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
"Unless someone like you cares a whole awful lot, nothing is going to get better.
It's not."
~ Dr. Seuss
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Featured Article
 Medical Debt Still a Problem under Health Law - Despite Protections  By Shefali Luthra
Kaiser Health News
February 4, 2015
The Affordable Care Act's (ACA) consumer protections, such as prohibiting denials based on pre-existing conditions and the elimination of annual and lifetime limits, help ensure that families won't lose their homes because someone develops a chronic health need or is born with one. However, the law does little to protect against the financial burden families incur due to cost sharing. This article profiles the story of a Maine family whose son was born with a congenital heart defect and asthma. Even though they had health insurance, they incurred thousands of dollars of medical debt due to the out-of-pocket costs for their son's care. This family is not alone. As cited in this article, almost 60% of the 64 million people with medical debt are insured. Even though the ACA caps the annual out-of-pocket maximum individuals and families have to pay, often just meeting the deductible is a financial burden. Narrow networks also contribute to medical debt, as costs for using out-of-network providers, as well as the cost of the insurance premium, do not count towards the deductible or the out-of-pocket maximum. In addition to worrying about making ends meet, families are also concerned that providers and hospitals will garnish their wages or claim other assets in an effort to be paid. The federal Consumer Finance Protection Bureau is at least a year away from providing rules about medical debt collection. |
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IN THIS ISSUE
News Items
Resources
Events and Announcements
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News Items
Save the Children's Insurance
By Hillary Clinton and Bill Frist
The New York Times
February 12, 2015
The Children's Health Insurance Program (CHIP) is authorized through 2019, but funding ends in September of this year. In this opinion piece, former legislators Hillary Clinton and Bill Frist make a bipartisan appeal for continuing the CHIP program by reauthorizing four more years of funding. Clinton and Frist, who are both parents and grandparents, remain committed to "supporting the health of children and their families." They note that since CHIP was created in 1997, the number of uninsured children has declined significantly, children miss fewer school days, and childhood mortality has decreased. Despite the health care reforms in the Affordable Care Act (ACA), there is a continued need for CHIP. The family glitch precludes some families from receiving premium tax credits to purchase Marketplace coverage. This is because the cost of employee-only insurance is considered affordable when the employee's share of the premium is less than 9.56% of household income, even if the cost of family coverage exceeds that affordability standard. It is estimated that two million children will lose coverage if CHIP is not reauthorized. Without coverage, children may not receive preventive services, which might exacerbate existing conditions or predicate a need for more costly care for health conditions that could have been avoided, which, in the long run, increases health care costs for everyone.
New Children's Health Insurance Program Bills Introduced
By Elisabeth Wright Burak
A Children's Health Policy Blog from the Center for Children and Families
February 13, 2015
On February 12, two pieces of federal legislation were introduced - one in the Senate, the other in the House of Representatives. Protecting & Retaining Our Children's Health Insurance Program Act of 2015 (S.522) and the CHIP (Children's Health Insurance Program) Extension and Improvement Act of 2015 (H.R.919) support continued funding for CHIP and the 23% increased match through 2019. Both bills also support the continuation of performance bonuses to states who adopt specific best practices to increase enrollment and retention, although each bill includes different criteria that constitute a best practice and the number of criteria a state would have to meet. In addition, the House bill would:
- Make Express Lane Eligibility (ELE) for children (use of eligibility information for other public programs to streamline eligibility and enrollment in Medicaid or CHIP) permanent and extend ELE and 12-month continuous eligibility to adults
- Simplify Medicaid eligibility for youth who age out of foster care, and guarantee the benefit, regardless of state of residence
- Adopt a standard Medicaid definition for Therapeutic Foster Care (see Portman Helps Introduce Foster Care Services Act below for more on Therapeutic Foster Care)
- Extend the Affordable Care Act's (ACA) primary care rate increase, which expired in December 2014, through 2019
The Georgetown University Center for Children and Families has prepared a comprehensive side-by-side comparison of the Senate and House Bills to Extend the Children's Health Insurance Program (CHIP) - 2015.
By Rick Boyte
Health Affairs Blog
February 2, 2015
The Maternal and Child Health Bureau (MCHB) uses a broad definition to describe children with special health care needs (CSHCN). While there is no standard definition for the subgroup of CSHCN who are medically complex, there is an increased focus on their impact not only on the pediatric health care system, but also on unmet need among the children and their families. The authors of an article published in Health Affairs titled Inequities in Health Care Needs for Children with Medical Complexity found that unmet need among children with medical complexity is independent of race, ethnicity, language spoken at home, family income, and type of health insurance. In this blog, Rick Boyte, a critical care and palliative care physician, comments that children with the most complex health needs often defy the odds, survive, and experience good quality of life. At the same time, the fragmented health care system does not support families' needs for continued social and financial assistance, such as respite or enhanced care coordination. In addition, the same physicians who took every measure to ensure a child's survival assume the child has poor quality of life. They now counsel families to limit continued critical care. These misconceptions and biases contribute to health care inequities among this subgroup of children.
