Say Ahhh! A Children's Health Policy Blog

Many Patient's Bill of Rights Provisions Go Into Effect on September 23rd

2010-09-08T18:40:12Z

September 23rd will mark the six-month milestone for the Affordable Care Act and several provisions impacting children and families will go into effect on that date including provisions in the "Patient's Bill of Rights" which:

o Prohibit employer or new individual health plans from excluding coverage of specific benefits associated with a pre-existing condition for any period of time and from denying coverage to a child based on a pre-existing condition.

o Eliminate lifetime dollar limits and establish restricted annual limits (until fully eliminated in 2014) for essential health benefits in employer and new individual health plans.

o Allow a parent/guardian to designate a participating pediatrician as their child's primary care provider and require plans providing emergency services to eliminate the need to prior authorizations, even when the services are out-of-network.

At the end of June, the Obama Administration issued an interim rule addressing how these provisions will provide important safeguards for families in obtaining and utilizing health insurance for themselves and their children. CCF joined with American Academy of Pediatrics, Children's Defense Fund, Family Voices, First Focus, March of Dimes, National Association of Children's Hospitals and Related Institutions, and Voices for America's Children to recommend ways to make the protections even stronger for families.

Specifically, the comments asked that revisions to the interim rule ensure that:

o Families with sick children can truly obtain coverage when they most need it, as envisioned by the pre-existing provision on the health reform bill. This includes prohibiting insurers from establishing unreasonable premium increases and/or excessive premiums for families with children with pre-existing conditions. In addition, it is important that guidelines be established for child-only plans establishing open enrollment periods (as allowed under an advisory released following in interim rule). Without rules on when and how these periods can be applied, it will be difficult for families to access coverage when they most need it; and

o Children can receive the services they need during the phase in of the annual dollar benefit limits. Families with children, especially those with special health care needs, may quickly hit the limits proposed under the interim rule. It is important that the limits more accurately reflect the experiences of these families and that the dollar limits be raised. In addition, it is important that health plans be prohibited from establishing non-dollar limits of families (e.g., restrictions on the number of doctor visits).

In the coming weeks, we will post additional information on the "September 23" reforms so check back in!

CK2C Event Inspires Action in States

2010-09-08T12:45:56Z

By Ann Bacharach, Pennsylvania Law Project and National Covering Kids and Families Network

I took a break from my stay-cation this week to get motivated for the fall. On behalf of the National Covering Kids and Families Network, I took the early morning train from Philadelphia to Washington on Friday to attend the re-launch of Secretary Sebilius' Connecting Kids to Coverage Challenge (CK2C).

It was inspiring:

Education Secretary Arne Duncan pledged to work with HHS to reach and enroll eligible children through a variety of school-based outreach strategies.
A mother courageously recounted her path to Maryland's M-CHIP program.
Sixteen national organizations, including National Covering Kids and Families Network, pledged to step up to the Secretary's Challenge.
Pastor Wiggins from Camden reiterated the challenge of reaching and enrolling families just trying to survive day to day.

According to the recently released report from the Urban Institute, there are 129,000 children in Pennsylvania who are eligible for Medicaid or CHIP but not enrolled. That means Pennsylvania is missing about 15% of those who could be covered.

That data prompted me to remember the number of proven strategies and tactics that agencies, organizations and even individuals in Pennsylvania have utilized: stationing enrollment assistors in Philadelphia's Health Centers as well as FQHC's in Greene, Fayette and Washington Counties, providing application assistance through Children's Hospital of Philadelphia, offering over-the-phone enrollment through the State's Helpline 800-986-KIDS using Pennsylvania's web-based application, and reaching out through community-based organizations in unlikely places such as volunteer firehouses.

Why not spread these ideas to other parts of the state? And share them with other trying to help connect kids with coverage across the country? And learn from other such as members of the National Covering Kids and Families Network?

And while we're at it, what about heading to barbershops and hair salons, laundromats, food banks? Friday night football games? Fishing and hunting license distributors? Sunday School, Hebrew School and other religious education classes?

