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The Catalyst Center team hopes you've successfully made the leap to daylight savings time. Despite the long, cold winter, with multiple disruptions due to excessive amounts of snow (Boston received 105.7 inches and is one of the top 5 snowiest cities for 2014-2015), we've had a productive season. We completed 43 interviews with Title V/CSHCN programs, published a paper in a peer-reviewed journal (forthcoming), given 7 in-person presentations, provided technical assistance to numerous individual callers, and added two new members to our team.
We hope you've safely made it through winter and that you enjoy a smooth transition to a warmer, sunnier season.
Happy Spring,
Sally, Meg, Beth, Angela, Kate, Melissa, Kasey, Yiyang, and Renee.
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Some children and youth with special health care needs and their families may face barriers to getting the coverage and access to care they need, due to race/ethnicity, age, language, or socioeconomic, immigration, or functional status.The Catalyst Center has produced two new resources to help organizations recognize and counter the impacts that health inequities may have on children and youth with special health care needs:
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News from Our Partners
Got Transition, a project of the National Alliance to Advance Adolescent Health, is the national center that works to improve transition from pediatric to adult health care. They have some exciting new resources:
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| Media Highlights
By Robert Pear
The New York Times
March 8, 2015
On March 4, 2015, the U.S. Supreme Court heard oral arguments in King v. Burwell. This challenge to the Affordable Care Act (ACA) says that Healthcare.gov, the federally facilitated Marketplace used by 27 states, is not "an Exchange established by the state." Therefore, people who purchase health insurance through Healthcare.gov should not be eligible for federal subsidies. The judges will consider, among other issues, if allowing states a choice of Marketplace and then penalizing them by withholding federal subsidies for choosing a federally facilitated one, is coercive. A decision is expected in June. In the meantime, states and consumers grapple with the potential implications of a decision in favor of the plaintiffs. Analysts forecast that without federal subsidies to help defray the cost of health insurance, more people will be uninsured. In addition, health insurance premiums will rise, as those who remain insured will most likely be sicker and require more care. Learn more about the King v. Burwell lawsuit at Obamacare, Back at the Supreme Court: Frequently Asked Questions.By Sara Rosenbaum and Kathleen Noonan
Health Affairs Blog
February 19, 2015 Every year, the U.S. Department of Health and Human Services (HHS) publishes regulations for the health insurers who are subject to federal oversight. These regulations include a prohibition on discrimination. Specifically, an insurer whose benefit design " discriminates based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions" is not providing Essential Health Benefits (EHBs). HHS's decision to allow states to select a state-specific health plan as the benchmark for defining EHBs has resulted in state-to-state variability in the scope of health services. For example, providing hearing aids only for children younger than 6 is discriminatory to adults. Other health service restrictions create health care inequities among children, especially children and youth with special health care needs. For example, many health plans refuse to cover habilitative services for children because they attend school and receive these services in an educational setting. The authors of this blog call for the development of a national standard for pediatric coverage to ensure children receive the quality health services they need, regardless of age. By Katie McKellar
Deseret News
February 20, 2015 Having health insurance and household income in excess of a state's income eligibility limit for children's Medicaid does not mean families are immune from medical debt. This is especially true for families raising children with special health care needs. Lawmakers in Utah, looking to bridge the financing gap between private health insurance and families' out-of-pocket costs, are considering a bill titled a " Pilot Program for Assistance for Children with Disabilities and Complex Medical Conditions." If passed, this state legislation would create a Medicaid waiver, which would provide about $6,000 per year to families raising children with complex health needs. Eligibility for the waiver would be based on the severity of the child's diagnoses and impact on the family's finances. The bill was approved by the Senate Health and Human Services committee and is now under consideration in the Utah Senate. CMS (Centers for Medicare and Medicaid Services) Newsroom
February 20, 2015 The Affordable Care Act (ACA) created open enrollment periods during which individuals and families can purchase health insurance through the Marketplaces. Because life happens, the ACA recognizes certain events, such as getting married or divorced, having a baby, or losing a job, when people need special enrollment periods outside of open enrollment. As the April 15 income tax deadline approaches, those who were uninsured in 2014 will have to pay a shared responsibility payment (a tax penalty of $95 per adult or 1% of income, whichever is higher). Individuals who did not purchase health insurance by February 15 of this year will face a higher penalty ($325 per adult or 2% of income, whichever is higher) for the 2015 tax year. The Centers for Medicare and Medicaid Services created a special, time-limited, special enrollment period from March 15 to April 30, 2015 to provide some tax relief for those subject to the individual mandate who remain uninsured and live in states that use Healthcare.gov, the federally facilitated Marketplace. They must attest to having paid the tax penalty for 2014 and must state that they did not understand the implications of the shared responsibility payment until after the recent open enrollment ended. Notes: The second open enrollment period ended on February 15, 2015. The next open enrollment period will begin on November 1, 2015 and last through January 31, 2016. Enrollment in Medicaid and the Children's Health Insurance Program (CHIP) is always open. Find out if you are exempt from the shared responsibility payment.Encuentre exenciones de cobertura medica que se apliquen a su caso. By Tricia Brooks
A Children's Health Policy Blog from the Georgetown Center for Children and Families
February 4, 2015
Medicaid and Children's Health Insurance Program (CHIP) determinations are made in reference to the federal poverty guidelines that are in use at the time of application. On January 22, 2015, the U.S. Department of Health and Human Services published the 2015 federal poverty guidelines. States have some flexibility about when to implement the new guidelines, but most states make the change by April 1, 2015. Eligibility determinations for Qualified Health Plans (QHPs) sold in the Marketplaces will continue to be made using the 2014 federal poverty levels (FPL) because they were in effect on November 15, 2014, the first day of the most recent open enrollment period. The two income standards will not be a problem in states where the state-based Marketplaces are integrated with Medicaid eligibility and enrollment and in states where the federally facilitated Marketplace makes Medicaid determinations. In the remaining states where the Marketplace and Medicaid systems are separate, the misalignment of the two income standards means some individuals will be caught in an insurance gap. By the 2015 FPLs, income will be too low for Marketplace coverage and too high for Medicaid .
