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
"Today me will live in the moment unless it's unpleasant in which case, me will eat a cookie."
~ Cookie Monster
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Featured Article
 Moving In Reverse? Potential Coverage Impacts for Children of King v. Burwell, Medicaid and CHIP Eligibility Changes  By Lisa Dubay, Matthew Buettgens, and Genevieve Kenney
Health Affairs Blog
March 17, 2015
Since the 1980s, the expansion of Medicaid, the creation of the Children's Health Insurance Program (CHIP), the CHIP reauthorization in 2009, and the passage of the Affordable Care Act (ACA) have worked to bring the number of uninsured children to an all-time low. Unfortunately, these gains for children are in jeopardy. Without reauthorization of funding, the CHIP program will not continue past September 30, 2015. Children in separate CHIP programs will move into Marketplace plans, which have higher costs and less robust benefits. Proposed CHIP legislation includes language to roll back the ACA's Maintenance of Effort provision for CHIP. This means states could reduce CHIP eligibility to 138% of the federal poverty level (FPL), again, moving children from CHIP to Marketplace plans. In addition, the U.S. Supreme Court is considering King v. Burwell, which challenges the constitutionality of providing tax credits to purchase health plans sold through the federally facilitated Marketplace, which operates in 34 states. This article provides estimates of the number of children who will lose their health insurance and the financial impact on families. Children's Coverage: What Lies Ahead? an interactive tool created by the Urban Institute, accompanies this article. It projects the uninsurance rates for children in 2016 in states with state-based and federally facilitated Marketplaces and by household income if:- States with federally facilitated Marketplaces can no longer provide tax credits
- CHIP is not refunded
- States roll back CHIP eligibility to 138% FPL
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IN THIS ISSUE
Featured Article
News
Resources
Events and Announcements
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News Items
On 5th Anniversary of Health Care Law, No End to Debate
By Ricardo Alonso-Zaldivar
The Washington Times
March 22, 2015
March 23, 2015 marked the 5th anniversary of the Affordable Care Act (ACA). What's changed in the 5 years since the national health care reform law was passed and what's stayed the same? Here's a partial list:
- An estimated 9.7 to 16.4 million adult U.S. residents have gained health coverage.
- Health insurers can't deny coverage to individuals with pre-existing conditions or charge more based on health status alone. Note: insurers can charge smokers more.
- Health insurance is not optional. Unless an individual is exempt from the individual mandate, he or she must enroll in coverage or pay a fine.
- The "rite of passage" for young adults no longer includes being dropped from their parents' health plan.
- The U.S. Supreme Court is still hearing constitutional challenges to the ACA. Learn why King v. Burwell is so important.
House Passes 2 Year CHIP Extension Included in 'SGR' Compromise Deal
By Elisabeth Wright Burak
A Children's Health Policy Blog from the Center for Children and Families
March 27, 2015
Funding for the Children's Health Insurance Program (CHIP) ends in September of this year. Various bills to reauthorize funding have been introduced in the U.S. Senate and House of Representatives, but there has been no progress to date. In the meantime, Speaker John Boehner and Minority Leader Nancy Pelosi developed compromise legislation ( H.R. 2, the Medicare Access and CHIP Reauthorization Act). On March 26, the House voted on and passed this bill. If it also passes in the Senate, H.R. 2 will repeal the physician payment formula in Medicare, known as the SGR (Sustainable Growth Rate) and more commonly referred to as the " doc fix." This bill would also extend CHIP funding for two years without offsetting the costs with cuts to Medicaid or the Affordable Care Act (ACA). In addition, it would preserve the ACA's 23% increased match rate for CHIP; maintain Medicaid eligibility for 6- to 19- year-olds up to 138% of the federal poverty level; extend Express Lane Eligibility (ELE) and Maintenance of Effort through 2017 and 2019 respectively; and include $40 million for the Children's Health Insurance Program Reauthorization Act outreach and enrollment grants. This legislation would also extend funding for the Family-to-Family Health Information Centers and the Maternal, Infant, and Early Childhood Home Visiting Programs. The Senate will take up this legislation when they return from recess on April 13.