And how do we promote retention? The number of very low-income children estimated to be eligible but not enrolled is disconcerting at best. This is, most likely, an outcome of losing eligibility at renewal. While we work to make renewal easier, how can we keep eligible families enrolled: reminders from their doctor's office, from their managed care plan or from their pharmacy? Renewal assistors working in health care settings?

And finally, the estimated 129,000 children who are eligible but not enrolled are not a finite group; children move in and out of health coverage all the time based on their family's status. If a parent loses or changes a job, if a parent divorces or remarries, if a parent gets sick, if a sibling ages out of the household, a child's health coverage can be interrupted or lost completely.

So, we need to keep up the drumbeat on available health care coverage and how to enroll going using the tried and true methods and in new and creative ways.

Let's get busy!

And if you have outreach and retention ideas, please share them with all of us avid readers and bloggers on Say Ahhh! and the National Covering Kids and Families Network.

Since You've Been Gone ...

2010-09-07T21:29:51Z

Having spent much of the summer in South America and without much access to American media, I was curious to see how things had changed when I returned to work this week. Hmmm. Not so good. Controversy over the health reform bill seems as rhetoric laden and inflammatory as ever as the election approaches.

That is why I was interested to see in my inbox a note about a new analysis done by the Congressional Budget Office on August 24th which estimates that if the health reform law (PPACA) was repealed, the deficit would actually rise significantly -- by $455 billion over a ten-year period 2010-2019. CBO found that PPACA will reduce the deficit by $28 billion in 2020. Sen. Crapo (R-ID) had requested the estimate.

I guess the good news here is that should Congress flip, it will be hard to repeal PPACA because it will cost money. Real money. But the likelihood of this kind of information breaking through the current heated debate seems slim. Say Ahhh! likes to share these little factoids with you though!

Kids Don't Have to Wait - Connecting Kids to Coverage Event Makes Case for Enrolling Kids Now

2010-09-03T20:26:33Z

I had a chance to go to a fantastic event this morning sponsored by Secretary Sebelius on the Connecting Kids to Coverage Challenge, which aims to reach the nation's 4.7 million uninsured children who already are eligible for Medicaid or CHIP. She made a compelling pitch that nothing is more important to our future than the health of America's children and that is why Medicaid and CHIP were created. Thanks to these programs, tens of millions of Americans have the peace of mind that comes from knowing that their child is safe.

In recognition that millions of our children are heading back to school this week, the event also featured Education Secretary Arne Duncan who tackled the issue from an education perspective. He argued that some foundational things have to be in place for students to be able to excel. If they can't see the blackboard, or if they are coping with untreated asthma, it is pretty tough to expect them to do well. He pledged to work with some of the major school districts in the states that have the furthest to go in covering uninsured children. (California, Florida, and Texas account for 40% of all uninsured kids, according to powerful new data released today by the Urban Institute. See my colleague Martha Heberlein's blog for more on the report).

The star of the morning, though, was probably Bonnie, a mom from Maryland. "I speak to you as a mother and as an American," she began before going on to explain that her husband is an auto-mechanic who doesn't have any affordable employer-based coverage. So, when she lost her job, she found her family uninsured. Luckily, she hooked up with a community-based organization that helped her file an application for child health coverage. It took only 15 minutes from start to finish, and within 24 hours she got a call that her son qualified. Since her son has asthma, it was an enormous source of peace of mind in a time of need. As she concluded, "No mother, no parents should have to choose their mortgage and utilities over health care" for their child.

I left encouraged about the level of commitment shown by two key leaders in the Obama Administration, as well as impressed by the broad array of national organizations they've already signed up to work on the Connecting Kids to Coverage Challenge.

Data Helps Focus Efforts to Connect Kids to Coverage

2010-09-03T12:00:00Z

Most of you know the CPS - the annual social and economic supplement (ASEC) has been our go to source for health insurance coverage on a national and state-by-state basis for years. However, given the nature of the sample, analysis has been somewhat limited, especially for those smaller states and for those interested in data on a sub-state level.

Now there's a new kid on the block. In 2008, a question on health insurance coverage was added to the American Community Survey. Like the CPS, the ACS is a national survey, but it has a much larger sample size (the CPS looks at about 78,000 households annually, whereas the ACS surveys 250,000 per month). It may seem somewhat counterintuitive, but the bigger the sample size, the smaller the area (geographic or demographic) that you can examine. We may just be able to get answers to some of those long-standing research questions.

