The Affordable Care Act (ACA) requires all new individual and small-group health plans, sold in and out of the Marketplaces, to provide services within ten categories of essential health benefits. Pediatric services, including oral and vision care, is one of the ten categories. However, medical insurance plans sold in the Marketplaces do not have to include pediatric dental services if at least one standalone dental plan is available in a state's Marketplace. As a result, families will have to pay two premiums and two deductibles. In addition, the current out-of-pocket maximum for dental care ($700 per child; $1400 for two or more children) does not count towards the medical out-of-pocket maximum. In order to relieve family financial burden, the U.S. Department of Health and Human Services (HHS) is proposing to reduce the dental out-of-pocket maximum to $300 per child ($400 for two or more) in the partnership and federally facilitated Marketplaces. HHS may impose this same standard for state-based Marketplaces. HHS may also allow dental insurers to reduce the actuarial value (the share of costs the plan covers), currently 70% or 85%, of their plans. While families would incur higher cost sharing, this may forestall dental insurers from raising premiums or deductibles. HHS might also consider other ideas for reducing family financial burden by adopting state-specific strategies. For example, California has enacted legislation that combines all out-of-pockets maximums and caps them at the level of a family's Marketplace health plan. Read the proposed HHS Notice of Benefit and Payment Parameters for 2015 rule. 

By Marissa Evans
Kaiser Health News
February 13, 2014  
Children in foster care in Florida are enrolled in Medicaid. However, because they move from placement to placement, there is little continuity of care. Often, their physical, mental, and dental health needs are not identified and are left untreated. In an effort to ensure children in the state's entire child welfare system receive comprehensive health care, including preventive care, Florida is moving them into Medicaid managed care. This program, which will begin in May 2014, will work to integrate each child's care, no matter where he or she is living. It will also strive to meet a child's social needs by providing $150 per child to be used for sports equipment or special occasion clothing.  Learn more about Financing the Special Health Care Needs of Children in Foster Care. 

By Joanne Jee
National Academy for State Health Policy (NASHP)
February 2014
In the past, state Medicaid programs did not require children and youth with special health care needs (CYSHCN) to enroll in managed care. A 2010 review of the Impact of Managed Care on Publicly Insured Children with Special Health Care Needs found "mixed results regarding access, utilization, unmet needs, and satisfaction." Times have changed. In response to budgetary issues, states have started to enroll CYSHCN in Medicaid managed care. NASHP recently completed a study about how states are working to ensure Medicaid managed care meets the needs of CYSHCN. In advance of the release of their report, Lee provides a preview of their findings from California, Massachusetts, and Michigan. This includes having managed care contracts include provisions for meeting the needs of CYSHCN, designing monitoring activities specially for CYSHCN, and including families as critical stakeholders in partnership activities. 

By Lorraine Gonzalez-Camastra
Say Ahhh! A Children's Health Policy Blog
February 11, 2014 
Are There Enough Doctors for the Newly Insured? The Affordable Care Act (ACA) has created new ways for people to get health insurance. But there are concerns that having health insurance will not mean they will be able to access care. In this blog, Lorraine Gonzalez-Camastra explains that school-based health centers can help build the capacity of the system of care for children. A new report by the  Children's Defense Fund - New York, titled School-based Health Centers in New York State: Ensuring Sustainability and Establishing Opportunities for Growth, suggests ways to sustain and expand school-based health centers under the state's transition to Medicaid managed care. 

By Emily R. Gee
Office of the Assistant Secretary for Planning and Evaluation (ASPE) Research Brief
February 11, 2014
As reported in this ASPE Research Brief, 25% of the more than 41 million uninsured U.S. citizens are Latino. The Affordable Care Act (ACA) created new ways for the uninsured to get health insurance. As a result, an estimated 234,000 uninsured Latino children whose household income is more than 250% of the federal poverty level (FPL) will be eligible for subsidized coverage in the Marketplaces. An additional 1.8 million Latino children whose household income is less than 250% FPL will be eligible for Medicaid or the Children's Health Insurance Plan (CHIP) in their state. This brief includes demographic information and implications of the optional Medicaid expansion for uninsured Latino adults.   

Robert Wood Johnson Foundation and Consumer Reports
2014

The Center for Linguistic and Cultural Competence in Health Care (CLCCHC) at the U.S. Department of Health and Human Services' Office of Minority Health works to "advance health equity at every point of contact." April 2014 is the first anniversary of the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. In preparation for the celebration, CLCCHC is asking health organizations throughout the country to provide answers to the following:

1. When did you first hear about the National CLAS Standards?
2. How does your organization use the National CLAS Standards (either the 2001 or the 2013 Standards) in its day-to-day operations or practice?
3. What are some of the challenges or difficulties your organization has had in using the National CLAS Standards?
4. May we contact you to find out more about your organization and its use of the National CLAS Standards?

Send responses to AdvancingCLAS@thinkculturalhealth.hhs.gov by April 1.  

CHIPRA Evaluation Highlight No. 7: How are CHIPRA Quality Demonstration States Designing and Implementing Caregiver Peer Support Programs? 
By Grace Ferry, Henry Ireys, Dana Peterson, and Joseph Zickafoose
Agency for Healthcare Research and Quality
February 2014
Maryland, Georgia, Utah, and Idaho worked to expand access to peer support for caregivers of children with special health care needs as part of their Children's Health Insurance Program Reauthorization Act (CHIPRA) quality demonstration projects. Learn how each state decided on the eligibility criteria for caregivers to become peer supporters, recruitment and training provided, and different models for providing care. Utah and Idaho used CHIPRA funds to compensate peer supporters. Maryland and Georgia received some reimbursement through Medicaid to pay the caregivers for the peer support they provided. See the Features of Caregiver Peer Support Programs in CHIPRA Quality Demonstration States.  

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.