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
"Look to the future, because that is where you'll spend the rest of your life."
~ George Burns
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Featured Article
By Paul Gionfriddo
Health Affairs Blog
May 6, 2015
Paul Gionfriddo, the author of this blog post, hopes 2015 is "the year for truly comprehensive mental health reform in America." The key to achieving mental health reform is two-fold. First, we need to take a proactive, rather than the current reactive, approach to mental health care. It's also important to start with children. Gionfriddo champions the inclusion of mental health screenings for children as part of preventive care so that mental health issues are identified and treated early, rather than taking action after a mental health crisis has occurred. Schools can also play a role in mental health reform by screening all children for mental health needs, along with the vision and hearing screenings they already provide. And Medicaid will reimburse schools for these preventive screenings for children enrolled in Medicaid. Gionfriddo also advocates for schools to include needed mental health services on a student's Individualized Education Program (IEP). In the past, schools had to pay for all services on a child's IEP. However, with the passage of the Affordable Care Act (ACA), new individual, small-group, and Marketplace health plans must include mental health and substance use disorder services, including behavioral health services, counseling, and psychotherapy as one of the 10 essential health benefits. With a rules change, schools could include mental health services provided in the community on a child's IEP and have insurers cover the costs.
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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
'Family Glitch' Puts 1.9 Million CHIP Kids at Risk 
By Marissa Evans
CQ Roll Call
April 29, 2015
Affordability of employer-sponsored insurance is based on the cost of the employee only premium, not the cost to cover the entire family, which is often more expensive. And when a family has access to employer-sponsored insurance that meets the affordability standard, the other family members are not eligible for subsidies to help purchase Marketplace coverage. This phenomenon is called the family glitch. When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 in April, it extended funding for the Children's Health Insurance Program (CHIP). But MACRA did not include a solution to the family glitch. Come 2017, children enrolled in separate CHIP programs will most likely transition into Marketplace plans. Even with subsidies, Marketplace plans are more expensive, and children's benefits are not as robust. Without subsidies, Marketplace coverage will be unaffordable for many families, and the number of uninsured children will increase.
There Is No Time Like the Present to Talk about EHB Benchmarks!
By Eva Marie Stahl and Ashley Blackburn
Health Policy Hub
May 7, 2015
Benchmark plans provide the framework for each of the 10 essential benefits that all qualified health plans sold through the Marketplaces must provide. In 2011, the U.S. Department of Health and Human Service decided to let each state select a benchmark plan from:
- One of the three largest small-group plans in the state by enrollment;
- One of the three largest state-employee health plans by enrollment;
- One of the three largest federal-employee health plan options by enrollment;
- The largest HMO plan offered in the state's commercial market by enrollment.
This decision resulted in state-to-state variability in the amount, scope, and duration of services. As states begin to revisit their choice of a benchmark plan for 2017, the authors of this blog post remind advocates that "there is no time like the present" to make sure the benchmark plan provides mental and behavioral health, pediatric, habilitative, and other services in amounts that meet consumers' needs.
By Magaly Olivero
New Haven Register
May 1, 2015
Many children develop chronic health and behavioral needs as a result of violence, abuse, and other traumatic events. In 2012, mental health problems were the number one cause of hospitalization for children and youth in Connecticut. Due to a shortage of providers, all families struggle to access mental health services for their children. Even with insurance, due to insufficient amounts of mental health benefits and/or high deductibles, many families struggle to pay for services. In response, Connecticut lawmakers are working to increase funding for Emergency Mobile Psychiatric Services (EMPS), a statewide, rapid response system for children up to 18 years old who are experiencing mental health emergencies.
HRSA Press Office
May 5, 2015
The Affordable Care Act (ACA) will provide $101 million to 33 states and 2 territories to fund 164 new health center sites. As a result, an estimated 650,000 people will have increased access to health care services. In the last four years, the ACA has funded more than 550 new health centers. These centers not only provide health services, they also provide outreach and enrollment and have helped more than 9 million people enroll in coverage.
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Resources
By Sabrina Corlette, Justin Giovannelli, and Kevin Lucia
The Commonwealth Fund
May 2015
Even before the Affordable Care Act (ACA), insurers used narrow provider networks to control premium costs. The ACA sets a national standard for Marketplace plans. This standard is a qualitative measure that says provider networks must include sufficient numbers and types of providers to ensure timely access to needed care. States have a lot of flexibility in how they enforce this standard. This issue brief explores how states are using some quantitative measures for assessing network adequacy. These include the ratio of providers to enrollees, wait time for appointments, travel time to services, and extended hours of operation. States also have different requirements for ensuring network transparency by specifying when plans must update their provider directories, such as quarterly, monthly, or any time there is a change.
Abstract: If Rollbacks Go Forward, Up to 14 Million Children Could Become Ineligible for Public or Subsidized Coverage by 2019
By Julie L. Hudson, Steven C. Hill, and Thomas M. Selden
Health Affairs
May 2015
Children in families whose income is too high to qualify for Medicaid and the Children's Health Insurance Program (CHIP) and is less than 400% of the federal poverty level are not eligible for subsidized Marketplace coverage if:
These children are caught in the "family glitch." When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 in April, they extended funding for CHIP through 2017. But then what? This study explores the potential insurance gulch that an estimated 26.5 million children may fall into if states end their separate CHIP programs in 2017 and also roll back Medicaid eligibility once the Affordable Care Act's (ACA) Maintenance of Effort provision ends in 2019.
During her tenure as Director of the Division of Services for Children with Special Health Needs at the Maternal and Child Health Bureau, Bonnie Strickland championed a comprehensive system of care for all children and youth with special heath care needs, including children with vision needs. When Bonnie retired in December 2014, the National Center for Children's Vision and Eye Health and the national Prevent Blindness organization created the Bonnie Strickland Champion for Children's Vision Award to commemorate her work. To nominate an individual or organization whose work has led to significant improvements in children's vision and eye health, download the Bonnie Strickland Champion for Children's Vision Award Nomination Form. The nomination deadline is Friday, June 19, 2015.
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Events & Announcements
Date: May 12, 2015
Time: 1:30 to 2:30 pm ET
Date: May 19, 2015
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.
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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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