One such question that has long plagued those of us looking to enroll eligible children in Medicaid and CHIP is: who are those kids and where can we find them? Thanks to the ACS (and some very talented folks over at the Urban Institute) we now have a much better idea, as today in Health Affairs, Dr. Genevieve Kenney and her colleagues released a paper that looks at that very question. (The report will also be highlighted at a media event today where HHS Secretary Sebelius will relaunch her Connecting Kids to Coverage Campaign. You can watch it live here).

They found that of the 7.2 million uninsured children in the U.S., 4.7 million or 65% were eligible for Medicaid or CHIP. Of those, about a third are concentrated in just three large states (California, Texas, and Florida), a piece of data that certainly highlights the need for outreach and enrollment efforts in those states.

But I think an equally appropriate (and far more upbeat) view of the data is the success states have had enrolling children in their Medicaid and CHIP programs. Nationwide, the participation rate in Medicaid and CHIP is 82% (high compared to other means-tested programs). And 11 states were shown to have participation rates that were close to or above 90%. Those are amazing numbers and states should celebrate their well-deserved accomplishments.

For those of you doubters who say, "well, that could never happen in my state," I beg to differ. To quote the authors: "since these states constitute a diverse group in terms of their size, income distribution, racial and ethnic composition, and region, it suggests that high participation rates can be achieved across a range of different circumstances." In other words, while it is certainly not easy to get all the eligible kids in your state covered, there are plenty of places to look to as role models, and ones that may be very much like your own.

California is Blazing a Trail on Establishing Health Insurance Exchange Under ACA

2010-09-02T18:02:06Z

By Mike Odeh (Children Now) and Kristen Golden Testa (The Children's Partnership) with the 100% Campaign

And we're off! Implementation of the Affordable Care Act (ACA) is officially underway! Less than six months after Congress passed the ACA, California has blazed the trail as the first state in the nation to create a statewide Health Insurance Exchange under the Act. Two complementary pieces of legislation create the California Health Benefit Exchange and are headed to Governor Schwarzenegger's desk for an expected signature - (AB 1602 creates the Exchange and SB 900 creates a decision-making board).

By creating the Exchange, the State has built a framework that will dramatically improve the way many Californians, particularly the uninsured, get health coverage and will set the right trajectory for health reform implementation by providing new affordable coverage opportunities for millions of children and their families!

Make no mistake - creating the Exchange was no easy task. The legislation that created the California Health Benefit Exchange only came about (on party-line votes) through strong legislative and gubernatorial leadership, thoughtful and dedicated staff, and the efforts of a broad coalition of health and consumer advocates. Certain insurers (ones that are apparently afraid of transparency and a little competition) worked throughout the process to water down the legislation and tried desperately to kill the bill in the final hours. Thankfully, other insurers were supportive and engaged earnestly in negotiating amendments.

CCF's recent blog and issue brief on Health Insurance Exchanges lays out some of the primary responsibilities of an Exchange and identifies some opportunities within the broader federal framework to coordinate among the Exchange and existing programs, like Medicaid and CHIP.

So, as many of you probably know, the ACA allows states to make some important choices, not least of which is the decision whether or not to create a state Exchange in the first place. Given that California is home to nearly 1.5 million uninsured children, the infamous 39% premium increase proposal and a seemingly infinite state budget stalemate, we really need a custom-designed Exchange that will work for California. Alan Weil and Jon Kingsdale cautioned the California Legislature that making an Exchange work by 2014 would require a lot of strategic planning, thoughtful coordination and time. It's a good thing the Legislature was listening and has been able to take the first step forward for California.