By Jay Hancock
Kaiser Health News
March 26, 2015
In the last three years, many employers have reduced insurance costs by offering high-deductible health plans (also known as consumer-directed health plans). But, in the long run, what will be the true cost? A study of consumer-directed plans found that many people reduce or forgo care because they cannot afford the deductible. And, unaware that there is little or no cost for preventive care, many skip screenings and yearly checkups. The concern is that health problems that could be identified and treated early on will go untreated, resulting in more serious medical problems that will also be more costly to treat.
California Healthline
March 30, 2015
In 2011, the Medicaid costs for psychiatric medications in California, Florida, Illinois, New York, and Texas, totaled 39% of all Medicaid expenditures for these types of drugs. This article, based on Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-of-Care Concerns, a March 2015 report from the Inspector General at the U.S. Department of Health and Human Services, is based on record reviews of children enrolled in Medicaid in 2011, including children in foster care. Prescriptions for "non-FDA-approved treatments" contributed to the high costs incurred by these five states. The report also notes that more than half the children were not adequately monitored, many were prescribed incorrect medications, and more than one-third were prescribed too many medications. Recommendations for improving the care of children and controlling costs included proper monitoring, compliance with "medically accepted standards" for use, and better tracking of psychiatric prescriptions for children.
Health Care Reform Opens Door to Allow US Colleges to Drop Student Health Insurance By Donna Gordon Blankinship
Associated Press
March 28, 2015As reported in this article, an increasing number of colleges and universities are no longer offering student health plans. This trend is in response to the Affordable Care Act (ACA), which provides more options for coverage. Prior to national health care reform, many health insurers dropped young adult children from their parents' health policies when they turned 18 or 21. Now young adults can stay on their parent's health plans until they turn 26. And, if staying on a parent's plan is not an option, depending on income, students can enroll in Medicaid (in expansion states) at no cost, or can receive subsidies to purchase insurance through the Marketplace. While this reduces the overall cost of post-secondary education, there are concerns about how it will affect student health as Marketplace plans do not always provide the same level of health services as student plans did. And, there will be students who remain uninsured because, even with subsidies, Marketplace plans are unaffordable.
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Resources
By Amy Fine and Patsy Hampton
Lucile Packard Foundation for Children's Health
March 19, 2015
Based on a literature review and interviews with stakeholders, including national experts on life course theory, families raising children with special health care needs (CSHCN), and "exemplary practices and programs," the authors identified six key themes that form a framework for implementing a Life Course approach to the medical care of CSHCN. These include:
- Early identification and timely interventions for all children in the pediatric practice
- Identification of critical transition points
- A focus on family
- Links to community supports and services
- Data collection to ensure CSHCN within the practice receive the same care and experience of care as children without special health care needs
- Continuous monitoring of functional status to keep current with changing needs for services and supports
Potential action steps, guidance, and toolkits are provided for each of these six core areas.
News From Our Partners
New Resources to Promote Family-Centered Care, Involvement
The Division of MCH Workforce Development has new resources to promote family-centered care and family involvement. As of March 2015, the MCH Navigator includes a Family-Centered Care training brief. There are resources to help MCH professionals and others develop knowledge and skills to include families in program design, delivery of services, and evaluations. The new Family Involvement page provides examples from MCH programs that support family leadership development and involve families as partners.
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Events & Announcements
This webinar, hosted by the National Academy for State Health Policy (NASHP) is an opportunity to learn about federal programs to advance health equity; incorporate health equity into state initiatives; and to align federal and state efforts to support payment and infrastructure to reduce health disparities. State leaders from Ohio and Louisiana will provide examples of how their states support health equity. Register for Building an Equitable Health Care Delivery System: Federal and State Strategies webinar.
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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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