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
"'For a while' is a phrase whose length can't be measured. At least by the person who's waiting."
~ Haruki Murakami, South of the Border, West of the Sun
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Featured Article
By Wallis Watkins
New Orleans Public Radio
April 20, 2015
Medicaid waivers provide pathways to coverage for individuals with complex health needs whose household income is too high for Medicaid and/or who require additional services that are not available to everyone enrolled in Medicaid. Depending on the type of waiver, these extra services might include skilled nursing, respite, environmental adaptations, and specialized medical equipment and supplies. These services and supports make it possible for individuals to remain at home, rather than in a hospital or other long-term residential setting. But, unlike "regular" Medicaid, which is an entitlement and cannot have a waiting list, states can maintain waiting lists for waivers. This article tells the story of a Louisiana family whose son Riley was diagnosed with Duchenne Muscular Dystrophy when he was five. He's been on a waiting list for Medicaid waiver services for seven years and his family worries he may not live long enough to finally secure a waiver spot. In response to state budget issues, 1,000 waiver spots were frozen. Along with 13,000 others on the list, Riley's family continues to wait and worry about their ability to continue to provide all of their son's care and about the financial toll on their household.
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 IN THIS ISSUE
Featured Article
News
Resources
News from Our Partners
Events and Announcements
In Case You Missed It...
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News Items
Some States Pay Doctors More to Treat Medicaid Patients 
By Elisabeth Wright Burak
Center for Children and Families: A Children's Health Policy Blog
April 14, 2015
On March 31, 2015, the U.S. Supreme Court ruled against disability providers, stating they do not have the right to sue their states for higher Medicaid reimbursement rates. While providers can't sue for higher wages, states always had the flexibility to increase Medicaid provider reimbursement rates, and some states are doing just that. With increased numbers of Medicaid enrollees, many states are concerned about provider shortages and access to care. As an incentive for current providers to accept new Medicaid patients and to entice new providers to accept Medicaid, 15 states are using general funds, tobacco settlement money, or an increase in the cigarette tax to continue, in whole or in part, the Medicaid Primary Care Payment Rate Bump that was funded from 2013 through 2014 by the Affordable Care Act (ACA). These states report that new doctors, physician assistants, and nurse practitioners are joining the ranks of Medicaid providers.
Healthcare.Gov Got the Math Wrong for Dependents with Social Security Income and It May Be Costing Families Thousands
By Tricia Brooks
Health Affairs Blog
April 20, 2015
The Affordable Care Act (ACA) includes a standardized methodology for computing household income, which is used to determine eligibility for Medicaid, the Children's Health Insurance Program (CHIP), and Marketplace coverage. The methodology, called MAGI (Modified Adjusted Gross Income), includes tax-exempt Social Security income, but only for individuals who file their own tax return. This blog details how states with federally facilitated Marketplaces are incorrectly including Social Security income paid to tax dependents, such as children who receive Social Security income and who do not file their own tax returns, in MAGI determinations. This glitch means household income appears higher than it should be and individuals who would be eligible for Medicaid or CHIP are determined eligible for Marketplace coverage, which has higher premiums and cost sharing.
Kamala Allen
Health Affairs Blog
April 17, 2015
Many children and youth in foster care have experienced trauma and may need behavioral health services, but the disproportionate use of psychotropic medications among children in foster care compared to other children also enrolled in Medicaid is concerning. This blog describes how states are working to improve oversight and monitoring of psychotropic medications for this vulnerable population. For example, New Jersey is improving data collection to better track medication use. The state is also training caseworkers and nurses to monitor children's behavioral health needs. Rhode Island is encouraging use of behavioral health therapies rather than medication. In other states, the child welfare agency must consent to the use of psychotropic medications and/or obtain prior approval by a mental health professional.
By Sylvia Mathews Burwell, HHS Secretary
U.S. Department of Health & Human Services
April 13, 2015
In recognition of April as National Minority Health Month, Health and Human Services Secretary Sylvia Matthews discussed the role of the Affordable Care Act (ACA) in reducing the uninsurance rate among African Americans and Latinos. To continue to reduce inequities, she noted the importance of focusing on health literacy and highlighted the Coverage to Care Initiative.
Why ACA Plans Don't Include Dental Coverage By Robert Calandra
The Inquirer
April 19, 2015Oral health is essential to overall health and wellness, yet when it comes to medical insurance, dental coverage is treated like a "second-class citizen." This article explores why oral health care is not included in many health plans, even though pediatric dental coverage is one of the Affordable Care Act's 10 essential health benefits.