Although the authorizing Exchange legislation creates a governance structure and outlines a framework for the core responsibilities of the Exchange in California, some of the details of coverage in the Exchange, such as the benefit design for the child-only insurance products, will be determined by the governing Exchange Board along with future federal guidance. That's why we believed it was very important that the Exchange be run by a qualified Board with expertise and the authority to negotiate health plan contracts based on price and value while not having conflicting financial interests. The board also needs representation from those that recognize the importance of coordinating with existing health care programs, systems, agencies, and regulators, so that children are protected and don't fall through the cracks and lose health coverage unnecessarily. Along with minimum benefit standards and cost-sharing limits in the federal law, we believe these factors are critical to ensuring that the coverage offered in the California Exchange is much more meaningful and more affordable than coverage today.

In fact, one of the key features is that the five-member appointed Board is authorized to be an "active purchaser" and will select health plans to participate in the Exchange through a competitive bidding process. Because Exchange board members will be required to have experience with health coverage, administration, and financing, they will be qualified and savvy in negotiating contracts with health plans based on price and value for an estimated 8.3 million lives (including 3.8 million small-business owners and employees and their dependents).

The legislation also lays out the overall duties and responsibilities of the Exchange, many of which are explicitly required in the federal law (e.g., operating a toll-free telephone hotline and website with comparative plan information) and some of which just make good sense (e.g., authorizing the Exchange board to maximally collaborate with existing health agencies and applying the same standards for insurers and health plans inside and outside the Exchange). It also will allow California to be one of the first states to apply for the federal planning grants that can be used to establish the Board, promulgate strong consumer protections regulations, and develop a process to coordinate effectively with existing state health insurance programs like Medi-Cal (Medicaid) and Healthy Families (California's CHIP).

Since the federal law builds upon (and protects) Medi-Cal and Healthy Families, it is critically important that the Exchange coordinate with existing state and local programs as much as possible. The Children's Partnership and the Kaiser Commission on Medicaid and the Uninsured point out in a recent issue brief that the ACA requires enrollment systems that are consumer-friendly, coordinated, simplified, and technology-enabled. But getting into the "nuts and bolts" of creating enrollment systems that will effectively talk to one another and be easy for families to use requires thoughtful planning and sufficient lead time. That is why we continue to recommend that, as the Board develops the enrollment system for the Exchange and its subsidies, the State buckle down now and start planning for the streamlining and coordination of the other enrollment systems, like Medi-Cal and Healthy Families.

The hard work is just beginning! The 100% Campaign and our partners will continue to advocate (administratively) for better and more program coordination among the Exchange and other programs - not just at enrollment but also during renewal (something we didn't get in the final bill) and at transitions (included in the bill but could still be strengthened). Coordination is especially important when families will be split across programs, for example, when a parent is covered through the Exchange while their child is enrolled in Healthy Families. We will be laying out detailed recommendations for the Board on seamless enrollment, renewal and transition coordination and protections to ensure that only the minimum necessary information is collected from families to determine eligibility for coverage.

While we pushed to get the state Exchange law as strong as possible, we recognize that many detailed decisions of the Board will be determined by federal guidance. That's why we are sharing our thoughts and concerns with the Office of Consumer Information and Insurance Oversight about how the Exchange should coordinate with other programs, and urge them to provide helpful regulatory guidance on the issue. Like stakeholders in other states, we are weighing-in as the federal government develops these guidelines, rules, and regulations, but here in California we are in the unique position of simultaneously sailing ahead into uncharted waters.

So we can't wait passively for guidance to be issued and instead need to focus like a laser on ensuring that we get clear federal guidance that will address such critical issues such as children's benefit design, access to databases for existing eligibility information, and assurances of a coordinated and streamlined enrollment system.

Furthermore, as part of our effort to ensure that families know about and actually enroll in available coverage, we continue to recommend a preferential role for experienced community-based organizations as navigators. Based on our experience here, health care advocates in other states should be prepared for attempts to narrow the navigator role to licensed brokers/agents.

In the end, our State did not develop a perfect bill - the 100% Campaign and our partners had hoped for greater public/consumer representation on the Exchange board, stronger conflict-of-interest prohibitions, more comprehensive coordination requirements, and a preferential navigator role for experienced local community-based organizations. Yet, we are pleased to have a strong starting point and hope to make improvements in the months and years ahead. The new legislation helps structure the incredible amount of work that will be needed to turn the concept of an "Exchange" into an actual gateway to affordable coverage for millions of Californian kids and their families when 2014 rolls around.

