Catalyst Center Coverage Roundup of news related to financing of care for children and youth with special health care needs |
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Quote of the Week
"If a man had as many ideas during the day as he does when he has insomnia, he would make a fortune."
~Griff Niblack
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IN THIS ISSUE
News Items
Resources
Events and Announcements
So, what do you think about
Catalyst Center Coverage?
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News Items
By Tricia Brooks Say Ahhh! Georgetown University's Center for Children and Families Health Care Policy Blog January 10, 2014
Prior to the implementation of the Affordable Care Act (ACA), some states provided Medicaid to children and pregnant women based on reported gross income without a full Medicaid determination. This presumptive eligibility (PE) determination provided immediate access to health services for a set period, with the hope that with a completed Medicaid application the individual would have an ongoing form of health coverage. Starting January 1, 2014, a provision of the ACA gives hospitals the option to make PE determinations for children, pregnant women, parents, and childless adults (in Medicaid expansion states), even if the state did not previously have a PE policy. As Brooks notes in this blog, "presumptive eligibility provides a great opportunity for hospitals to connect uninsured kids and their parents to coverage, especially during this breaking-in period for new Medicaid eligibility systems." This good news is tempered by the unrealistic standards that some states have set for hospitals. The concern is that these requirements will discourage hospitals from providing PE.
By Michelle Diament Disability Scoop January 10, 2014
Home and community-based services (HCBS) waivers, also known as 1915(c) waivers, allow states to provide additional Medicaid services to individuals who, without extra services and supports, would have to live in institutional settings. States can also use HCBS waivers to transition individuals from institutional settings to community-based living situations. The Centers for Medicare and Medicaid Services (CMS) has issued a new Medicaid rule for HCBS waivers to clarify that housing built on institutional sites, nursing facilities, and mental health facilities are not community-based. This will ensure that individuals who need long-term supports will be able to choose where they live and that the setting allows privacy, choice of daily activities, and access to community life. States that have existing HCBS waivers must review them for compliance with the new rules and plan to transition any waivers that need modification. Review the list of current 1915(c) waivers. By Sabrina Tavernise New York Times January 20, 2014 Can having health insurance improve mental health without necessarily receiving mental health services? In 2008, The Oregon Health Insurance Experiment evaluated the effects of providing Medicaid to uninsured, childless adults with limited household income. Researchers found a 30% decrease in observed rates of depression. In West Virginia, a state that has implemented the optional Medicaid expansion of the Affordable Care Act (ACA), newly enrolled individuals report, "the mere fact of having it [health insurance] has drastically improved their mental health." The Medicaid expansion creates a pathway to Medicaid eligibility for childless, non-pregnant, legally residing adults without disabilities whose household income is less than 133% of the federal poverty level (FPL). States that have adopted this provision are seeing a reduction in the number of uninsured. As reported in this article, the newly insured no longer have to decide between paying for medical care or food and other necessities. See the Status of State Action on the Medicaid Expansion Decision, as of December 11, 2013. Read Your Questions About the Medicaid Expansion Provision of the Affordable Care Act Answered for information about how a state's decision to implement the Medicaid expansion may affect youth and young adults with special health care needs. By Lisa Stiffler Kaiser Health News in partnership with The Seattle Times January 17, 2014Eighteen to thirty-four year olds represent almost half of Washington State's uninsured population. While not implying that music is best medicine, the state is hopeful that music will lure this demographic into accepting "a dose of health-care education." Washington Healthplanfinder, the state's health insurance marketplace has partnered with Live Nation, a concert promoter. They are sponsoring multiple educational events about health insurance at concerts and via social media to make sure young adults know about new opportunities to enroll in affordable, adequate health insurance. [If you need health insurance and want to know if you or your family members are eligible for Medicaid, the Children's Health Insurance Plan (CHIP), or Marketplace coverage, connect with the Marketplace in your state at HealthCare.gov. Open enrollment ends March 31, 2014.]
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Resources
By Karen Pollitz, Cynthia Cox, Kevin Lucia, and Katie Keith The Henry J. Kaiser Family Foundation January 2014Having health insurance does not shield an individual or family from incurring medical debt. Even with insurance, premiums, deductibles, co-pays, co-insurance, and higher costs for out-of-network care can make it difficult to keep up payments for medical expenses. As reported in this study, paying medical bills is a financial hardship for about 33% of American families. The authors analyzed data from the 2012 National Health Interview Survey and used their case studies of 23 individuals who were in medical debt to provide a comprehensive overview of the factors that lead to medical debt and the consequences. And while the Affordable Care Act (ACA) will not end medical debt, some provisions will help mitigate the problem. Insurers can no longer deny coverage or charge more for people with pre-existing conditions. Other helpful provisions include cost-sharing subsidies for marketplace coverage, the end of annual benefit limits, and mental health parity. KidsWell January 17, 2014This report provides a description of the different types of consumer assistors available to help individuals and families enroll in health insurance. It includes a database of consumer assistance organizations and funding available in each state. Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP By Kelly Devers, Leslie Foster, and Cindy BrachAcademic PediatricsNovember 2013Nine of the eighteen states that received Children's Health Insurance Program Reauthorization (CHIPRA) Quality Demonstration (QD) grants conducted collaboratives as part of their overall quality demonstration work. The collaboratives addressed a variety of topics, including advancing patient-centered medical home capability and using the Centers for Medicare and Medicaid Services (CMS) Initial Core set of Children's Health Care Quality Measures to increase knowledge and skills around quality improvement. The authors interviewed more than 250 participants in all 9 states. While staff appreciated the learning and networking opportunities provided through the collaboratives, they reported that it was difficult to keep up with the vast number of materials, meetings, and conference calls. It was also challenging to engage staff members who did not participate in the collaborative. Despite the challenges, states are striving to sustain and disseminate activities that they found effective. News From Our Partners  The Genetic Alliance will fund awards, up to $25,000, for existing collaborative projects that improve access to genetic services and supports. Letters of intent are due by February 15; proposals are due March 14, 2014. Read the request for proposals. |
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Events & Announcements
Date: Wednesday, February 12, 2014 Time: 2:00 to 3:00 pm EST This webinar, hosted by the Connecting Kids to Coverage National Campaign, will explore why eligible teens are less likely to be enrolled in Medicaid and the Children's Health Insurance Program (CHIP) than younger children are. Participants will learn strategies to increase enrollment of this age group. Register for this webinar.
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Want more news?
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.
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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.
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