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
"There can be no keener revelation of a society's soul than the way in which it treats its children."
~ Nelson Mandela
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Featured Article
About 8 million children are enrolled in the Children's Health Insurance Program (CHIP), a public benefits program that provides comprehensive health care benefits for children who do not have access to affordable health insurance and whose household income is too high for Medicaid. The CHIP program was reauthorized in 2009. The Affordable Care Act (ACA) extended funding through September 30, 2015. If funding for CHIP is not extended past this date, children will move from CHIP to qualified health plans sold in the marketplaces. This article summarizes the findings of the Comparison of Benefits and Cost Sharing in Children's Health Insurance Programs to Qualified Health Plans, a July 2014 study prepared by the Wakely Consulting Group for the Robert Wood Johnson Foundation. They compared CHIP and marketplace coverage for children in the 35 states that either have a separate CHIP program or that use CHIP funds to expand children's Medicaid. Their findings include:
- Pediatric benefits provided by CHIP, particularly for dental and vision services, are more comprehensive
- Marketplace coverage is more expensive, due in part to the purchase of a standalone dental plan if dental benefits are not included in the health plan
- On average, families raising children and youth with special health care needs with annual incomes less than 210% of the federal poverty level (FPL) would pay as much as $5200 annually in out-of-pocket costs for marketplace coverage, compared to $92 annually for CHIP
An additional concern is that affordability for employer-sponsored health insurance is based on the cost of an individual policy being less than 9.5% of household income, even though family coverage costs more. Thus, many families whose children would move from CHIP to the marketplace will not be eligible for advanced premium tax credits (if household income is less than 400% FPL) and cost-sharing subsidies (if household income is less than 250% FPL) because they have access to affordable employer-based coverage.
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 IN THIS ISSUE
News Items
Resources
Events and Announcements
In Case You Missed It...
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News Items
Rep. Pallone and Rep. Waxman Introduce House Bill to Extend CHIP Funding 
By Elisabeth Wright Burak
Say Ahhh! A Children's Health Policy Blog
July 31, 2014
In June, U.S. Senator Jay Rockefeller introduced the CHIP Extension Act of 2014 (S. 2461). On July 31, U.S. Representatives Frank Pallone and Henry Waxman introduced the CHIP Extension and Improvement Act of 2014. Like its companion in the Senate, this bill would extend funding for CHIP through 2019. In addition, it would extend state performance bonuses for streamlining enrollment and retention in Medicaid and CHIP. If passed, this proposed legislation would make Express Lane Eligibility (use of data from other public programs, such as the Supplemental Nutrition Assistance Program or the national school lunch program to determine eligibility for Medicaid or CHIP) permanent. This would especially benefit children aging out of foster care by streamlining eligibility. This bill also proposed a way to keep entire families ensured by allowing states to offer Express Lane Eligibility and 12-month continuous enrollment to adults.
U.S. Health Insurers to Pay $330 Million in Premium Rebates
By Caroline Humer
Reuters
July 24, 2014
The Affordable Care Act (ACA) includes a Medical Loss Ratio (MLR) Requirement. This regulation, also called the 80/20 rule, requires health insurers to spend at least 80% of the premiums they collect (85% for large insurers) on health care services and quality improvement activities. If insurers spend more than 20% (or more than 15% for large insurers) on salaries, bonuses, advertising and other non-medical services, they must provide rebates to the families or to the employers who paid the health insurance premiums. The employers can pass those savings along to employees or put the rebates towards future premiums. This year, 6.8 million people will receive a total of $330 million in rebates that average $80 per family. This is lower than the $500 million insurers rebated last year. This decline, as reported in this article, is most likely due to lower insurance premium costs and is a direct result of the passage of national health reform.
By Venetia Lai
UCLA Center for Health Policy Research
July 24, 2014
California parents report that more than 70% of their children ages 4 to 11 who need mental health services do not receive them. A new policy brief, Three Out of Four Children with Mental Health Needs in California Do Not Receive Treatment Despite Having Health Care Coverage, from the UCLA Center for Health Care Policy examined factors associated with mental health needs and barriers to treatment. Children with underlying medical conditions such as asthma, children who live in poverty, and children who live in single-parent households are more likely to have mental health needs. Boys are more likely to have mental health needs than girls are. A parent's mental and physical health also influences a child's mental health. Having health insurance does not ensure a child receives needed mental health services. Difficulties navigating the mental health system and stigma are barriers to treatment. And, not only is there a shortage of mental health providers, there is also a shortage of providers who speak more than one language. Children whose parents speak English are more likely to receive mental health services than children whose parents have limited English proficiency.