Editor's Note: The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.

HHS Listening Session Promotes Transparency & Provides Rich Dialogue With Stakeholders

2010-08-31T22:12:09Z

It used to be that late August in Washington, D.C. was the perfect time to clean the junk out of your office, delete old emails, and go to the dentist. Now, though, the high energy folks in the Obama Administration charged with implementing health reform are bringing yet more change to Washington, D.C.. Yesterday, they sponsored an all-day listening session with stakeholders to gather thoughts and insights on the new Exchanges that are so central to health reform. They brought together employers, labor leaders, consumer advocates, insurers, and a host of other experts to cover exchange issues such as how to communicate with consumers; small businesses and exchanges; governance issues; promoting delivery system reform; and the role of exchanges in determining eligibility for premium and cost-sharing subsidies and coordinating with Medicaid.

The discussion was incredibly rich, but one theme that emerged over the course of the day - and that also was very much in keeping with HHS's vision for the meeting - is the importance of securing consumer input into health reform implementation and using a transparent decision-making process. Glen Schor with the Massachusetts' Connector was particularly eloquent on this point, calling transparency a "hallmark" of how Massachusetts has succeeded in implementing health reform. He and others noted it can be time consuming and cumbersome to solicit consumer input and to share all sorts of details about policymaking, but it is ultimately vital to helping people feel comfortable with major changes.

From a consumer perspective, there also was a fascinating discussion about the kinds of information that people will need to make decisions about their health care coverage under reform. Of particular note, I thought, were comments by DeAnn Friedholm of Consumers Union about the importance of recognizing that people make decisions in different ways. Drawing on Consumers Union's experience with publishing Consumer Reports, she pointed out that not everyone is likely to want a detailed chart comparing a health plan along a zillion different dimensions. Instead, some people may want a much simpler set of information, such as three good health plan options from which they can choose. While I personally am a huge fan of multi-dimensional charts and love a good spreadsheet, I'm guessing that much of America will want dramatically simplified information about how to secure coverage and enroll in subsidies.

I participated in a panel headed by Director of the Center for Medicaid and State Operations Cindy Mann on coordinating Medicaid and Exchange coverage. Many of the ideas will be deeply familiar to long-time Medicaid and CHIP experts and advocates, including the need for unified and simplified application and retention procedures for Medicaid and the Exchange; the importance of building a strong information technology infrastructure for eligibility determinations that allows linkages between the Exchanges, Medicaid and CHIP and databases that can be used to verify eligibility; and the value of providing people with multiple ways to apply for (renew) coverage, such as the option to submit applications on-line and/or to secure help from a community-based organization. At the same time, we discussed that the tax credits for premium assistance and cost-sharing subsidies pose some unprecedented challenges, including that the tax system is based on annualized income and is not designed to respond when incomes fluctuate over the course of a year.

As intended, the day raised more questions than answers, but, all-in-all, was much better than a trip to the dentist. Seriously, it was impressive to the extent to which people are beginning to roll up their sleeves and work on turning the health reform law into a practical reality.

Exchanges are Critical to Success of Affordable Care Act

2010-08-30T13:21:57Z

Health care "exchanges" are critical to fulfilling the promise of the Affordable Care Act and how states decide to meet their responsibility to establish them will have an enormous impact on children and families. Today, the Department of Health and Human Services is hosting a stakeholder conference to discuss exchanges. To coincide with the conference, my colleagues, Dawn Horner and Sabrina Corlette, released an issue brief that takes a deeper look at exchanges and what's at stake for children and families.

HHS's day-long conference is intended to engage stakeholders on the important policy decisions surrounding the establishment and operation of exchanges. CCF's Jocelyn Guyer will take part in a panel discussion and Dawn Horner will attend the conference. (You can view the conference via be webcast here.)

We'll hear more from them about the conference tomorrow, so let's get back to the issue brief. "Health Exchanges: New Coverage Options for Children and Families" provides a comprehensive overview of exchanges and key questions policymakers must consider when establishing exchanges. It outlines the funding and design decisions the states will have to make fairly quickly and points out the broad responsibilities exchanges will have in ensuring that consumers can make informed health care coverage choices.

