Catalyst Center Coverage
Roundup of news related to financing of care for children and youth with special health care needs |
|
|
|
|
|
|
|
Quote of the Week
"Feeling gratitude and not expressing it is like wrapping a present and not giving it."
~ William Arthur Ward
The Catalyst Center extends its thanks to our stakeholders, national advisors, project officers, and others too numerous to mention who have provided input, advice, and suggestions for improving our work.
Wishing you all a Happy Thanksgiving,
Sally, Meg, Angela, Beth, Edi, Kate, Melissa, and Kasey
|
|
Featured Article
Eligibility for subsidized marketplace coverage (advanced premium tax credits and cost-sharing reductions) depends on both family size and income in relation to the federal poverty level (FPL) and on family access to affordable employer-sponsored health insurance. As Tricia Brooks of the Georgetown Center for Children and Families explains in this article, the "family glitch" is a result of how the employee's contribution toward employer insurance is defined. The Obama administration did not want large employers to stop offering health insurance to their employees. In order to find a middle ground that would make it cost effective for large employers to keep offering insurance rather than pay the fee for not complying with the employer mandate, the employee's contribution is based on self-only coverage. As a result, even though family coverage is more expensive and generally exceeds the 9.5% affordability standard, an employee's dependents are not eligible to purchase subsidized marketplace coverage. This phenomenon has been dubbed the "family glitch." In opposition to one of the primary goals of the Affordable Care Act (ACA), which was to make health insurance more affordable, many lower income families are faced with paying an increased percentage of their income for health insurance. Or, if the cost of insurance exceeds 8% of household income, the family members are exempt from the individual mandate. This means they will not pay a tax penalty for not having insurance, but it also means they are more likely to be uninsured. While the majority of children in families with limited household income are eligible for Medicaid or the Children's Health Insurance Program (CHIP), it is estimated that almost half a million children are caught in the glitch. There are concerns even more children (estimates range from 1.9 to 5.3 million) will be caught in the glitch and become uninsured if funding for CHIP does not continue past September 2015. In an effort to fix the glitch, Minnesota Senator Al Franken has introduced the Family Coverage Act. If passed, the secretaries of the departments of Health and Human Services and the Treasury could use their administrative authority to redefine the employee's contribution toward employer-sponsored insurance to include the cost of family coverage. |
|
|
 IN THIS ISSUE
News Items
Resources
Events and Announcements
In Case You Missed It...
|
|
|
|
|
News Items
Millions of Medicaid Kids Missing Regular Checkups 
By Phil Galewitz
Kaiser Health News
November 13, 2014
Georgetown Health Policy Institute's Center for Children and Families
Many children enrolled in Medicaid are not receiving the "ounce of prevention" (services) that will avoid a "pound of cure." Children enrolled in Medicaid are entitled to the federally mandated EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit that guarantees they receive well-child visits that include physical exams, immunizations, vision and hearing tests, dental checkups and other age-appropriate services. These services are free. However, provider shortages, low Medicaid reimbursement rates, and a lack of awareness about the importance of regular checkups are barriers, and children often do not receive well-child exams. This means preventable or minor health problems may go undetected and become major health problems that are more expensive to treat later on. Since 2006, the percent of children receiving preventive exams has increased from 56% to 63%. But Iowa and California are the only states that have exceeded the U.S. Department of Health and Human Services (HHS) goal of 80%. Want to know how your state did? This article includes a state-by-state listing of the percent of children who receive regular screenings.
SC Medicaid Needs $30 Million More for Autism Services Next Year
By Lauren Sausser
The Post and Courier
November 16, 2014
In July, the Centers for Medicare and Medicaid Services (CMS) released Clarification of Medicaid Coverage of Services to Children with Autism, an informational bulletin about state options for providing services to individuals with autism spectrum disorders (ASDs) who are eligible for Medicaid. Having guidance for providing autism services through Medicaid is good, but there is still the problem of not enough providers. Currently, South Carolina provides autism services to 625 children through a Medicaid waiver, and there are more than 1,000 children on a waiting list. Moving forward, states can provide autism services as part of the federally mandated EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit. This will negate the need for a waiver for children and the waiting list. Christian Soura, the new Medicaid director in South Carolina, will ask the legislature for an additional $30 million to serve an estimated 9,700 children who need autism services. If approved, some of the additional funding will be used to increase the Medicaid reimbursement rate for autism therapists.
By Rebecca Elliott
Disability Scoop
November 12, 2014
Oral health care is critical to the overall health and wellness of children with special health care needs (CSHCN), whose underlying conditions can put them at increased risk for oral health problems. But many parents forego dental visits for their CSHCN because their children's behaviors make it difficult for them to tolerate dental exams without restraints, sedation, or anesthesia. Thanks to David Tesini, a pediatric dentist in Massachusetts, this is no longer a problem for Texas children with autism spectrum disorders and other special health care needs. The D-Termined program, developed by Tesini 10 years ago, uses the principles of applied behavioral analysis (ABA) to break down a visit to the dentist into a series of small steps, such as sitting in the dentist's chair for 10 seconds, then sitting with the chair reclined, etc. Each successive visit builds on the preceding steps until the child can sit through a dental procedure.
