The Affordable Care Act (ACA) included a Medicaid rate increase for primary care physicians for 2013 and 2014. While the President's budget includes a one-year extension that would include physician assistants, nurse practitioners, and obstetricians and gynecologists who provide "significant" amounts of primary care, the Obama Administration as well as hospital and physician groups are advocating for a two-year extension. An additional six million people have enrolled in Medicaid since October 2013; this means the demand for primary care services will increase. An extension of the enhanced Medicaid rate will help retain current primary care providers and encourage new ones to accept Medicaid as a form of payment.

Former Foster Care Youth Get Help Paying For Health Care

Prior to January 1, 2014, when youth aged out of foster care, typically at age 18, they lost their Medicaid benefit, unless they lived in a state that extended Medicaid to youth formerly in foster care until age 21 under the Chafee Option. Now all youth who have aged out of foster care and, moving forward, youth who will age out, can reenroll in or retain the Medicaid benefit until they turn 26, thanks to a provision of the Affordable Care Act (ACA) that went into effect in January. However, there is one small proviso: states may elect to extend Medicaid only to youth who age out of foster care in their state. [See the next summary for a new bill that contains a provision addressing this issue.] This article shares the story of one of the estimated 55,000 young adults who aged out of foster care prior to 2014. This 23-year-old Californian did not have the resources to pay for the vision services he needed to succeed at work and school until he reenrolled in Medicaid. Extending Medicaid to youth who age out of the child welfare system is an important way to meet the health needs of a vulnerable population that is more likely to have mental health and medical needs than their peers who were not in foster care.

The Children's Health Insurance Program (CHIP) was created in 1997. This public insurance program provides comprehensive health benefits with little or no cost sharing for uninsured children (and, at state option, pregnant women) whose household income is too high to qualify for Medicaid. [See CHIP income eligibility for children and for pregnant women.] In 2009, the Children's Health Insurance Program Reauthorization Act (CHIPRA) extended funding for CHIP through October 1, 2015. On June 11, Senator Jay Rockefeller introduced the CHIP Extension Act of 2014 (S. 2461). If passed, this federal legislation would fund CHIP through 2019. It also requires states to provide Medicaid to youth who were formerly in foster care, even if they aged out of foster care in a different state. Several sections of this Act address continuity of coverage for children with special health care needs (CSHCN) by increasing the CHIP age limit for CSHCN to 26 and extending express lane eligibility.

Tricare, health insurance for military families, covers applied behavioral analysis (ABA) therapy for children with autism spectrum disorders. However, the annual cap of $36,000 for ABA stops short of what children need to benefit fully from the therapy. Once the cap is reached, children go without services or families put themselves at risk of financial hardship and pay out of pocket for additional services. In May, Representative John Larson introduced H.R. 4630: Caring for Military Children with Developmental Disabilities Act of 2014. If passed, this bill would not only increase ABA coverage for children with autism diagnoses, it would also provide ABA for children with other types of developmental disabilities.

Does having health insurance increase a child's chances of graduating from high school and attending college?  It appears that, indeed, health insurance "benefits" include an increased potential for academic success. Using data from the American Community Survey and Current Population Survey, researchers at Harvard and Cornell studied young adults, ages 22 to 29 years old, born in the 1980s - the decade in which states expanded children's eligibility for Medicaid and the Children's Health Insurance Program (CHIP). Increasing Medicaid and CHIP eligibility and benefits corresponded with a decrease in the number of high school dropouts, an increase in college attendance, and an increase in the percent of students who completed a four-year degree. Implications of these findings include:

• Public benefits have a positive impact on educational achievement,
• Medicaid and CHIP, public health programs that generally serve children with limited household income, can help close the educational achievement gap that exists among children of different socio-economic status, and
• When families do not incur medical debt, they have more resources for other activities with their children.    

Churn occurs when individuals cycle on and off of health insurance due to changes in income, family size, employment status or other life changes. The Affordable Care Act (ACA) created new opportunities for individuals and families to obtain affordable health coverage. But there are concerns that churn will persist among Medicaid, the Children's Health Insurance Program (CHIP) and subsidized health plans sold in the health benefits marketplaces, especially for households with income less than 200% of the federal poverty level (FPL). Churn is a concern for all, but especially for children and youth with special health care needs (CYSHCN). Medicaid, CHIP and marketplace plans have different cost-sharing and coverage limits. Provider networks also differ, which can disrupt continuity of care for CYSHCN. The authors examine strategies to reduce churn. Having insurers offer plans in Medicaid, CHIP, and the marketplace will ensure the same provider network. Using Medicaid dollars to subsidize marketplace plans for adults newly eligible for Medicaid will lessen the need for transitions from Medicaid to a marketplace plan if income rises above 133% FPL. Providing 12-month enrollment in Medicaid and CHIP will stabilize coverage for a full year, regardless of household changes. Offering a Basic Health Plan for individuals with income between 133% and 200% FPL will also stabilize coverage. This issue brief includes a table showing plan-to-plan transition policies in 18 states.

CHIPRA Quality Demonstration States Help School-Based Health Centers Strengthen their Medical Home Features

More children with complex health needs are surviving to adulthood. This population of youth and young adults in transition from pediatric to adult systems of care account for a disproportionate percentage of inpatient health care costs. The authors provide strategies for facilitating the transition to adult medical care that aligns with the Institute for Healthcare Improvement's Triple Aim to improve clinical outcomes; to improve patient, family, and provider experiences of care; and to decrease per capita costs of care. These strategies include helping patients develop self-management skills, supporting the care team, and helping patients and families navigate the transition process.

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 grant #U41MC13618 from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.