For example, the Affordable Care Act requires plans to offer child-only policies (reflecting the importance policymakers placed on the need to ensure that children could secure coverage even if their parents were ineligible for an exchange plan). Beyond the essential benefits packages, exchange plans must provide children with a comprehensive package of preventive care services (referred to as Bright Futures), including immunizations, well-child visits, vision and hearing tests, health and behavioral assessments, and developmental screenings, with no cost-sharing. These federal standards are only a floor and states can require plans to cover services for adults and children that are not in the minimum package. In fact, a number of states already have policies mandating that plans cover specific services, some of them critical to children. (Sixteen states and the District of Columbia mandate that insurers offer at least some level of services for autism.)

Another issue that could impact many families is how well states meet the "no wrong door" policy established by the new law. It is vital that exchanges coordinate closely with Medicaid and CHIP because many people will move back and forth between subsidized exchange coverage and public program eligibility as their income fluctuates. The brief points out that states should consider ensuring that some plans offered in the exchange also serve Medicaid and CHIP beneficiaries, creating overlapping provider networks and requiring plans to help facilitate transitions for those in the middle of treatment.

The brief also covers the importance of dynamic technology applications to the success of the exchanges. The exchange procedures envisioned under the ACA rely heavily on the application of smart technology systems. States should consider setting up a working group now to begin to build these systems. As a first step, a state can pave the way toward electronic interfaces by implementing the proven Medicaid and CHIP automated linkage with the Social Security Administration allowed under CHIPRA to verify citizenship status.

These are but a few of the insights included in the issue brief. I hope you'll take the time to read it for yourself and share it with others in your state. We would also love to hear from you on how your state is approaching the establishment of its exchange.

Group of State Medicaid Directors Creates New Association

2010-08-25T19:31:36Z

After two weeks in New Hampshire and Maine and a few extra cups of coffee to get moving, I returned from vacation yesterday to find this very interesting development in my inbox - the nation's Medicaid directors are breaking away from the American Public Human Services Association to start their own independent organization - the National Association of Medicaid Directors. In explaining why they are making the change, the new President of NAMD, Carol Steckel of Alabama Medicaid, explained "Healthcare reform is dramatically changing the face of Medicaid in all of our states and with those changes brings the need for a change to an organization specifically focused on Medicaid and its Directors."

Since I got myself in serious trouble over vacation by expressing an opinion on a family member's new boyfriend, I'm officially out of the business of offering my thoughts on anyone else's relationships, including that of the nation's Medicaid Directors with APHSA. So, leaving aside whether the split was a good idea or not, I do think it is clear that Medicaid is entering a new era. As a companion program created alongside Medicare in 1965, it long has been a cornerstone of the nation's health care system, especially for low-income children and families. And, now it is destined for even greater things in the months and years ahead as we move toward broader health reform.

The success of both organizations and close collaboration between them will be vital to fostering the critical connections between health care and other social services programs needed to improve the lives of America's families.

CMS Releases Guidance on the Extension of Enhanced FMAP Funding

2010-08-19T19:01:57Z

On August 10th, President Obama signed an extension of the state fiscal relief first authorized under ARRA. Under the extension, states will continue to receive a phased-out increase in their federal Medicaid matching rate through June of 2011, as opposed to it expiring at the end of this year.

CMS released guidance on the FMAP extension, clarifying that all the maintenance of effort requirements that applied to states under ARRA continue under the extension.

There was one change, however, to the manner in which states request and receive funds. Under the extension, as a condition of receiving the additional federal Medicaid funds, the Governor must submit a request within 45 days of enactment, or by September 24, 2010.

Three Cheers for Dependent Coverage Expansion!

2010-08-19T13:15:00Z

By Patrick Tigue, New England Alliance for Children's Health

While there are many provisions in the Affordable Care Act (ACA) that will benefit children and families, the expansion of dependent coverage to children up to age 26 is among the most important - especially in the short-term. In 2011 alone, as many as 1.64 million previously uninsured young adults are estimated to gain coverage under their parents' health plans. The provision takes effect after September 23, 2010.