By Naomi Stark
Say Ahhh! A Children's Health Policy Blog
July 23, 2014
This blog provides an overview of Improving the Road to Coverage: POLICY RECOMMENDATIONS FOR ENROLLMENT SUCCESS. This report from the Action for Health Justice (AHJ) network details barriers encountered by Asian Americans, Native Hawaiians, and the Pacific Islander Community during the Affordable Care Act's first open enrollment period and recommendations for improving the next open enrollment period. Lack of language access and concerns about immigration status are among the biggest barriers to enrollment. AHJ identified a need for improved training for all consumer assistors and interpreters. This should include increased knowledge of health insurance in general and a focus on eligibility and enrollment rules for immigrants. Translated materials need to be higher quality, available both online and on paper, available in more languages, and should address varying levels of health literacy. There is also a need for more resources to support in-person assistors. In an effort to speed enrollment, the Centers for Medicare and Medicaid Services (CMS) should work with the Department of Homeland Security to finalize policies for identification and confirmation of immigration status so individuals can prepare these materials in advance of the open enrollment period that begins on November 15, 2014.
By Sonya Schwartz
Say Ahhh! A Children's Health Policy Blog
July 31, 2014
As part of a national effort, this blog from the Center for Children and Families identifies barriers to enrollment and health coverage for eligible immigrant and mixed status families. These include fixing errors in the immigration status verification system for lawfully present immigrants; fixing errors in the eligibility determination systems for lawfully present immigrants whose income is less than 100% of the federal poverty level; allowing use of leases, phone bills, or other documents to serve as proof of identity; and increasing language access.
By Michelle Diament
Disability Scoop
August 1, 2014
On July 31, the U.S. Senate renewed the Autism Collaboration, Accountability, Research, Education and Support Act (Autism CARES). This legislation, formerly known as the Combating Autism Act, includes $260 million a year through 2019 for existing programs, which include early diagnosis, tracking the prevalence of autism, professional training, and research. New initiatives include an "autism point person" at the U.S. Department of Health and Human Services (HHS) and a report to identify the needs of youth and young adults in transition. In addition to this work in the Senate, a U.S. House of Representatives panel approved the Achieving a Better Life Experience (ABLE) Act. If approved, this legislation would raise the savings limit for people with disabilities who are eligible for Supplement Security Income (SSI) without worrying about losing Medicaid.
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Resources
By Ellen Albritton, Dana Petersen, and Margo Edmunds
Agency for Healthcare Research and Quality
July 2014
Six of the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration grantees are working with primary care practices in their states to integrate care coordinators into their practices. This is part of each practice's efforts to become patient-centered medical homes (PCMHs) and to support children with special health care needs. This National Evaluation Highlight from the Agency for Healthcare Research and Quality (AHRQ) profiles the various ways Alaska, Idaho, Massachusetts, Oregon, Utah, and West Virginia used grant funds to support care coordinators, what worked and what didn't. It includes an excellent table about funding sources, hiring responsibility, hours worked, and more.
Agency for Healthcare Research and Quality
July 2014
The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 created the Pediatric Quality Measures Program (PQMP) as part of an effort to improve and strengthen the quality of care and health outcomes for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The PQMP program works to improve the core set of children's health care quality measures, develop new measures, and expand the evidence base for pediatric quality measures. The measures that have been developed are available in Table 1. Available Measures Developed by PQMP Grantees. Domains include continuity of health insurance coverage through the Medicaid and CHIP programs. See additional CHIPRA PQMP Pediatric Quality Measure Topics for Measures in Development, by Domain, which includes access to care, care coordination, and foster care measures (in the "other varied domains or domains to be determined" section).
By Margaret A. McManus and Harriette B. Fox
The National Alliance to Advance Adolescent Health
July 2014
This fact sheet from the National Alliance to Advance Adolescent Health compares benefits and cost-sharing between separate Children's Health Insurance Programs (CHIP) and child-only qualified health plans sold through the health benefits marketplaces in Colorado, Georgia, Oregon, Texas, and West Virginia. The authors found that even with federal subsidies, cost-sharing for marketplace plans was greater than cost-sharing for CHIP and the benefits were less generous, particularly for dental and hearing services. This fact sheet includes tables comparing benefits and costs between CHIP and qualified health plans in each of the five states.
News From Our Partners
The MCH Navigator is a learning portal for maternal and child health (MCH) professionals and others. Currently, there is a training spotlight on Children and Youth with Special Health Care Needs. It includes introductory videos, links to trainings about eligibility and enrollment, insurance and financing of care, the Affordable Care Act, cultural competence, and more. Additional links direct users to MCH library resources.
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Events & Announcements
Date: August 12, 2014
Time: 2:30 to 4:00 pm ET
Date: August 13, 2014
Time: 3:00 to 4:00 pm ET
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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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