Staff Report
Morrow County Sentinel
February 12, 2015
In an effort to improve the quality of Therapeutic Foster Care services for children and youth with serious medical and behavioral health needs, Senators Portman and Baldwin introduced the Family-Based Foster Care Services Act (S.429) on February 10. On the same day, Representatives Delauro and Rosa introduced a companion bill "to amend Title XIX of the Social Security Act to provide a standard definition of therapeutic foster care services in Medicaid" (H.R.835). If passed, this federal legislation would increase access and improve the quality of Therapeutic Foster Care services by creating a standard Medicaid definition. Therapeutic Foster Care Services train foster families, kinship, and biological families to care for children and youth with complex medical, mental, and behavioral health needs. The goal is to keep children and youth in stable home environments, provide needed therapy, and avoid overmedication.
Bid to Force Higher Medicaid Payments Reaches Supreme Court By Melanie Zanona, CQ Roll CallReprinted in Washington Health Policy Week in ReviewThe Commonwealth FundJanuary 20, 2015Do health care providers have the right to sue their state Medicaid program for inadequately reimbursing for services? In January, the U.S. Supreme Court heard oral arguments about a lawsuit filed by health providers against the Idaho Department of Health and Welfare. This case has worked its way through the Idaho district court and 9th U.S. Circuit Court of Appeals since 2011. At issue is the state's low reimbursement rate for providers that not only affects the sustainability of their practices, but also affects individuals with disabilities and children's access to health care services. The providers claim that the state is in violation of federal Medicaid law because Medicaid recipients cannot access services on a par with others in their geographic area. The state says that only federal agencies can decide if a state is in violation of Medicaid rules. A decision in favor of the providers could result in higher reimbursement rates. If the Court decides for the state, moving forward, private groups will not be able to sue their states. A decision is expected in June.
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Resources
By the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance
December 2014
The Fostering Connections to Success Act of 2008 and the Affordable Care Act (ACA) both extend Medicaid eligibility for youth in the foster care system past the age of 18. This Practice Bulletin from the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA) compares the two laws. The Fostering Connections Act provides states with an option to extend Title IV-E child welfare services to foster, adoption, and guardianship youth to age 21 if they meet certain educational or work criteria. These services include the extension of Medicaid eligibility to age 21, a benefit the youth retains even if he or she moves to another state. The ACA includes a mandatory extension of Medicaid to age 26 for youth who age out of foster care, but only for youth who remain in the same state. Under this provision of the ACA, states may opt to provide Medicaid to youth who age out of foster care in one state and move to another. Note: If the House version of the CHIP Extension and Improvement Act of 2015 passes, all states would have to provide Medicaid to youth who age out of foster care up to age 26, regardless of state of residence. As of October 2014, twelve states have opted to extend Medicaid to youth who aged out of foster care in another state.
Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015
By Tricia Brooks, Joe Touschner, Samantha Artiga, Jessica Stephens, and Alexandra Gates
The Kaiser Commission on Medicaid and the Uninsured
January 20, 2015
The 13th annual report from the Kaiser Commission on Medicaid and the Uninsured provides up-to-date information on state policies regarding Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal, premiums, and cost-sharing. The report highlights states' efforts to expand coverage for children. Nearly all states have increased income eligibility to 200% of the federal poverty level or higher. Twenty-one states eliminated the waiting period for CHIP, and 28 states eliminated the 5-year waiting period for Medicaid for lawfully residing immigrant children. In addition, the Affordable Care Act (ACA) further protects children's coverage by barring states from restricting Medicaid and CHIP eligibility or services through 2019, although states can expand eligibility. (See the Events section below to access the recorded web briefing about this report.)
News From Our Partners
Nora Wells and Bonnie Strickland Recognized for their Leadership on Behalf of Families Raising Children and Youth with Special Health Care Needs
At this year's AMCHP (Association of Maternal and Child Health Programs) conference (January 24 to January 27), Nora Wells and Bonnie Strickland received well-deserved leadership awards. Members of the Catalyst Center team were there to clap, cheer, and congratulate them. Nora, the Executive Director of Family Voices, received the Merle McPherson Leadership Award for her efforts to advance family-professional partnerships. Bonnie, the former Director of the Division of Services for Children with Special Health Care Needs at the Maternal and Child Health Bureau, received the Vince Hutchins Leadership Award for leading the Bureau's Division of Children and Youth with Special Health Needs through the implementation of the six core outcomes and the National Surveys around Children's Health. Read more about these two exceptional women.
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Events & Announcements
Webinar: Primary Care Integration into Behavioral Health Settings: Supporting Individuals with Serious Mental Illness
Date: February 26, 2015
Time: 1:00 to 2:00 pm ET
Webinar: The Promise and Pitfalls of State-Based Payment Reform Date: February 27, 2015Time: 1:00 to 2:30 pm ETJoin this webinar, hosted by the National Academy for State Health Policy (NASHP), to learn about state-based, multi-payer payment reform initiatives that work towards lowering costs, improving health outcomes, and enhancing quality of care. Speakers will discuss payment reform models in Arkansas and Vermont. Register for the Promise and Pitfalls of State-Based Payment Reform webinar. Webinar: Using Dental Services and Benefits to Motivate Families to Enroll in Medicaid and CHIP Date: February 27, 2015Time: 2:00 to 3:30 pm ETFebruary is National Children's Dental Health Month. To promote this event and the importance of oral health services for children, the Connecting Kids to Coverage Campaign is hosting this webinar. Participants will learn about the dental services available through Medicaid and the Children's Health Insurance Program (CHIP), outreach and enrollment tips, and resources for families. Register for the Using Dental Services and Benefits to Motivate Families to Enroll in Medicaid and CHIP webinar. Note: Enrollment is always open for Medicaid and CHIP.
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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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