Recently, the federal government issued regulations further explaining how this provision will work. Here at the New England Alliance for Children's Health, an initiative of Community Catalyst, we support these regulations because they clarify several important points that will benefit young adults and apply the law with their interests at heart:

Young adults are eligible for coverage under their parents' plan regardless of what state they live in and whether they are tax dependent, financially independent, or a student, employed, or married.
Premiums or benefits cannot vary based on the age of a young adult who qualifies as a dependent.
The provision applies to all health plans and only grandfathered health plans (those in existence prior to March 23, 2010) can exclude young adults with access to an employer-sponsored plan until 2014. After 2014, this exception no longer applies.
Insurance companies must provide prominent notice to enrollees about the special enrollment period for dependents.
States have the option to extend dependent coverage beyond age 26.

All of these clarifications and others included in the regulations will ensure that dependent children and their families can take full advantage of this important opportunity to secure the health coverage they need.

While we are enthusiastic about the regulations, we've also been working collaboratively with a group of our partners to offer some suggestions to the federal government on how to improve them in a few key areas:

Clarify that stepchildren and adopted children are included in the definition of a dependent child.
Further explain the situations where grandfathered plans can remove young adults who are eligible for employer-sponsored insurance to ensure that this does not unduly burden young adults.
Require that prominent notice be clear and conspicuous--ideally in the form of a stand-alone document highlighting the availability of the new coverage option and how to enroll.

It's our hope that the regulations will be revised soon to reflect these suggestions, but in the meantime you can find out more about the dependent coverage expansion here. This provision is one of the many examples of the very real opportunities that ACA provides to extend coverage to those who otherwise would go without.

This blog post was originally posted on the Health Policy Hub. The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.

Editor's Note: CCF also submitted comments on the dependent coverage regulations which you can read here.

Location Matters

2010-08-17T13:05:00Z

I know I've said it dozens of times - states are different. Like people themselves, they have their own characteristics, quirks, and personalities that make them unique. But what about within states - are there differences of note? Why, of course (I'm sure we can all think of a long list of differences between, say New York City and upstate NY). And lucky for us, a recent data release from the Census highlights how health insurance coverage varies within states' very own borders.

(Quick methodological note for those of you who are interested in such things: the Small Area Health Insurance Estimates (aka SAHIE) are model-based and combine data from a variety of sources. These data represent coverage in 2007, prior to the economic downturn. They are currently the Census' only data source on health insurance for every county in the US. For more on the various measures Census has on health coverage, check out this helpful fact sheet. The Census also computes small area estimates for income and poverty (aka SAIPE).

Now back to the data at hand - at 26.8%, Texas has the highest rate of uninsured in the country. But where are those 5.8 million folks living? The range in the uninsured rate is quite wide, from 16.6% in Collin County to 49.5% in Kennedy County. What makes these two counties in the same state so wildly different in terms of health coverage? A quick look at some demographic data provides us some idea:

Collin County, located just north of Dallas, is about 850 square miles and has about 765,000 people. In 2007, the median household income was around $80,000.

Kennedy County is located on the Gulf Coast between Brownsville and Corpus Cristi. It's almost twice the size of Collin County, 1,450 square miles, but has less than 400 residents, with a median income of about $30,000 in 2007.

I think it's fair to say that we don't have to pick on Texas as an example, as other states are bound to have within-state variation (even Massachusetts - known for its low uninsured rate of 7.8% - has a range of 6.6% to 13.9%).

State officials and advocates should find these data very helpful in identifying which areas of their states have the greatest number of uninsured residents and possibly understanding the reasons for such differences. (Note - although I didn't do it here, you can also look at the data by age ranges and income levels). And when making the case for targeting outreach efforts, both for those who may already be eligible for coverage through Medicaid and CHIP and, in 2014, for those who will become newly eligible, having data to support your claims will make your case that much stronger.

Getting Kids Covered and in the Game

2010-08-16T14:55:32Z

Last week, Cindy Mann blogged about the importance of kids' coverage on healthcare.gov. "As back-to-school time approaches, families are thinking about making sure their children have every opportunity to learn. Now is also the time to make sure that kids have the coverage they need to be healthy - the first step to a successful school year."