Press Release from CMS.gov
November 12, 2014
Compared to all children, American Indian and Alaskan Native children have higher rates of uninsurance. The Centers for Medicare and Medicaid Services (CMS) awarded grants totaling $3.9 million to Indian Health Services, tribes, tribal organizations, and urban Indian organizations located in Alaska, Arizona, California, Mississippi, Montana, New Mexico, and Oklahoma. This funding is part of an effort to boost outreach efforts, enroll eligible American Indian and Alaskan Native children in Medicaid and the Children's Health Insurance Program (CHIP), and ensure access to quality care. Several states will focus on enrolling teens. All states will support families in understanding the application process. Read the Summary of Connecting Kids to Coverage: American Indian and Alaska Native Outreach and Enrollment Grant Awards.
By Elise Hu
National Public Radio: All Tech Considered
November 10,2014
The Affordable Care Act's (ACA) second open enrollment period, which began on November 15, 2014 and will continue through February 15, 2015, is off to a much better start than the first open enrollment period. Healthcare.gov is not only functional - it's improved! The site loads faster and a new system reduces wait times. This is important because the 8 million people who enrolled during the first open enrollment period will also be accessing the site to reenroll in their current plan or to shop for new coverage for 2015. Customers can also figuratively "try on" a health plan before they buy. A window-shopping feature lets shoppers check eligibility for tax credits to get an idea of their actual cost. Those who enroll or reenroll by December 15, 2014 will have coverage starting January 1, 2015. A Quick Guide to the Marketplace provides more information, dates, and deadlines.
|
 |
Resources
By Sonya Schwartz, Alisa Chester, Steven Lopez, and Samantha Vargas Poppe
Georgetown University's Center for Children and Families and National Council of La Raza
November 2014
Using data from the 2011 and 2013 American Community Survey, researchers from the Georgetown Center for Children and Families and the National Council of La Raza examined the status of health insurance among Hispanic children. Since 2009, the number of Hispanic children has increased to 24% of the total child population. While insurance rates for Hispanic children have also increased, nationally 11.5% of Hispanic children continue to be uninsured, which is significantly higher than the 7.1% of all children without health insurance. And, while 93% of Hispanic children are citizens, two-thirds are eligible for, but unenrolled in, Medicaid and the Children's Health Insurance Program (CHIP). Arizona, Florida, Georgia, and Texas have the highest rates of uninsured Hispanic children. California also has a high rate of uninsured Hispanic children, but along with New York and New Jersey, the rate is lower than the national average. Hispanic children are more likely to be uninsured if their parents are not citizens and if they do not speak English, or have limited English proficiency. Creating culturally appropriate materials in Spanish and providing enrollment assistance to families in their communities will help remove barriers to children's coverage. In addition, if family income is too high for Medicaid or CHIP, citizen children are eligible for federal subsidies that make marketplace plans more affordable. Expanding Medicaid will also bring children into coverage along with eligible parents.
By Claire McAndrew
Families USA
November 2014
Prior to the passage of the Affordable Care Act (ACA), narrow networks were one of many ways that health insurers could control health care costs. In a post-ACA world, narrow networks play an increasingly important role, as some former cost control "tools" are no longer allowed. For example, insurers can no longer deny coverage to individuals with pre-existing conditions, charge more based on health status, or impose annual and lifetime limits on the dollar amount of care they provide. This issue brief from Families USA highlights the network adequacy protections some states have implemented to ensure consumers receive the right care at the right time with a minimum amount of travel. For example, Medicaid Managed Care plans in New Jersey must have contracts with inpatient psychiatric facilities that serve children and youth and with hospitals that provide tertiary pediatric services. Barring a contract, the plans must have arrangements so families can obtain these services for children at in-network costs. This ensures networks include adequate types of providers. In addition, a state law in California helps ensure continuity of care by allowing children up to age three to continue to see a provider who has left the plan's network for up to one year with the same cost-sharing as for in-network providers.
News From Our Partners
|
|
|
Events & Announcements
Date: Thursday, December 4, 2014
Time: 11:45 am to 1:30 pm ET
Date: Tuesday, December 2, 2014
Time: 9:00 am to 3:30pm ET
|
|
|
|
|
 |
|
Want more news?
To view more articles from past issues of Catalyst Center Coverage, visit the Catalyst Center website. Or follow the Catalyst Center on Facebook or Twitter.
|
|
|
|
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. LT Leticia Manning, MPH, 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.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
