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 are no shortcuts to any place worth going."
~ Beverly Sills
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Featured Article
Prior to the passage of the Affordable Care Act (ACA), President Obama was quoted as saying " If you like your health care plan, you'll be able to keep your health care plan." But, what if you don't like your health plan? Some large employer-sponsored health plans do not cover inpatient hospitalization, a benefit that is especially important for children and youth with special health care needs (CYSHCN). And, even though inpatient hospital treatment is one of the ten essential health benefits, these benefits only apply to new individual health plans and to Qualified Health Plans sold through the Marketplaces. Employees who didn't like their employer's plan could decline that coverage and purchase a Marketplace plan. But, if the employer's plan met the ACA's standard for Minimum Value of an Employer-Sponsored Health Plan (pays at least 60% of the cost of benefits provided under the plan) they would not be eligible for federal subsidies. As of November 4, this is no longer true. The U.S. Department of Health and Human Services (HHS) and the Treasury Department issued a new rule for Group Health Plans that Fail to Cover In-Patient Hospitalization Services. Starting in 2015, large employer plans that do not include coverage for inpatient hospital benefits will no longer meet the ACA's minimum value standard and employees will be allowed to purchase subsidized Marketplace 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
Children's Coverage at a Crossroads: Progress Slows
By Joan Alker and Alisa Chester
November 5, 2014
Georgetown Health Policy Institute's Center for Children and Families
In this short video, Joan Alker, the executive director of the Georgetown Center for Children and Families, explains that children who have health insurance have better access to primary care, do better in school, and their families are protected from medical debt due to health costs. Using 2011 and 2013 data from the American Community Survey, Alker and Chester have just completed Children's Coverage at A Crossroads: Progress Slows. They found that for the first time in 5 years, progress towards reducing the number of uninsured children has stalled. It is a particular concern that children living in households with income between 100% and 199% of the federal poverty level have the highest rate of uninsurance. Funding for the Children's Health Insurance Program (CHIP) ends on October 1, 2015. Alker estimates an additional 2 million children will "swell the ranks of the uninsured" if CHIP is not refunded.
Obama's Health Law: Who Was Helped Most
By Kevin Quealy and Margot Sanger-Katz
The New York Times
October 29, 2014
The interactive map in this article, compiled from data from Enroll America and Civis Analytics, shows the overall percent change in American's health insurance status from 2013 to 2014. Separate charts break down the change in insurance status by: states that expanded Medicaid and those that did not; race, age, neighborhood income, and gender; democratic and republican counties; and rural areas, small cities, and large cities. While Hispanics and Blacks continue to have the highest rates of uninsurance, they made the biggest gains in coverage. Uninsurance among 18- to 34-year-olds decreased from 21.6% to 14.2%. Neighborhoods with the lowest income showed the biggest reductions in numbers of uninsured. Overall, people fared better in states that expanded Medicaid. Who Would Have Health Insurance if Medicaid Expansion Weren't Optional, a companion article by these same authors, shows that an additional three million people would have gained insurance if every state had implemented the Medicaid expansion at the beginning of this year. See the Status of State Action on the Medicaid Expansion Decision.
By Christine Vestel
Stateline
October 8, 2014
As reported in this article, children enrolled in Medicaid are 50% more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than other children are. The costs for ADHD treatment are taking an increasingly bigger bite out of state Medicaid budgets. ADHD commonly co-occurs with other diagnoses, which makes it difficult to diagnose and treat. Medicaid programs in Georgia, Missouri, and Vermont are working with the Centers for Disease Control and Prevention to improve diagnosis and care. Arizona, Illinois, and Arkansas have implemented prescription drug pre-authorization policies to reduce costs and avoid medicating children unnecessarily. Evidence-based treatments depend on the age of the child. Some experts say therapy and medication is the most effective treatment, but therapy is expensive, and there is a nationwide shortage of child psychiatrists. The effects of poverty can also exacerbate ADHD. Experts note that parents and other caregivers, as well as teachers could benefit from education and support around providing structure for children with ADHD.
By Arielle Levin Becker
The Ct Mirror
October 7, 2014
Connecticut is revamping its supports and services for children and youth with "significant mental health needs." In recognition of the challenges of finding placements for children with autism spectrum disorders (ASDs), the state's plan includes children with mental health needs who also have an ASD diagnosis. The state will increase the number of crises stabilization and respite beds so children and teens won't have to wait in hospital emergency rooms until beds become available while they are experiencing a mental health crisis. They will do this by repurposing empty beds from underutilized facilities that provide temporary placements for children who have been removed from their families. Using state and federal funds, the state will also expand supports for children living at home and in out-of-home placements.
