Catalyst Center Coverage
Roundup of news related to financing of care for children and youth with special health care needs
 
  Jan. 13, 2014
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"Life is a challenge, meet it! Life is a dream, realize it! Life is a game, play it! Life is love, enjoy it!."
~Sri Sathya Sai Baba 
Featured Article
 
By Jenni Bergal
The Washington Post
January 5, 2014  
Churn describes what happens when an individual "ping-pongs" between public and private health insurance programs. Increases in household income, and/or inability to afford employer-sponsored coverage, renewal forms and other administrative glitches contribute to churn. People who experience churn often also experience gaps in coverage, which is especially problematic for individuals with special health care needs. The Affordable Care Act (ACA) will not end churn. In fact, at this article reports, there are concerns that churn will continue. Individuals can still lose Medicaid coverage if they do not renew coverage or report changes in income and/or family size. Even though federal subsidies will help make insurance affordable for people who move from Medicaid to a marketplace plan, they may experience gaps in care and/or a lack of continuity of care because the Medicaid provider networks may not be the same as the networks in the marketplace. Delaware, Nevada, and Washington State are implementing strategies to ensure continuity of care. In Delaware, the provider networks may change as individuals move from Medicaid to marketplace plans, but medical services that were already ongoing will continue to be covered by the marketplace plan. Medicaid managed care plans in Nevada must offer a comparable marketplace plan. In Washington, marketplace plans that maintain the same provider network can become Medicaid plans.
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News Items

By Ricardo Alonso-Zaldivar
Associated Press
January 4, 2014

In September 2010, a provision of the Affordable Care Act (ACA) prohibited most private health insurers from denying or limiting coverage to children younger than 19 with pre-existing conditions. On January 1, 2014, this same protection went into effect for adults with pre-existing conditions. This is welcome news for individuals with chronic illnesses and/or disabilities who could not obtain health insurance or whose coverage excluded needed health services for a pre-existing condition. However, as this article notes, the problem of underinsurance persists. Even with health insurance, families raising children and youth with special health care needs and individuals with chronic conditions will still incur out-of-pocket expenses due to deductibles, co-payments, and co-insurance. These mounting expenses can cause financial hardship and lead to medical debt.   

By Michelle Diament
Disability Scoop
December 20, 2013
Using 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN) data, researchers from West Virginia University compared the experiences of families raising children with autism spectrum disorders (ASDs) to families whose children were diagnosed with other intellectual or developmental disabilities, or mental health conditions. They found that families whose children were diagnosed with ASDs were more likely to report that their insurance was inadequate, that they experienced financial hardship, and that the burden of their caregiving duties was the reason they left the workforce.  
Note: The NS-CSHCN considers insurance to be inadequate when a child experiences gaps in coverage and/or the insurance does not provide all needed health services and/or does not allow the child to see needed providers and/or a family's out-of-pocket expenses are not reasonable.

From Cindy Mann
Center for Medicaid and CHIP Services (CMCS) Informational Bulletin
December 30, 2013  
For the past five years, states that enhanced their Medicaid and Children's Health Insurance Programs (CHIP) to simplify enrollment and retention and that also increased enrollment of eligible children received performance bonuses. On December 30, 2013, 23 states received awards totaling $307 million. These states implemented at least five of eight program features and increased children's enrollment above a baseline level established using enrollment data from fiscal year 2007. [FY 2013 CHIPRA Performance Bonus Awards lists the states, program features, and if the state exceeded its enrollment target.] This was the last year for these awards, which were included in the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. Fortunately, the Affordable Care Act (ACA) contains provisions to streamline enrollment for Medicaid, CHIP, and marketplace coverage. Examples include use of a single application, a standardized method for computing income, determination for subsidized coverage, and elimination of assets tests.

