Health Reform Highlights for Children with Special Health Care Needs May 19, 2010

Health Reform Highlights for Children with Special Health Care Needs

May 19, 2010

Who is AMCHP?

The Association of Maternal & Child Health Programs is a national resource,

partner and advocate for state public health leaders and others working to

improve the health of women, children, youth and families, including those with

special health care needs.

2May 19, 2010

AMCHP Center for Health Reform Implementation

Immediate Opportunities

Intermediate Reforms and Insurance Expansions

Long Term – Role of Title V in a Reformed System

3MARCH 13, 2009 LOREM IPSUM DOLOR

Health Reform Highlights for MCH

Big Picture

Patient Protection and Affordable Care Act became law March 23, 2010.

• Coverage for 32 million uninsured people.

• Broad reforms in insurance industry practices.

• Major new investments in health care access and care coordination through medical homes.



• Expands Medicaid to all under 133% of poverty

• Preserves Medicaid & CHIP coverage for children above 133% of FPL.

• Extends Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) to all children gaining coverage via Medicaid

• Assures continuation of CHIP benefits package to eligible children until 2019.


Coverage and Benefits Basics


Coverage and Benefits Basics• Creates state-based Exchanges to provide coverage and provides tax credits to help people with income up to 400% of FPL

•Establishment of temporary high-risk pools until state exchanges are up and running

•Establishes four benefit packages available within Exchanges - bronze, silver, gold, and platinum will vary by actuarial value.

•The bronze plan provides minimum essential coverage at actuarial value of 60%; platinum at 90%.



Exchange Plan Benefits Must Include• Ambulatory services

• Emergency services

• Hospitalization

• Maternity & newborn care

• Mental health & substance abuse disorder services, including behavioral health treatment

• Prescription drugs


• Rehabilitative & habilitative

services and devices,.

• Laboratory services,

• Preventive & wellness services

and chronic disease

management, and

• Pediatric services, including oral

and vision care.

• Eliminates co-pays for

preventive services.


Insurance Market Reforms

• Young adults can remain on their parents’ health plan until age 26

• Children with insurance can no longer be denied coverage for pre-existing conditions

• Insurance plans can no long impose lifetime caps or restrictive annual limits



Access and Care Coordination through Medical Home Investment

Health Homes in Medicaid: $25 million in planning grants to states to develop a state plan amendment to provide health homes.

CMS Center for Medicare and Medicaid Innovation: establishes a new Center for Medicare and Medicaid Innovation within

CMS to test innovative payment and service delivery models for Medicare, Medicaid, and CHIP programs. Includes mandatory

appropriation of $10 billion over the next ten years for implementation.



Access and Care Coordination through Medical Home Investment

Pediatric Accountable Care Organization Demonstration Project: authorizes participating states to recognize pediatric medical providers as an accountable

care organization (ACO) for purposes of receiving incentive payments

State Grants to Promote Community Health Teams that support the Patient-Centered Medical Home : grants for community-based interdisciplinary teams

which will provide support services to primary care practices.


Healthy Children. Healthy Families. Healthy Communities.

WWW.AMCHP.ORG

Michelle Alletto, MPAAssociate Director

Public Policy & Government [email protected]

(202) 266-3045

Documents

Health Reform Highlights for Children with Special Health Care Needs May 19, 2010