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
"Change is inevitable--except from a vending machine."
~ Robert C. Gallagher
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Featured Article
 Children in Crisis: Where Can They Go? Psychiatric In-patient Services for your Baystaters are Declining
By Stephanie Kraft
Valley Advocate
May 20, 2015
In response to the Rosie D lawsuit, in 2008 Massachusetts revamped its mental health system for children enrolled in Medicaid with serious emotional disorders and created a community-based system of care. Yet some children have periods when their behaviors make it unsafe for them to be cared for at home. The two boys profiled in this article were fortunate that there was an Acute Residential Treatment (ART) center where they could receive the care they needed, while also participating as much as possible in community, school, and home life. With the closure of the ART unit at Providence Behavioral Health Hospital in Holyoke, Massachusetts, behavioral health supports, which were always hard to access, are even scarcer. This article explores the difficulties of finding a balance between limited community-based supports, diminishing inpatient placements, and emergency rooms crowded with children waiting for in-patient psychiatric services on one side and the costs of children's behavioral health services on the other. |
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IN THIS ISSUE
Featured Article
News
Resources
News from Our Partners
Announcements and Events
In Case You Missed It...
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News Items
Court: State Wrongly Ended Girl's Medicaid 
Associated Press
May 21, 2015
On Friday, the Nebraska Supreme Court ruled that the state's Department of Health and Human Services must reinstate Medicaid Home and Community-based waiver services for a young girl with a rare genetic disorder. The Court's decision was guided by the state's inconsistent use of eligibility criteria for the waiver. The child will once again receive the nursing, assistance with activities of daily living, and other services she needs to live at home. Moving forward, other children who require waiver services to be cared for at home will be evaluated appropriately.
Children's Hospital Set to Expand
By Priyanka Dayal McCluskey
The Boston Globe
May 21, 2015
Families raising children with special health care needs come to Boston Children's Hospital from across the country and throughout the world. With the acquisition of Children's and Women's Physicians of Westchester, Boston Children's Hospital will soon be coming to families in Connecticut, New York, and New Jersey. This is part of the hospital's plan to build a regionalized system of care for children with complex health care needs. Online evaluations and communications will increase children's access to pediatric specialists and facilitate coordination of care.
Doctors Largely Unprepared to Treat Adults on the Spectrum
By Michelle Diament
Disability Scoop
May 21, 2015
The Maternal and Child Health Bureau has six core outcomes for children and youth with special health care needs. One of those outcomes is that youth with special health care needs will receive the services necessary to transition to adult life. This includes transitioning from pediatric to adult health care services. However, researchers at Kaiser Permanente Northern California found that providers of adult primary care, mental health, and other services in their network report they do not have the knowledge or resources to accommodate patients diagnosed with autism spectrum disorders.
May 14, 2015
When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 in April, they not only extended funding for the Children's Health Insurance Program (CHIP), but also included funds for the Family-to-Family Health Information Centers (F2Fs). There is a F2F in every state and the District of Columbia. These centers are run by family members raising children and youth with special health care needs (CYSHCN). Staff members help other families with CYSHCN and their professional partners navigate the complex system of health care coverage, services, and supports. See the list of 2015 F2F awardees.
Busting the Medicaid Myths in North Carolina By Thomas R. White and William A. Dennis
The News & Observer
May 23, 2015
This op ed piece by two family physicians busts two myths about the North Carolina Medicaid system. To combat the myth that Medicaid spending is out of control, the authors state that per-patient costs have decreased 9% over the last 4 years. Furthermore, the state's share of Medicaid costs has not increased, despite an increase in Medicaid enrollment. The second myth is that Medicaid is "an entitlement program for able-bodied adults." In fact, 65% of the state's Medicaid enrollees are children in families with limited household income. Pregnant women make up 2% of the state's Medicaid population. Another 15% are blind, disabled, or born with a birth defect.
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Resources
By Sara R. Collins, Petra W. Rasmussen, Sophie Beutel, and Michelle M. Doty
The Commonwealth Fund
May 20, 2015
For this study, the measures of underinsurance included out-of-pocket expenses that exceeded 10% of household income, or that were equal to or greater than 5% of income when household income was less than 200% of the federal poverty level (FPL). The study did not factor in health plan premium costs. In addition, adults were considered underinsured if their health plan deductible was greater than or equal to 5% of household income. The authors found that 23% of continuously insured 19- to 65-year-old adults were underinsured and that there was no change in underinsurance from 2010 to 2014. The study includes a breakdown of underinsurance by insurance type (employer-sponsored or individual coverage) and the kinds of access challenges (unmet medical need, unfilled prescriptions, etc.) underinsured individuals faced due to cost.
Network Adequacy Checklist
By Quynh Chi Nguyen
Community Catalyst
May 2015
Availability, accessibility, affordability, quality, and transparency are all elements that contribute to network adequacy. For each of these elements, this checklist from Community Catalyst provides the requirements of the Affordable Care Act (ACA) and the U.S. Department of Health and Human Services (HHS) guidance, alongside consumer priorities and questions to consider when assessing network adequacy.
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Announcements & Events
TRICARE, the health care program for active, reserve, and retired military service members and their families, produces a weekly beneficiary podcast to help members understand and navigate services. On May 22, 2015, the weekly bulletin, podcast #306, covered speech and language disorders and hearing loss for children. This podcast also included information about the prior authorization process. Listen to the podcast or read the transcript.
Date: May 28, 2015
Time: 2:00 to 3:30 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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