Press Release
Centers for Disease Control and Prevention
December 18, 2013

In February 2014, the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention will launch a Native Hawaiian/Pacific Islanders National Health Interview Survey. This effort will accomplish several important goals. It advances the data collection goals of the Affordable Care Act (ACA). It also provides health indicator information for this population, which is underrepresented in public health reports and policies, and it will help advance the HHS Action Plan to Reduce Racial and Ethnic Health Disparities

N5Detailed Report Delivers Good News On Health Costs, But Will It Last? link2
B
y Jay Hancock
Capsules: The KHN (Kaiser Health News) Blog
January 6, 2013

Some attribute the slowed increase in health care spending to the 2008 recession. Others say it's due to one-time deals such as reduced Medicare payments for nursing home care and the availability of generic forms of high-cost medications whose patents have expired. A few credit the Affordable Care Act (ACA). No matter the cause, spending on health care rose only 3.7% in 2012, which is significantly lower than earlier in the decade. From early reports on 2013 spending, it looks like this trend will continue.
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Resources

Kaiser Health News
December 20, 2013

This map, in addition to showing each state's decision about the adult Medicaid expansion (as of December 20), also includes interactive features. Hover over a state to see the number of currently uninsured children who are eligible for Medicaid but not enrolled, the number of uninsured adults who would be eligible for Medicaid under the Medicaid expansion, and the number who will fall into the coverage gap if a state does not expand Medicaid. Click on a state for information about the numbers of undocumented immigrants who are ineligible for coverage, numbers of adults, ages 19 through 64, who are eligible for subsidized coverage in the marketplace, and the child and adult income eligibility for Medicaid and CHIP (Children's Health Insurance Program).

By John Richardson, Tami Mark, and Kay Miller
Substance Abuse and Mental Health Services Administration (SAMHSA)
2013

This report was developed to help providers and payers improve the system of care to better address the needs of children in foster care. Using 2010 data from the Truven Health MarketScan Multi-State Medicaid Database, the authors compared the prevalence of diagnoses and co-morbid conditions for children in foster care and children "outside" of foster care.  This report provides key findings and a series of tables. There is data, presented by age group (birth - 5; 6 - 11; 12 - 17), about the most common diagnoses, comorbid conditions associated with each of the 10 most common primary diagnoses, and use of health care services.

News From Our Partners 

P1Child Health USA 2013 is an annual report published by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HHS/HRSA). This version focuses on perinatal health. It's a compendium of data and narratives about perinatal health indicators, risk factors and behaviors, health services utilization, and programs and policies, including the Affordable Care Act (ACA), that support the health of women and children throughout the lifespan.
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Events & Announcements

Date: January 14, 2014
Time: 3:00 - 4:00 pm
ET

This webinar, co-hosted by the Catalyst Center and the National Center for Children's Vision & Eye Health will provide an overview of the consumer protections and coverage options in the Affordable Care Act (ACA), how the ACA impacts children's vision, and vision considerations for children with special medical needs
Please note: Response to this webinar has been so enthusiastic that we have had to switch to a different webinar hosting service to accommodate the larger number of participants. If you registered for this event prior to January 10, you should have received an email asking you to re-register.  You must re-register in order to receive instructions for joining the webinar. If you have not yet re-registered, please do so now by clicking the registration link for this event: Register for the vision and eye health webinar

E2Webinar: Health Insurance Marketplace Refresher  link2

Date: January 16, 2014
Time: 2 pm ET
The Centers for Medicare and Medicaid Services (CMS) is hosting this webinar.  This is an opportunity to learn about Marketplace updates and materials that facilitate enrollment
Webinar: https://cms.webex.com/cms/j.php?ED=218734867&UID=0&ORT=MiMxMQ%3D%3D         
Participant Line: 1-877-267-1577
Conference ID: 992 605 070
Submit questions in advance to Partnership@cms.hhs.gov. For those unable to participate at this time, a recording will be posted on Health Insurance Marketplace within 2 weeks after the call.

E3Webinar: Early Hearing Detection & Intervention: AAP Tools for Medical Home Providers to Address Loss to Follow-Up/Documentation (LTF/D)
Date: January 17, 2014
Time: 1:00 - 2:00 pm CT
This webinar, hosted by the American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention Taskforce (EDHI) will share tools and resources that explain the role of medical home providers in early hearing detection and intervention and strategies for preventing loss to follow-up care. Register for the early hearing detection webinar.
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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. Kathleen Watters, MA, 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.