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
"Opportunity is missed by most people because it is dressed in overalls and looks like work."
~ Thomas A. Edison
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Featured Article
State Medicaid programs, in an effort to control costs, increasingly contract with managed care organizations (MCOs). In Tennessee, 90% of people enrolled in managed care through the Tennessee Medicaid program are satisfied with their care. But this cost-control strategy comes at great expense to families raising children with complex health needs. This article profiles two families who are spending increased amounts of time fighting for services, waiting for appointments due to narrow provider networks, and waiting for judges' rulings. Lynda Douglas appealed the MCO's decision to cut back nursing for her daughter Charla, who has cerebral palsy, does not speak, is tube fed, and needs medication and monitoring for frequent seizures. After Lynda won the case, the insurer appealed. A judge eventually ruled in Lynda's favor, but it took two additional rounds of hearings. In another case, a mother fought her MCO to get partial coverage for behavioral health services for her young son with autism and Down syndrome. In response to families' experiences and reports of huge MCO profits, the Centers for Medicare and Medicaid Services (CMS) will update managed care rules to regulate MCO profits and ensure network adequacy.
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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
Implementing Health Reform: As King Decision Looms, GOP Senators Introduce Transition Plans 
By Timothy Jost
Health Affairs Blog
April 23, 2015
In early March, the U.S. Supreme Court heard oral arguments in the King v. Burwell case. This challenge to the Affordable Care Act (ACA) says that Healthcare.gov, the federally facilitated Marketplace that operates in 34 states is not "an Exchange established by the state." Therefore, people who purchase health insurance through Healthcare.gov should not receive federal subsidies. This blog provides an overview of two contingency bills introduced by Republican senators and details the domino effect that would occur if the Court rules in favor of the plaintiffs. Without federal subsidies to reduce families' monthly premium costs, 8 million people would lose coverage, including 450,000 to 730,000 children. Premiums would rise dramatically (the ACA Spotlight provides estimates of the average monthly increase in premium costs by state), more people would forgo care, health providers' incomes would decrease, and the amount of uncompensated care they provide would increase.
Program Streamlines Health Care for Foster Children
By Robert Gebelhoff
The Journal Sentinel
April 27, 2015
Wisconsin children in the foster care system have a new place to call home and a new set of grown-ups to watch over them. In an effort to improve care for this vulnerable population and reduce the time health providers spend connecting children in foster care with specialty providers, Wisconsin created a Medicaid medical home team. This partnership between Children's Hospital of Wisconsin clinics and the state's Children and Families and Health Services provides care coordination, collects all medical information, and develops a care plan to ensure timely access to comprehensive care, oversight of medications, including psychotropic medications, and provides access to dentists and other specialty services so often needed by children who have experienced trauma.
By Emily Polk
Health Policy Hub
April 27, 2015
In this blog, Emily Polk iterates the benefits of the Medicaid and Children's Health Insurance Program (CHIP). In addition to providing an important pathway to coverage for children, these two public benefit programs help reduce coverage inequities for Black and Latino Children. Medicaid and CHIP also safeguard families' financial health by protecting them from large out-of-pocket costs. Findings from Medicaid and Intergenerational Economic Mobility, a report from the Institute for Research on Poverty, has determined that Medicaid and CHIP may be a contributing factor to the upward mobility of young adults whose mothers were enrolled in Medicaid in the 1980s and 1990s because they were pregnant. Polk asks states to consider this additional Medicaid "benefit" before limiting Medicaid eligibility for pregnant women or rolling back coverage for parents.
By Sinsi Hernández-Cancio
Families USA Blog
April 22, 2015
Health care payment and delivery reform is sweeping the country. This blog post focuses on how to find the sweet spot between implementing these reforms, many of which have the potential to alleviate health care inequities, and ensuring they do no further harm. It's not realistic to assume that all payment and delivery reforms will have an equally beneficial effect on everyone, especially when health equity may not have been considered when developing the model. For example, reforms that provide incentives to providers whose patients have good outcomes and for whom hospital admissions are reduced may create barriers to care for individuals of color who may have poorer baseline health and be more expensive to treat. Minnesota has found a way to help overcome this type of barrier. Among Latinos, community health workers, known as promotores, provide many health services. Minnesota became the first state to provide Medicaid reimbursement for services provided by community health workers.
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Resources
Sara Rosenbaum and Timothy Westmoreland
The New England Journal of Medicine
April 22, 2015
The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act was introduced to Congress in February. If passed, this proposed federal legislation would repeal the Affordable Care Act's (ACA) insurance reforms, roll back federal subsidies for Marketplace coverage, end federal funding for the Medicaid expansion, and reform Medicaid by making it a block grant program. The authors discuss the implications of ending Medicaid as an entitlement program and the implications for children, families, and individuals with disabilities.
2014 National Healthcare Quality and Disparities Report
U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality
April 2015
The Affordable Care Act (ACA) includes a National Quality Strategy with three aims that are derived from the Triple Aim. These are better care, healthy people/healthy communities, and affordable care. This report shows areas where disparities have been eliminated, but we're "not there yet." For example, there are still disparities in access to care between children with Medicaid and CHIP and those who are privately insured. Overall, the number of parents who reported poor communication with their child's doctor has decreased, but is still highest for Latino families. When this indicator was examined by household income, poor families reported the least satisfactory communication with their children's doctors.
Medicaid Timeline
Kaiser Family Foundation
Was EPSDT (Early and Period Diagnosis and Treatment) always a Medicaid benefit? Was the EPSDT benefit always for children up to age 21? Explore the Medicaid timeline to find out and learn more about Medicaid and its role in our health care system.
The Division of Maternal and Child Health Workforce Development (DMCHWD) has established a Trainee Ambassador Group. This 15-month virtual experience was designed to link trainees and the Maternal and Child Health Bureau. Learn more about the program, eligibility, and application. The application deadline is Sunday, May 31, 2015.
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Events & Announcements
Health Reform: Beyond the Basics
Special Enrollment Periods (SEPs) are times, outside of open enrollment, when people can purchase qualified health plans in the Marketplaces. On February 19, 2015, Sarah Lueck, from the Center on Budget and Policy Priorities, presented a webinar about the different circumstances that trigger Special Enrollment Periods. This webinar recording provides an excellent overview of the life changes, loss of other coverage, and special rules for Indians and Alaska Natives that trigger SEPs. There are also "other situation" SEPs. This includes moving out of the Medicaid coverage gap. In states that have not expanded Medicaid, individuals whose household income is less than 100% of the federal poverty level and who are not eligible for Medicaid are also not eligible for tax credits and cost-sharing subsidies to purchase Marketplace coverage. However, if income increases above the federal poverty level outside of an open enrollment period, that person is eligible for an SEP, and can then purchase Marketplace coverage and be eligible for federal subsidies.
Time: 3:00 to 4:00 pm ET
The Affordable Care Act has created new pathways to health care coverage. Now that more people have health insurance, they need help understanding how to find providers, make appointments, and use the health benefits. This is also an opportunity to learn about recommended screenings and Coverage to Care materials, available in several languages and designed to promote health insurance literacy. Register for the Got Coverage? Next Steps in Using Your Health Insurance webinar.
Date: May 28, 2015
Time: 12 noon to 1 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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