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
"A positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort."
~ Herm Albright
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Featured Article
 Bill to Speed FDA Approvals Includes Rewards for Drugs Designed for Kids 
By Lisa Gillespie
Kaiser Health News
June 8, 2015
H.R.6 (the 21st Century Cures Act) was introduced in the U.S. House of Representatives on May 19, 2015. Depending on the stakeholder group, this bill elicits hope and hesitation. For parents whose children have rare diseases that often result in death, H.R. 6 provides hope. If passed, the National Institutes of Health (NIH) would establish a national consortium where research institutions could pool resources and activities related to treatments for children's rare diseases and birth defects. It would also extend a voucher program that provides incentives for companies to develop drugs for the treatment of rare pediatric diseases. Others, concerned about children's safety, hesitate to see children included in human subject research. They worry that drug approvals based on trials with small numbers of children will not be enough to fully explore detrimental side effects. Learn more about the 21st Century Cures Act in the section-by-section summary from the U.S. House of Representatives Committee on Energy and Commerce. |
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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
What's At Stake When the Supreme Court Rules on Health Plan Subsidies
By Julie Rovner and Mary Agnes Carey
Kaiser Health News
June 8, 2015
A Kaiser Health Policy News Index poll, conducted from April 8 to 14, 2015, found that Most Not Paying Close Attention to Coverage of King v. Burwell. For those in the 59% who reported they are not following the case too closely or not at all closely, this article, in question and answer format, explains what the case is about, what will happen if the court rules in favor of King (short answer: about 6 million people who purchased plans in the federal Marketplace will lose the subsidies that help them afford health insurance), and if Congress will provide a "fix." In a follow-up article from Kaiser Health News on June 10, Health and Human Services Secretary Sylvia Burwell Says It's Up to States, Congress to Help Consumers If Court Strikes Down Subsidies. More specifically, Secretary Burwell told the House Ways and Means Committee it will be up to "Congress and states and governors to determine if those subsidies are available." She also noted that President Obama would not sign proposed legislation that would extend the subsidies through August 2017 because the bill also includes a repeal of the individual and employer mandate.
High Court Won't Hear Maine Appeal over Medicaid Cuts
By Alanna Durkin
Associated Press
June 8, 2015
When the 1st U.S. Circuit Court of Appeals ruled that Maine couldn't cut 19- and 20-year olds from its children's Medicaid program, the governor asked the U.S. Supreme Court to consider the case. Now that the justices have refused the case, the state must abide by the lower court's decision. The Appeals Court ruling stated that eliminating coverage for 19- and 20-year olds was a violation of the Affordable Care Act's Maintenance of Effort (MOE). This provision protects Medicaid and Children's Health Insurance Program (CHIP) coverage for children until 2019. The eligibility criteria and benefits for children that were in effect on March 23, 2010, the day the ACA became law, are protected through September 2019. Advocates, concerned about continuity of health coverage for young adults in transition, are relieved. Learn more about MOE in the Catalyst Center publication What's the Deal with MOE?
About 23,700 Poor Parents to Lose Medicaid Coverage
By Mackenzie Rigg
Newstimes.com
June 9, 2015
Rhode Island decreased Medicaid and Children's Health Insurance Program (CHIP) eligibility for parents in 2013, stating that parents could purchase a Marketplace health plan. Only 11% did, leaving 30% of those who lost their public coverage uninsured. When Maine rolled back Medicaid and CHIP eligibility for parents, the number of enrolled children decreased. Due to budget issues, Connecticut also plans to reduce Medicaid eligibility for parents. Advocates worry that as parents lose coverage, so will their children.
The CT Mirror
June 3, 2015
The good news is that the cuts to health care and social services in Connecticut are not as drastic as originally proposed. The bad news is that the reductions that will go into effect will affect services that individuals with developmental disabilities and mental illness rely on, and their providers will see a reduction in Medicaid reimbursement rates. Day programs for young adults with intellectual or developmental disabilities who aged out of special education services will still exist. Parents who thought they would have to quit their jobs to care for their young adults can keep working. There is no new funding for residential programs, even though there are more than 2,000 people waiting for group home services.
By Margie Menzel
The News Service of Florida
June 9, 2015
The Florida Children's Medical Services Network (CMSN) provides medical, therapeutic, and support services for children with medically fragile conditions and their families. Over a 90-day period, which began in May, the state is screening more than 65,000 children using a new eligibility tool and has already transitioned more than 2,000 children from CMSN into Medicaid managed care plans. Parents, pediatricians, specialty providers, and others are concerned that the children and their families will not receive the same level of support in managed care plans as they did in the CMSN program. In addition, during the redetermination process, the state has stopped enrolling new children into CMSN, except on an emergency basis.
Exposing the Dark Secret of Unequal Health Care Inequalities and Disparities in the U.S. By Robert TilfordGround ReportJune 5, 2015Each state receives a matching amount of federal funds for each dollar it spends on Medicaid. This federal support is called the Federal Medical Assistance Percentage (FMAP). Medicaid programs in the U.S. territories are also supported with federal funds, but unlike in the states, federal support is capped. To resolve the inequities this creates for providers, hospitals, insurers, and patients, Representative Pedro Pierluisi of Puerto Rico has proposed legislation which, if passed, would remove the funding cap and provide FMAP to the U.S. territories.
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Resources
By MaryBeth Musumeci
The Kaiser Commission on Medicaid and the Uninsured
June 2015
This issue brief provides a summary of the proposed Medicaid behavioral health parity rules. It also explains how behavioral health parity applies in different Medicaid delivery systems (managed care, prepaid inpatient health plans, prepaid ambulatory health plans, and fee for service).
Transition to Adult Care: What's Age Got to Do with It?
By Edward L. Schor
Lucile Packard Foundation for Children's Health
May 18, 2015
For youth and young adults with complex health needs, transition to adult systems of care can be a stop-and-go process. They may be ready to stop sharing waiting rooms with young children and ready to go see an adult provider. Pediatricians also reach a point where they can no longer meet the health care needs of their young-adult patients. As more children with chronic health needs live longer, adult specialty providers are seeing patients with pediatric onset conditions for the first time. Many lack training and experience. As proposed in this article, pediatric subspecialists can fill this void by partnering with adult primary care and adult specialty providers to provide condition-specific care to young adults with complex conditions.
Helping Teens Transition from Pediatrics to Adult-Centered Care A Podcast with Helen Osborne and Corey Ellen NourieHealth Literacy Out LoudApril 7, 2015Nourie is a transition coordinator at Nemours Hospital for Children. In this 20-minute podcast, Nourie and Osborne discuss how to support both parents in "letting go" and their adolescents and young adults with special health care needs in learning the skills they need to transition from pediatric to adult health care and manage their own health care needs.
Next month, the Medicaid program turns 50! Every day between now and July 30, the Centers for Medicare and Medicaid Services will post history, highlights, and accomplishments of this public program that works to ensure the health and well-being of more than 70 million people, including children and youth with special health care needs. Follow along at Medicaid.gov.
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Announcements & Events
Date: June 17, 2015
Time: 1:00 to 2:00 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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