employer, Medicaid helps ensure she receives medically necessary services, such as home nursing care, a benefit most private health insurance plans do not cover. In addition, Medicaid, as the secondary payer, helps bridge the gap between what the private insurance pays and her family's out-of-pocket expenses.
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News Items

By Michelle Andrews
Kaiser Health News
September 10, 2013

Will it be "cheaper" to purchase a marketplace health plan with higher premiums than a plan with lower premiums? This article reminds individuals and families that the total cost of health care includes not only the monthly cost of insurance premiums, but also any deductible, co-payments, and other out-of-pocket expenses. Families with children and youth with special health care needs who have high medical costs may save money by purchasing a more expensive health plan. In addition, buying a more expensive insurance plan may make them eligible for tax credits and cost-sharing subsidies that will reduce their out-of-pocket costs.  

By Eric Whitney
National Public Radio
August 13, 2013
Habilitative services are included in the ten categories of Essential Health Benefits that the Affordable Care Act (ACA) requires all health plans sold through the marketplaces and new plans in the individual market to provide. This is encouraging news for individuals with physical and developmental disabilities that require habilitative therapies to learn new skills. However, because states are using a benchmark plan to define the amount, duration, and scope of benefits, there is concern about how insurers will define the need for services for individuals with chronic conditions. In addition, the use of a benchmark plan will perpetuate state-to-state differences in covered services for individuals with disabilities. 

By Karina Wagnerman

Say Ahhh! A Children's Health Policy Blog

September 12, 2013  

Factors that contribute to loss of Medicaid coverage include small changes in household income and failure to update and/or complete and return renewal paperwork. This blog revisits the importance of continuous Medicaid eligibility, how it enables access to quality health care, and reduces costs.

Health Affairs
August 15, 2013
This health policy brief from Health Affairs discusses the factors that contribute to health disparities, the three categories of preventable disparities, and the long-term effects of unhealthy lifestyles on the health and life expectancy of the population, including children. It provides policy solutions that will help mitigate disparities by removing the barriers to health that are due to preventable causes. Policy solutions to overcome these barriers include promoting healthier lifestyles and improving "social, cultural, and physical environments." The Affordable Care Act (ACA), with its focus on creating opportunities for affordable health care, will also help reduce disparities because it will create better access to primary and preventive care.

HHS Press Office
August 15, 2013

In addition to the support provided by the U.S. Department of Health and Human Services (HHS) Marketplace Educational Tools, which includes a 24-hour-a-day Call Center, HHS has awarded 105 Navigator grants. These are organizations whose personnel will be trained to provide outreach and education about health insurance options through the marketplaces. They will also provide in-person assistance to individuals and families who need help understanding their health insurance options and enrolling in marketplace coverage. This press release provides additional information about Navigator security and privacy standards and training. See the list of Navigator Grant Recipients.
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Resources

Prepared by Manatt Health Solutions
August 2013

Created for health insurance marketplace staff, navigators, certified application counselors, and other assistors who will help individuals and families apply for health insurance through marketplaces, this issue brief contains a slide set that is useful for anyone looking to learn more about pathways to coverage and costs in 2014. It includes detailed information about the different "metal levels" of Qualified Health Plans (QHPs) that will be offered through the marketplaces, and clarifies the difference between and eligibility for Advance Premium Tax Credits and Cost-Sharing Subsidies.

News From Our Partners 

  1. Positioning the Family and Patient at the Center: A Guide to Family and Patient Partnership in the Medical Home is a family-centered care monograph by Rebecca Malouin, Assistant Professor and Director of the Primary Care Research and Evaluation Program in the College of Human Medicine at Michigan State University. Two objectives of the Affordable Care Act (ACA) are to transform the national health care system by improving prevention, wellness, and safety, and ensuring people with disabilities have access to support services. This publication is a resource to help primary care keep up with the changing landscape of health care delivery. It highlights the promising practices employed by 17 pediatric practices to achieve "true family-centered care."  One section includes case studies, lessons learned, strategies, and tools that each practice used to achieve their goals. Another section describes the key findings and how the practices are working to advance the Maternal and Child Health Bureau's (MCHB) principles of family-centered care for children.  
  2. A Retrospective Look at Programs and Initiatives Toward a Family-Centered Medical Home for Every Child and Youth, highlights the NCMHI's activities from 2008-2013 and their work to build partnerships, create tools, foster community and state collaborations, and integrate Medical Homes through the AAP (American Academy of Pediatrics). Data and quotes from advisors and other stakeholders are interspersed throughout this engaging report.    

R3New MCH Library Resource Guides about the Patient Protection and Affordable Care Act link2
The University of Miami Leadership Education in Neurodevelopmental Disabilities (LEND), the University of South Florida College of Public Health MCH Leadership Training Program, the University of Florida Pediatric Pulmonary Center (PPC) Leadership Training Program, and the MCH Library at Georgetown University, have developed two resource briefs about the Affordable Care Act. Patient Protection and Affordable Care Act: Resources for Professionals  provides an overview of the law, and links to websites, reports, briefs, webinars, journal articles, and other related MCH Library resources that provide in depth information about the national health reform law. Patient Protection and Affordable Care Act: Resources for Families has information about how to enroll in coverage, resources to learn more about the law, and links to Family Resources, including Non-English-Language Materials and Resources.   

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Events & Announcements

E1New Publications from the National Evaluation of the CHIPRA Quality Demonstration Grant Programlink2
  1. How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? This Evaluation Highlight, the second from the National Evaluation of the CHIPRA (Children's Health Insurance Program Reauthorization Act) Quality Demonstration Grant program provides an overview of the tools that some grantees are using to assess progress towards medical home implementation in their states.   
  2. How are CHIPRA Quality Demonstration States Working to Improve Adolescent Health Care? 
    This third Evaluation Highlight examines grantees' efforts to improve adolescent health, the barriers they have encountered and the strategies they are using to overcome them.
 
E2Maternal and Children Health Bureau (MCHB) Webcast: Title V, Medicaid and Oral Health: Strategies for Quality Improvement and Financing Care link2
DATE: September 25, 2013
TIME: 2:30 - 4:00 pm EDT

This is an opportunity for Maternal Child Health/Title V Directors and Children with Special Health Care Needs (CSHCN) Directors, State Dental and Medicaid personnel, and others working on quality improvement initiatives to learn about strategies for improving oral health quality, policy, and financing for Title V and Medicaid beneficiaries. Submit your questions to the presenters in advance and register for this event.
PastIssuesIn case you missed it...  the most popular news item from our last issue

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To view more articles from past issues of Catalyst Center Coverage, visit the Catalyst Center  website. For state-specific news, visit the Catalyst Center Facebook page.
 
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News to share?
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 Project 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, Co-Principal Investigator, at mcomeau@bu.edu.

The Catalyst Center is funded under cooperative agreement #U41MC13618 from the Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Marie Mann, MD, MPH, FAAP, MCHB/HRSA Project Officer. The contents of Catalyst Center Coverage are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies or the U.S. government.