Catalyst Center Coverage
Roundup of news related to financing of care for children and youth with special health care needs
 May 8, 2014
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Featured Article
 
By Eric Whitney
Shots: Health News from National Public Radio (NPR)
May 2, 2014   
March 31, 2014 marked the end of the Affordable Care Act's (ACA) first open-enrollment period. The U.S. Department of Health and Human Services (HHS) continues to examine the numbers. In total, 17.8 million people obtained coverage through the marketplace, in the individual market, or through Medicaid. Of the 8 million people who signed up for coverage through the marketplaces, almost half (3.8 million) signed up in the six weeks before the deadline. This mirrored the activity outside of the marketplace, where 50% of total purchases occurred during the final two weeks of open enrollment. While the numbers are encouraging, there is disappointment that only 400,000 of the estimated 10.8 million Latinos who were eligible for coverage in states with federally facilitated marketplaces enrolled. This number may be higher in the states that have state-based marketplaces.  
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N1Health Exchange Enrollment Ended with a Surge link2
The New York Times
May 1, 2014
This infographic, a compilation of data from the U.S. Department of Health and Human Services (HHS), provides demographic information about who purchased health insurance through the marketplaces and the type of plan they chose. It includes a state-by-state listing of the number of individuals found eligible for Medicaid or the Children's Health Insurance Program (CHIP), the number who purchased marketplace plans, how well each state reached its enrollment target, and the percent of 18- to 34-year-olds who selected private plans.  

 

N2States Enroll Former Foster Youth in Medicaid link2  

By Christine Vesta
Stateline
April 30, 2013
The implementation of the provision of the Affordable Care Act (ACA) that allows coverage for "adult" children on their parent's health insurance to age 26 was very successful, extending coverage to 6.6 million young adults. Unfortunately, a companion provision for children without parents, implemented on January 1, 2014, has been less successful. This provision allows children who age out of foster care and those who aged out before January 1 of this year, regardless of income, to reenroll in Medicaid until age 26. This article notes the lack of federal guidance to help states identify and enroll the 26,000 youth - many with complex medical and behavioral health needs - who age out of foster care each year. Outreach and enrollment efforts are further complicated because children who age out of foster care in one state often move to another state. States do not have to extend the Medicaid benefit to foster care recipients who aged out of the system in other states. Social networking between youth who have aged out of foster care has been an effective way to spread the word about this benefit. To aid retention, some states automatically enroll youth in foster care before they age out. This article includes a chart showing the numbers of youth who aged out of foster care between 2008 and 2012 in each state that are potentially eligible to reenroll in Medicaid. 

 

By Anita Soni
U.S. Agency for Healthcare Research and Quality (AHRQ)
April 2014
Using data from the 2011 Medicaid Expenditure Panel, the author found that mental disorders, asthma, trauma-related disorders, acute bronchitis and upper respiratory infections, and otitis media were the five most costly conditions in children, birth through age 17. The number of children treated for mental disorders, at 5.6 million, was the smallest, but costs per child, at $2,465 were the highest, totaling $13.8 billion. Of the five conditions, private insurance covered the smallest percentage of the costs for mental disorders. Medicaid paid the highest percentage of costs for asthma/COPD (Chronic Obstructive Pulmonary Disease), followed by mental disorders. Out-of-pocket costs were highest for children with acute bronchitis and upper respiratory infections and trauma-related disorders.  
 
A Policy Statement from the American Academy of Pediatrics 
Pediatrics 
April 28, 2014
This policy statement, from the American Academy of Pediatrics (AAP) explains the implications of high-deductible health plans (HDHP) for children, with a focus on children whose household income is limited and children with special health care needs (CSHCN). This article provides a description of HDHPs, advantages, and disadvantages, which include concerns about the financial impact on families with limited income and on families raising CSHCN. While premiums are lower for HDHPs, out-of-pocket costs are higher because families must meet the high deductible before the insurer begins to pay.  Recommendations  include researching the impact of HDHPs on children, providing "a generous number" of primary care visits without cost-sharing and before the deductible is met, eliminating the deductible for children with certain special health care needs, and prohibiting the use of HDHPs for children younger than 18 years.   

By Michelle Andrews 
Kaiser Health News
April 11, 2014
Depending on household income and a state's income eligibility limits for Medicaid and the Children's Health Insurance Plan (CHIP), families who apply for health insurance through the marketplaces may have different coverage types. In this installment of A Reader Asks, a family applied for insurance during open enrollment. The parent was eligible for private health insurance; the children were eligible for CHIP. The parent was concerned about incurring a penalty for the children, who would have been uninsured for more than three months in 2014, because their CHIP coverage didn't start until April. Andrews explained that the Shared Responsibility Provision Question and Answer document from the Centers for Medicare and Medicaid Services (CMS) clarified that no one who applied for insurance - private or public - during open enrollment would have to pay a penalty, even if coverage didn't start until April.
Note: The next open enrollment period for marketplace coverage begins on November 15, 2014. Enrollment is always open for Medicaid and CHIP.
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Resources
  
By Andrew Snyder, Keerti Kanchinadam, Catherine Hess, and Rachel Dolan
National Academy for State Health Policy (NASHP)
April 2014
Oral health is an integral part of overall health and wellness. Pediatric dental benefits are included in the essential health benefits that the Affordable Care Act (ACA) requires new individual and small group health plans, sold in and outside of the marketplaces, to provide. However, federal guidance allowed marketplace health plans to exclude pediatric dental benefits as long as a standalone dental plan was available. This meant families incurred separate premiums, for which they would not receive federal subsidies, and additional out-of-pocket maximums.  In January 2014, the National Academy for State Health Policy (NASHP) convened an expert workgroup to collect suggestions for overcoming challenges associated with the design, affordability, and consumer experience with pediatric and adult dental benefits. This report provides state-specific examples of policy solutions and additional policy options for overcoming the identified challenges. Appendices include summaries of the federal guidance related to dental benefits and a table with information about each state-based marketplace's benchmark plan for pediatric dental benefits, requirements for purchase of pediatric dental plans, out-of-pocket maximums, and more.  