Keerti Kanchinadam
Statereforum
October 3, 2014
As noted below in the issue brief Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements, states could decide how to implement some of the essential health benefits. Pediatric dental care was one of those benefits. States had options for how to offer pediatric dental coverage through the Marketplaces. For example, some states required Qualified Health Plans (QHPs) to embed pediatric dental services. In other states, QHPs could exclude pediatric dental care if standalone plans were available in the Marketplace. Some states required families to purchase standalone plans, unless their children were enrolled in the state's Children's Health Insurance Program (CHIP), which includes pediatric dental care. As states prepare for the second open-enrollment period, this blog describes how California, Washington state, and Connecticut, each with a state-based Marketplace, managed pediatric dental benefits, what they learned, and changes they will make for 2015.
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Resources
By Vernon K Smith, Ph.D., Kathleen Gifford, and Eileen Ellis of Health Management Associates and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation
Kaiser Family Foundation
October 2014
This report summarizes the findings from the 14th annual survey of Medicaid officials in all 50 states and the District of Columbia (DC). This year and next will be a time of great change for Medicaid programs due to the continued implementation of the Affordable Care Act (ACA) and other reforms aimed at improving access to care. Now that the ACA's Maintenance of Eligibility (MOE) requirement for adults has ended, some states that provided Medicaid to parents at incomes greater than 100% of the federal poverty level (FPL) have rolled back eligibility to 100% FPL. Parents in these states will now have to purchase Marketplace coverage. Some states also eliminated Medicaid Buy-in programs for working adults with disabilities, imposed limits on services for specialty care, or eliminated certain categories of services such as vision care. A pharmacy policy change in one state led to application limits for use of ADHD medications with children. However, MOE for children continues through 2019, so children's coverage remains intact. In fact, some states have expanded Medicaid eligibility for children by waiving the 5-year bar for lawfully residing immigrant children. Others have implemented 12-month continuous Medicaid eligibility or eliminated premiums for children whose family income is more than 150% FPL. The report includes tables that list eligibility, benefit, and premium and copayment changes for each state and DC for 2014 and 2015. The survey is included as an appendix.
Justin Giovannelli, Kevin W. Lucia, and Sabrina Corlette
The Commonwealth Fund
October 2014
All new individual and small group health plans sold in and outside the Marketplace must include ten essential health benefits. The U.S. Department of Health and Human Services (HHS), rather than define the amount, scope, and duration of each service, let each state choose one of four benchmark plans to define each covered benefit. States also had the authority to decide how they will implement some aspects of the essential health benefits, which has resulted in state-to-state variability. This issue brief discusses state variability for four "critical" implementation issues: benefit substitution, habilitative services, state-mandated benefits, and pediatric dental care.
By Kathryn A. Paez and Coretta J. Mallery
American Institutes for Research
October 2014
In 2014, an estimated 8 to 11 million people were able to obtain health insurance due to the health care reforms included in the Affordable Care Act (ACA). Now the challenge is make sure people know how to use their health care coverage. The ACA includes funding for navigators to help people choose a health plan and enroll in coverage and requires plans to use plain language to describe benefits. Despite these supports, many people do not understand the implications of deductibles, copays, and coinsurance, and the additional costs of using out-of-network providers. This issue brief summarizes the results of a health literacy survey. It includes a consumer checklist for choosing a health insurance plan, including considerations for individuals with chronic health needs. Note: The Centers for Medicare and Medicaid Services (CMS) website includes Coverage to Care materials in English and Spanish, which help the newly insured learn how to understand their coverage, make appointments, prepare for visits, and more.
News From Our Partners
The Catalyst Center extends our congratulations to Nora Wells, the new Executive Director of Family Voices. We have enjoyed working with Nora in her former role as director of the National Center for Family/Professional Partnerships at Family Voices. We look forward to a continued partnership on behalf of children and youth with special health care needs.
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Events & Announcements
Date: November 13, 2014
Time: 4 pm ET
To Join By Phone Only Dial: 480-297-0022, Access Code: 160-972-179 (For those joining by phone only, the Pin Number is the # key)This webinar, hosted by the HHS Partnership Center and the Centers for Medicare & Medicaid Services, will be presented in English. Participants will learn about the benefits available to immigrant families through the Health Insurance Marketplace and how to get covered during open enrollment, which starts on November 15, 2014 and ends on February 15, 2015. Send questions in advance to ACA101@hhs.gov by 12 noon on November 13. Register for the Health Insurance Options for Immigrant Families webinar.
Date: September 9, 2014
Time: 3:00 - 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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