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
"The next time you're faced with something that's unexpected, unwanted and uncertain, consider that it just may be a gift."
~ Stacey Kramer
A new year brings new challenges, which may or may not be expected. May we all have the courage to look forward and meet the challenges that arise, and may we recognize and be grateful for all the gifts that life has to offer.
Looking forward to working with you all in 2015,
Sally, Meg, Beth, Angela, Edi, Kate, Melissa, Kasey, and Renee
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Featured Article
 How Medicaid for Children Partly Pays for Itself  By Margot Sanger-Katz
The New York Times
January 12, 2015
This article provides a summary of Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts? a report from the National Bureau of Economic Research. The authors reviewed tax records to see if there was a cost-benefit to providing Medicaid to children. They compared the taxes paid by groups that received Medicaid benefits as children and those who did not and found that the group who received Medicaid as children earned more and paid more federal taxes than the group who did not. In addition, those who received more Medicaid benefits over a longer period had even higher earnings, and as a result, paid higher taxes. Additional findings included that children eligible for Medicaid are more likely to attend college and less likely to die before their 28th birthdays. And, when children are eligible for Medicaid, families' medical expenses are reduced, potentially freeing up money for other experiences that promote child development. Limitations of this study include that the tax records were only available up to age 28. Therefore, projections of lifetime earnings were extrapolated based on the available records. |
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IN THIS ISSUE
News Items
Resources
Events and Announcements
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News Items
Florida Illegally Deprived Needy Kids of Healthcare, Judge Rules
By Carol Marbin Miller
The Miami Herald
December 31, 2014
In 2005, pediatricians, dentists, and nine children initiated a lawsuit against Florida's Agency for Health Care Administration, the Department of Children and Families, and the Department of Health. They accused these state agencies of violating the federal Medicaid Act by setting Medicaid reimbursement rates so low that children with limited household income and children with disabilities could not access needed care. Almost 10 years later, U. S. Circuit Judge Adalberto Jordan agreed with the plaintiffs after he found:
- Low Medicaid reimbursement rates exacerbated the provider shortage and resulted in long wait times for appointments or forced families to drive long distances to access care
- High percentages of children enrolled in Medicaid were not receiving dental and other preventive care
- Medicaid benefits for thousands of children were incorrectly terminated due to bureaucratic errors
- Children's Medicaid providers were changed without notifying their families
The Judge's decision gave children's advocates, pediatricians, and families whose children are enrolled in Medicaid cause to celebrate. They hope 2015 brings new awareness of these problems to the Governor and state legislature, who must allocate the necessary funding to improve the Medicaid program.
State: Old Medicaid System for Kids 'No Longer Exists'
By Jim Saunders,
The News Service of Florida
January 8, 2015
The Florida Medicaid system has undergone many changes since 2005 when health providers and children accused the state of violating federal Medicaid laws. In reaction to U.S. Circuit Judge Adalberto Jordan's ruling (see above article) Justin Senior, the Medicaid director, said the Medicaid managed care model, which is now in place, ensures children have access to adequate networks of providers. However, the Florida Chapter of the American Academy of Pediatrics, a participant in the original lawsuit, disputes that the Medicaid managed care plans will lead to an increase in provider reimbursement. The Chapter also reports continued problems within the Medicaid system, including incorrect termination of Medicaid benefits for children.
By Dennis Thompson
U.S. News and World Report
December 24, 2014
Do health care costs decrease and does patient health improve when a primary care physician oversees an individual's care and coordinates with other providers, including specialists? While there is impirical knowledge that the Patient-Centered Medical Home (PCMH) model of care does reduce costs and improve health, a two-year study performed in the High-Risk Children's Clinic at the University of Texas in Houston provides empirical evidence. Children with chronic illnesses were randomly assigned to two groups. One group received care within an enhanced medical home model. A team shared primary care responsibilities and helped families learn to manage their child's acute health problems without going to the emergency department. Specialists were located in the same clinic as the primary care team. The other group received care from their usual doctors and clinics. Children in the medical home had fewer serious illnesses, were less likely to go to the emergency department, and were hospitalized less often than the children who did not receive care in a medical home. Annual costs of care, $16,500 versus $27,000 were also lower for children in the enhanced medical home. It is not clear if this model will be cost effective for children with less complex health needs.
By Elisabeth Wright Burak
A Children's Health Policy Blog: Georgetown University Center for Children and Families
December 19, 2014
The Children's Health Insurance Program (CHIP) is authorized until 2019, but funding was only allocated through September 30, 2015. Last June, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that CHIP funding should continue at least two more years while they assess if Marketplace plans are meeting children's health and developmental needs. The Center for Children and Families is one of 49 national groups that are concerned that Marketplace coverage is less robust than CHIP. They do not want to see CHIP end until Marketplace plans include "child-focused and child-designed coverage" and the family glitch is resolved so that children who lose CHIP coverage do not end up uninsured.
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Resources
The Kaiser Commission on Medicaid and the Uninsured
January 6, 2015
Medicaid provided a foundation for national health care reform. The Affordable Care Act (ACA) builds on Medicaid to expand eligibility for current populations, such as 6- to 19-year-old children, and creates a new pathway to eligibility for childless adults. This fact sheet from the Kaiser Commission on Medicaid the Uninsured provides an overview of the key reforms within the ACA that affect Medicaid eligibility, benefits, access to care, costs, and more.
Medical Debt among Insured Consumers: The Role of Cost Sharing, Transparency, and Consumer Assistance
By Karen Pollitz
Kaiser Family Foundation
January 8, 2015
The Affordable Care Act (ACA) focuses on reducing the number of people without insurance. However, as noted in this article, meeting the health plan deductible and other cost sharing is a financial burden for the majority of individuals who have health insurance and is a leading cause of medical debt. This report examines the lack of transparency that surrounds medical debt, such as separate deductibles for medical services and prescription medications, health plan terminology, and the difficulty in understanding the tidal wave of bills that people receive after costly episodes of care.
News From Our Partners
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Events & Announcements
Date: January 22, 2015
Time: 2:00 to 3:30 pm ET
Date: January 27, 2015
Time: 2:00 to 3:30 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. Or follow the Catalyst Center on Facebook or Twitter.
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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, the National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs, is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U41MC13618, $473,000. This information or content and conclusions are those of the Catalyst Center staff and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. LT Leticia Manning, MPH, MCHB/HRSA Project Officer.
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