The 2009/10 National Survey of Children with Special Health Care Needs found that only 52.7% of the California children with special health care needs (CSHCN) who needed care coordination received all needed components. The national average is 56%. In this blog, Shor cites Harvard University Professor Robert Putnam's call to action to rebuild social capital. Shor suggests that stakeholders who work together, share information, and develop common goals, among other ideas, will help break down the silos that exist among child-serving agencies. This type of collaboration will also maximize resources and help build social capital to develop a coordinated system of care for CSHCN. 

By Meghanne Bearden
Health Policy Hub  
January 30, 2014  
Dental care is expensive and there is a shortage of dentists. Children whose household income is limited, diverse communities, and rural populations are the most underserved, resulting in more than 80 million people who do not receive oral health services. The goal of the Dental Access Project, based at Community Catalyst, is to improve access to dental care. This blog explains how the advocacy efforts of consumer stakeholders in five states increased access to oral health care.

By Christine Vestal
Disability Scoop
January 22, 2014
The Affordable Care Act (ACA) includes provisions that allow the elderly and individuals with disabilities to live at home, participating in community life, rather than residing in costly institutional settings such as nursing homes. Seventeen states are utilizing one of these provisions - the Balancing Incentive Program - to provide home and community-based services to help individuals with disabilities continue to live at home. These states receive enhanced federal matching funds for Medicaid if they simplify the process for community-based living, train state and social services organizations to help individuals apply, and ensure individuals receive needed services. States must also create a standardized assessment to determine eligibility and provide a case manager. In New Hampshire, one of the 17 states, 99% of residents with developmental disabilities are receiving the services and supports they need to live at home.

Miami Children's Hospital Part of a Trend: Revealing Some Price Information
By Daniel Chang
The Miami Herald
January 19, 2014
The cost of hospital services and the out-of-pockets costs a family incurs when a child is hospitalized vary widely. If the child is uninsured, the hospital may discount the service, but the family incurs the full cost. If a child has public health insurance, the family may not have any out-of-pockets costs, or for CHIP (Children's Health Insurance Plan) they may have minimal co-pays. If the child has private health insurance, depending on the plan's deductible, co-insurance, and co-pays, the family may have many out-of-pocket expenses. To make matters more complex, hospitals do not have standard pricing for each medical procedure. As health insurers shift costs to families, Miami Children's Hospital is not releasing prices, but is making some information available so families can estimate their out-of-pocket hospital costs and make informed decisions about where to seek care for their child.

By Andrew Racine and the Committee on Child Health Financing
Pediatrics
January 27, 2014
Congress created the Children's Health Insurance Program (CHIP) in 1997 as part of the Balanced Budget Act. This policy statement from the American Academy of Pediatrics provides an overview of the original CHIP legislation and subsequent reauthorization in 2009 - the Children's Health Insurance Program Reauthorization Act (CHIPRA). The authors discuss the importance of the CHIP program to children whose family income is too high for Medicaid and who have no access to affordable health insurance. They also point out issues about the future of CHIP under the Affordable Care Act (ACA), noting that while the ACA extends CHIP authorization through 2019, it only funds the program through 2015. This policy statement concludes with a series of recommendations, which include funding CHIP through 2019, reconciling premiums for parents who are eligible for marketplace coverage and whose children are eligible for CHIP, ensuring adequacy of CHIP provider payments, and providing comprehensive and affordable CHIP benefits to a wider range of children and youth. 

By Robin A. Cohen and Whitney K. Kirzinger
National Center for Health Statistics
January 2014
Using data from the 2012 National Health Interview Survey, the authors examined the factors that contribute to financial burden. They found that:

• Families with children had higher incidence of medical debt than families without children.
• Almost 40% of uninsured families experienced financial burden due to medical care.
• Forty-six percent of families with mixed insurance status (some were insured, others were not) experienced financial burden.
• The incidence of financial burden was higher in families where some members had private coverage and others had public coverage, compared to families where everyone had the same type of insurance.
• Families with household income less than 250% of the federal poverty level ($74,550/year for a family of four) experience the highest levels of medical debt and are most likely to pay medical bills over time.  

Guide to Disability for Healthcare Insurance Marketplace Navigators
National Disability Navigator Resource Collaborative
December 2013
This guide, created by the National Disability Navigator Resource Collaborative, helps marketplace navigators and other consumer assistors understand when individuals with disabilities may be eligible for full Medicaid coverage, alternative Medicaid benefits, or health insurance through the marketplace. The scenarios presented are adult-focused, but the guidance and tips about communicating with individuals with disabilities, disability etiquette, and health literacy apply across the lifespan. In addition, this guide prompts navigators to ask questions about an individual's health providers and services to ensure current providers are included in a new health insurance plan to ensure continuity of care. There is also guidance about counseling individuals to consider total out-of-pocket expenses, rather than just the cost of the premiums. It may be cost effective for people who use a lot of health services to pay higher health insurance premiums so they have smaller deductibles, co-insurance, and copays.

News From Our Partners 

Child Complementary and Alternative Medicine Data

Those interested in knowing about the prevalence of complementary and alternative medicine (CAM) use among children, including children with special health care needs, can now access that data from the 2012 National Health Interview Survey (NHIS), which is newly available on the Data Resource Center for Child & Adolescent Health. Indicators include health coverage and out-of-pocket expenses for CAM, reasons for use and the perceived benefits, how families learn about CAM, and more.

Evaluation Highlight No. 6: How Are CHIPRA Quality Demonstration States Working Together to Improve the Quality of Health Care for Children?  
By Dana Petersen, Henry Ireys, Grace Ferry, and Leslie Foster
Agency for Healthcare Quality and Research
January 2014
The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 included funding for Quality Demonstration (QD) programs. Six of the ten QD grantees are multi-state partnerships involving 14 states. This Evaluation Highlight summarizes the strategies states used to share information and coordinate activities, maximize each other's resources and expertise and ensure the spread and impact of what they learned. Projects included medical home, quality measurement, coordinating health care between neighboring states for children who crossed state lines for care, and other efforts to improve the quality of children's health care and integration of behavioral health services.  

Technical Assistance Network for Children's Behavioral Health
University of Maryland News
By Patricia Fanning
December 3, 2013
The Institute for Innovation and Implementation at the University of Maryland's School of Social Work, has a five-year contract with the Substance Abuse and Mental Health Services Administration (SAMHSA) to serve as the lead agency for a Technical Assistance Network for Children's Behavioral Health. The Center for Health Care Strategies (CHCS) is one of the partners in this national endeavor. They will develop an online database of best practices for children's behavioral health resources for states and communities and provide technical assistance about Medicaid and child health quality to expand systems of care.

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.