  

By Tricia Brooks and Martha Heberlein 
Georgetown University Health Policy Institute's Center for Children and Families 
April 2014 
The Affordable Care Act (ACA) strives to streamline eligibility determinations, enrollment, and retention in Medicaid, the Children's Health Insurance Program (CHIP), and marketplace health plans. However, the use of the Modified Adjusted Gross Income (MAGI) rule for determining household income and size will complicate the first round of renewals. This brief, from the Center for Children and Families, outlines:
  • The MAGI renewal process for Medicaid and CHIP, 
  • The extension that the Centers for Medicare and Medicaid Services (CMS) granted so states would have more time to transition to MAGI,
  • The delays CMS allowed so states would not have to conduct renewals using pre-MAGI and post-MAGI rules, and
  • The protections for children who may lose Medicaid eligibility because states now use a standard five percent disregard, rather than state-specific disregards.  

 

News From Our Partners 
 
The National Center for Hearing Assessment and Management (NCHAM) and the  Catalyst Center worked together to create Health Care Reform: What's in it for Children who are Deaf or Hard of Hearing? This easy-to-read document, created for families and health care providers, provides information about the consumer protections and covered benefits within the Affordable Care Act (ACA). It explains the implications of the ACA for children who are deaf or hard of hearing and the state-to-state differences in covered services, such as speech and language therapy and hearing aids. This brief was introduced at the 2014 Early Hearing Detection and Intervention (EHDI) Annual Meeting held April 13-15 in Jacksonville, FL, where Meg Comeau, Co-Principal Investigator of the Catalyst Center, presented a plenary session on this topic. For her presentation and more, see EHDI Presentations Regarding Implications of the ACA for Children Who are Deaf or Hard of Hearing.

P2New Report from Lucile Packard Foundation for Children's Health link2
The Lucile Packard Foundation for Children's Health: Program for Children with Special Health Care Needs is pleased to announce the availability of a new report, Achieving a Shared Plan of Care with Children and Youth with Special Health Care Needs. There is agreement that a shared plan of care helps ensure that children and youth with special health care needs receive coordinated care and can easily access related services. However, until now, there has been little guidance about the process for developing shared plans of care and about what the plans should include. This report and implementation guide addresses these issues. Download the full report and slide show.

CDC Celebrates 20 Years of Protecting America's Children link2
P3
On April 24, 2014, the Centers for Disease Control and Prevention (CDC) issued a press release celebrating the 20th anniversary of the Vaccines for Children (VFC) program.  VFC provides vaccines for children who do not have health insurance. The program makes it possible for uninsured children to receive vaccines the same way children who have insurance do - without copays or deductibles. Thanks to a provision of the Affordable Care Act (ACA), many health insurers now provide vaccines and other preventive services without cost-sharing. This VFC infographic illustrates how childhood vaccines prevent illness, avoid unnecessary deaths, and save money.
 
AMCHP Conference Session Recordings Now Available link2
P4
The Association of Maternal and Child Health Programs (AMCHP) held its annual conference in January of this year. If you were unable to attend, or did attend and didn't make it to all the sessions you wanted to, you can access the recordings and slides from this year's conference, The Road Ahead: Challenges, Changes and Opportunities for Maternal and Child Health. Among them is What's New in 2014: The ACA and Maternal and Child Health Populations, a panel presentation by staff from the Catalyst Center and representatives from AMCHP and the Maternal and Child Health Bureau.  
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Events & Announcements

Date: May 15, 2014
Time: 2:00 pm ET
This webinar, hosted by the Association of Maternal and Child Health Programs (AMCHP) will feature the work of the Tennessee Department of Health and the Maryland Office for Genetics and People with Special Health Care Needs. The presenters will discuss their successful efforts to build resilient workforces that meet the needs of the maternal and child health populations and communities whom they serve. Register for the Building and Retaining a Resilient MCH Workforce for Tomorrow webinar. 

Date: May 19, 2014
Time: 11:30 to 12:30 pm MT
This webinar, hosted by the National Center for Hearing Assessment and Management (NCHAM) is for Early Hearing Detection and Intervention (EDHI) programs and others interested in improving the readability of parent materials. The presenters will share information about evaluating and modifying materials to promote health literacy. Register for the Improving Readability and Usability of EHDI Newborn Hearing Screening Brochures webinar. 

Date: May 21, 2014
Time: 2:00- 3:00 pm ET
The National Academy for State Health Policy (NASHP) is hosting a webinar to explore how states are engaging youth, developing innovative strategies to increase adolescent well-care visits, and strengthening provider-adolescent partnerships. Learn more and register for the Engaging Adolescents through the Medicaid Benefit for Children and Adolescents webinar. 

Date: May 22, 2014
Time: 2:00 to 3:30 pm ET
The Connecting Kids to Coverage National Campaign works to educate, identify, and enroll eligible children in Medicaid or the Children's Health Insurance Program (CHIP). This webinar is an opportunity to learn about best practices for reaching out to and enrolling the most vulnerable children - those who are aging out of foster care or who are homeless. Register for the Enrolling Vulnerable Youth in Medicaid and CHIP 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.