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Children's Health Insurance Program: CHIP and Exchanges Comparability Research Guide
Children's Hospital Association
February 2015
In order for the Children's Health Insurance Program (CHIP) to continue past September of this year, Congress must reauthorize funding. Even if CHIP receives additional funding, with plan approval from the Secretary of the U.S. Department of Health and Human Services, states can opt to transition children from CHIP to Qualified Health Plans (QHPs) in the Marketplaces. This brief from the Children's Hospital Association provides an overview of research about the differences between QHPs and CHIP, a public health benefit program designed specifically for children.
Autism and Families' Financial Burden: The Association with Health Insurance Coverage (Abstract)
By Susan L. Parish, Kathleen C. Thomas, Christianna S. Williams, and Morgan K. Crossman
American Journal on Intellectual and Developmental Disabilities
March 2015
Using data from the Medical Expenditure Panel Survey, these authors examined family financial burden for families raising children with autism spectrum disorders. Out-of-pocket costs related to the child's health care needs averaged almost $10 per $1,000 of income. Families whose children had private insurance were more likely to have out-of-pocket costs than families whose children were enrolled in public health insurance programs.
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Announcements & Events
Webinar: Excelling on CAHPS (Consumer Assessment of Healthcare Providers and Systems): Lessons from Top-Performing Medicaid and CHIP Health Plans
Date: March 17, 2015
Time: 1 - 2 pm ET
Hosted by the Agency for Healthcare Research and Quality (AHRQ), this webinar will highlight Medicaid and the Children's Health Insurance Programs (CHIP) in Minnesota and Alabama, which have achieved high patient experience scores in the following areas: access to care; communication with doctors; member information and customer service; and overall health plan ratings.
Webinar Series: Pushing the Boundaries: Emerging Innovations in Payment and Delivery System Reform
AcademyHealth is hosting this series of three webinars about new models of payment reform that promote cost-effective, high-value health care.
Note: There is no registration fee for this webinar series, but you must have or create an AcademyHealth account (also free) before you can register for the webinar.
Webinar I: Treating the Whole Patient: Addressing Social Determinants of Health
Date: March 19, 2015
Time: 2:00 to 3:30 pm ET
This first webinar is an opportunity to learn about payment reforms that align delivery of health care services with other social supports. (Visit the webinar series page to register)
Webinar Series: Transition of PSHCNs (Patients with Special Health Care Needs) to Adult Medical Care
The New York - Mid-Atlantic Consortium for Genetic and Newborn Screening Services (NYMAC) is hosting this series of 7 webinars, which provide an opportunity for providers, youth, and families to develop an understanding of transition for youth with special health care needs and their roles and in that process.
Webinar 4: Insurance Concerns and Solutions: How does the ACA Impact this Population? (Register for the series to participate)
Date: March 25, 2015
Time: 1:00 pm ET
Webinar Series: Pediatric Care Coordination: Beyond Policy, Practice, and Implementation
The National Center for Medical Home Implementation is hosting this three-webinar series focusing on the benefits of patient- and family-centered care coordination for children, families, and providers.
Webinar 1: Beyond Policy: Implementing Care Coordination in Practice
Date: March 30, 2015
Time: 1:00 pm ET
This first webinar will define care coordination, identify tools and resources, and provide strategies for implementing care coordination.
Register for the Beyond Policy: Implementing Care Coordination in Practice webinar.
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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. For more information, please visit us at www.catalystctr.org or contact Meg Comeau, Co-Principal Investigator, at mcomeau@bu.edu.
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