Luckily, many kids already have an affordable coverage option through Medicaid and CHIP. As part of the challenge to get all eligible kids signed up, CMS has launched Get Covered. Get in the Game. to bring coaches, schools, families, and communities together to raise awareness. (Maryland's Suzanne Schlattman blogged about the campaign for us earlier this month.)

Check it out to see how you or your organization can help get children covered and in the game.

CCF & Kaiser Identify Key Issues for Policymakers to Consider for Newly Eligible Medicaid Beneficiaries

2010-08-11T18:47:09Z

Under the Affordable Care Act, states will have considerable flexibility, within federal guidelines, to design Medicaid benefit packages and cost-sharing rules that are appropriate for newly-eligible adult beneficiaries. The often-extensive health care needs and very low incomes of the newly-eligible adults are important considerations for states as they put the new law into effect, according to a new issue brief written by CCF and the Kaiser Commission on Medicaid and the Uninsured.

Half of all uninsured adults below 133 percent FPL have income below 50 percent FPL. When it comes to their health status, about one-third have a diagnosed chronic condition, such as hypertension or depression, and about 1 in 6 are in fair or poor health. Given the limited income and often-extensive health care needs of newly-eligible adult Medicaid beneficiaries, it will be critical that they be provided with benefits designed to reflect their unique needs if health reform is to work as intended.

Both the federal and state governments will play important roles in making sure the new law works for newly-eligible adult Medicaid beneficiaries. The issue brief identified two key areas for policyakers to consider as they move forward on implementing the new law:

Benefit Packages: The content of the coverage provided to the millions of low-income adults slated to secure Medicaid coverage under the health reform law will depend, in part, on how the federal government addresses key issues, such as the definition of "essential health benefits." In addition to covering these essential benefits, the coverage for the newly eligible must be equal to coverage provided under one of three "benchmarks." Importantly, states can also provide additional benefits on top of the benchmark.
Continuity of Care: Given that changes in income, health status, and other factors are common, coordination and consistency of coverage between Medicaid groups and over time are key aims. Because individuals may also shift between eligibility for Medicaid and Exchange coverage, identifying ways in which states can promote continuity of care between the two systems is a priority.

The responsibility of creating a coherent program that provides the full range of groups served by the Medicaid program with the benefits that they need when they need them falls mainly to the states. Thankfully, the federal government has helped make it easier on the states by making a commitment to finance the full cost of care for the newly-eligible Medicaid adults for the first three years of reform and at least 90 percent of the cost thereafter.

Hope for uninsured low-income adults is on the horizon. Let's hope policymakers finish the job by making wise choices in how they design the benefit packages and address the need for continuity of care for newly eligible Medicaid beneficiaries.

Extension of Medicaid Relief Clears Last Hurdle in Congress

2010-08-10T20:04:50Z

We've been following for some time the inconsistent progress of legislation that would extend increased federal Medicaid payments to states. While versions of the legislation have previously passed both houses of Congress, the two chambers had not succeeded in making the extension law by agreeing to the same bill. Today, they have, with the House interrupting its August recess to pass a bill approved by the Senate last week that includes both the Medicaid funding and more support for public schools. The act will continue for six months a portion of the increased Medicaid funding that states have been receiving under the economic recovery legislation. The funds had been scheduled to expire in December of this year, but instead will phase out through June of 2011.

States have been receiving an extra 6.2 percentage points in federal matching funds for their Medicaid programs, plus an additional amount based on the state's unemployment rate. Under the extension, this will drop to 3.2 percentage points in January 2011 and 1.2 percentage points in April, again with an additional increase based on unemployment figures. See this Center on Budget and Policy Priorities report for an estimate of the amount each state will receive over the first six months of 2011.

This extension will give states a bit more breathing room in their 2011 budgets. The Medicaid and education funds will help protect not only health coverage and kids' schooling, but should reduce pressure across states' budgets. Many states had already counted on the extension in the budgets they approved earlier this year, so Congress's action is an important contribution to keeping those budgets intact. State budgets remain challenged but it's good to see Congress take action to protect important services that are helping kids and families today.