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
"People ask me what I do in winter when there's no baseball. I'll tell you what I do. I stare out the window and wait for spring."
~ Rogers Hornsby
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Featured Article
By Shaun Heasley
Disability Scoop
March 31, 2015
Do health care providers have the right to sue their state Medicaid program for inadequately reimbursing for services? On March 31, the U.S. Supreme Court ruled they do not. In 2011, The Exceptional Child Center, Inc. and three other Medicaid providers filed a lawsuit against the Idaho Department of Health and Welfare. The four organizations alleged the state was in violation of federal Medicaid law because the low provider reimbursement rate negatively impacted access to services for individuals with disabilities, including children with special health care needs. In January of this year, the U.S. Supreme Court heard oral arguments in Armstrong v Exceptional Child Center, Inc. On March 31, the Court ruled against the providers, stating that only the U.S. Secretary of Health and Human Services can enforce Medicaid law.
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 IN THIS ISSUE
Featured Article
News
Resources
Events and Announcements
In Case You Missed It...
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News Items
Vermont Doctors Say There's Another Reason to Boost Medicaid Rates 
By Peter Hirschfeld
VPR: Vermont's NPR News Source
March 4, 2015
In an effort to reduce the Medicaid cost shift (increases in private insurance costs and premiums to cover the reduced per dollar reimbursement rate for services provided to individuals enrolled in Medicaid), Vermont Governor Shumlin proposes to use payroll taxes to increase the Medicaid reimbursement rate. He has the support of physicians who find it increasingly difficult to sustain their practices on 60% of the cost of services provided to Medicaid enrollees. Doctors also worry that the low reimbursement rates will cause barriers in access to care. Vermont businesses, looking to reduce health insurance costs, support the proposal as well.
Health Affairs Web First: Without CHIP, Sharply Higher Insurance Costs For Many Low-Income Families
By Lucy Larner
Health Affairs Blog
March 26, 2015
Unless Congress reauthorizes funding for the Children's Health Insurance Program (CHIP) by September 30, 2015, separate CHIP programs will end. Children will move to Marketplace coverage, or, if their families have access to employer-sponsored insurance, they will be added to those plans. This blog explains the increased costs families will incur if they add dependent coverage to their employer-sponsored plans. And if the additional costs exceed 8.05% of household income, families can claim a hardship exemption and will not incur a tax penalty for not having insurance. But the bottom line will be more children will lack both insurance and access to needed health services.
Charlie Biggs and Seven Co-Signers
The Missoulian
March 31, 2015
Montana's Medicaid Autism Waiver for children expires in December 2016. It provides comprehensive services to children with Autism Spectrum Disorders, but because it's a waiver, the number of slots is limited to 55 children. Recognizing the positive difference the services have made in the children's development, the Governor's 2017 budget included funding for autism services in the Medicaid state plan. This would replace the waiver and all children enrolled in Medicaid who needed autism services could receive them, in accordance with the federally mandated Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Unfortunately, the proposed funding was reduced by one-third. This article, written by advocates, urges the Montana State Senate to restore the full amount of funding.
By Lenny Bernstein
The Washington Post
April 1, 2015
This article reports on the large number of children, age six and younger, who take psychotropic medications to manage attention deficit hyperactivity disorder (ADHD), despite the American Academy of Pediatrics (AAP) recommendation that behavioral therapy is preferred for young children. Seventy-four percent of older children take ADHD medications, and only 44% received behavioral therapy. A combination of medication and therapy is preferred. There is also wide variability in the use of medications and behavioral therapy across the states, perhaps reflecting differences in the availability of behavioral health services.
Will the Affordable Care Act Eliminate Health Disparities? University of Chicago Medical CenterEurekAlert!April 1, 2015The Massachusetts health care reform law, passed in 2006, was the model for the Affordable Care Act (ACA). One of the primary goals of both laws is to reduce the number of people without health insurance. As found in Massachusetts, reducing the number of uninsured helped reduce disparities in coverage for racial minorities and individuals with lower socio-economic status. But inequities in quality of care and health outcomes persist. A focus on improved doctor and patient communication, financial incentives, and additional supports for safety-net providers who care for the most vulnerable populations may help close these gaps in Massachusetts and nationwide.
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Resources
By Michael C. Lu, Cassie B. Lauver, Christopher Dykton, Michael D. Kogan, Michele H. Lawler, Lauren Raskin-Ramos, Kathy Watters, and Lee A. Wilson
Maternal and Child Health Journal
February 18, 2015
Since 1935, the Title V program has worked to ensure the health and well-being of mothers, children, and youth, including children and youth with special health care needs. The program has gone through several transformations and in response to "rapid scientific advancements as well as changing health and political environments," Title V is once again undergoing transformation. This journal article provides an overview of the new mission, vision, and public health framework for Title V programs that will reduce reporting burden for states, increase flexibility and accountability, and strengthen partnerships.
A New Performance Measurement System for Maternal and Child Health in the United States
By Michael D. Kogan, Christopher Dykton, Ashley H. Hirai, Bonnie B. Strickland, Christina D. Bethell, Iran Naqvi, Carlos E. Cano, Sheri L. Downing-Futrell, and Michael C. Lu
Maternal and Child Health Journal
April 1, 2015
This journal article explains the new performance measurement system for Title V programs and provides information about the national outcome measures, the national performance measures and evidence-based/informed strategies states can use to document measureable progress.
News From Our Partners
New MCH Financing Lecture from National MCH Workforce Development Center
The National MCH Workforce Development Center has posted a MCH Financing lecture for Title V programs and interested others who want to learn more about Medicaid, the Children's Health Insurance Program (CHIP), the Health Insurance Marketplaces and how these three programs intersect. Download the MCH Lecture.
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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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