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Resources
By Nora Wells, Suzanne Bronheim, Stephen Zyzanski, and Clarissa Hoover
Maternal and Child Health Journal
April 8, 2015
The Maternal and Child Health Bureau (MCHB) has six core outcomes for children and youth with special health care needs (CYSHCN). One of the outcomes is "families are partners in shared decision-making for children's optimal health." Family-centered care is a foundational element of this core outcome. This journal article provides an overview of the importance of family-centered care and describes the family-driven process the authors used to develop a tool to assess family experiences of family-centered care. The process also models the importance of family/professional partnerships and the unique contribution they can make to quality improvement initiatives.
Recent Trends in Medicaid and CHIP Enrollment as of January 2015: Early Findings from the CMS Performance Indicator Project
By Samantha Artiga, Robin Rudowitz, Alexandra Gates, and Laura Snyder
The Kaiser Family Foundation
March 31, 2015
This issue brief examines enrollment trends in Medicaid and the Children's Health Insurance Program (CHIP) since 2013 so changes could be examined based on states' decisions to implement the optional Medicaid expansion included in the Affordable Care Act (ACA). Children's enrollment has increased by 5%, most likely due to increased outreach efforts to children who were eligible but not enrolled. In expansion states, children are 43% of the total Medicaid enrollment compared to 71% in states that have not expanded Medicaid.
New Data Resources on Children with Autism Spectrum Disorder and their Families
The Data Resource Center for Child & Adolescent Health (DRC) provides access to national data including the National Survey of Children's Health, the National Survey of Children with Special Health Care Needs (NS-CSHCN), and the National Health Interview Survey of Complementary and Alternative Medicine Supplement. The DRC portal now includes the Survey of Pathways to Diagnosis and Services. This survey, a follow-up to the 2009-10 NS-CSHCN, interviewed parents and guardians whose 6- to 17-year-old CSHCN were ever diagnosed with an autism spectrum disorder, intellectual disability, or developmental disability. Data indicators include developmental concerns; diagnostic experiences; health and education services; unmet needs and adequacy of insurance; and functioning, strengths, and difficulties.
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Events & Announcements
This proposed rule includes anticipated regulatory and statutory changes that would clarify and improve state vocational rehabilitation services and state-supported employment programs. To submit a comment, click on the "SUBMIT A FORMAL COMMENT BUTTON." The comment period ends June 15, 2015.
Webinar: ACA Outreach to Rural and Diverse Populations Date: April 30, 2015Time: 3:00 to 4:00 pm ETThe Family Voices National Center for Family Professional Partnerships (NCFPP), in collaboration with the Catalyst Center and the Family-to-Family Health Information Centers (F2Fs) in North and South Dakota, is hosting this webinar. The Catalyst Center will present data about health care coverage inequities experienced by children and youth with special health care needs living in rural areas and/or who are part of minority populations. Family Leaders from the North and South Dakota F2Fs will share strategies they use to share information about the Affordable Care Act (ACA) and to assist diverse rural populations in enrolling in health care coverage. Register for the ACA Outreach to Rural and Diverse Populations webinar.
Webinar: Special Enrollment Periods and Resources for the Uninsured
Date: May 6, 2015
Time: 2:00 to 3:00 pm ET
Certain life events such as turning 26, getting married, or having a baby can affect health insurance status, necessitating the need to enroll in different health coverage. The Affordable Care Act (ACA) allows for Special Enrollment Periods (SEPs) so individuals and families who experience qualifying life events can enroll in Marketplace coverage outside of an open enrollment period. Join this webinar to learn about SEPs as well as resources for those who are not eligible for a SEP. Register for the Special Enrollment Periods and Resources for the Uninsured webinar. To join by phone only, dial (415) 655-0059, Access Code: 419-734-181. The PIN is the # key.
The New York - Mid-Atlantic Consortium for Genetic and Newborn Screening Services (NYMAC) is hosting 7 webinars focused on transition. This series provides an opportunity for providers, youth, and families to develop an understanding of transition for youth with special health care needs and their roles in that process.
Webinar 7: Patient Panel Perspectives, Questions and Answers
Date: May 14, 2015
Time: 1:00 to 2:30 pm ET
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In case you missed it... the most popular news item from our last issue |
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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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