Tag Archives: Medicaid

Staff Spotlight: Susan Hogarth

Susan Hogarth and her son, Jake
Susan Hogarth and her son, Jake

Susan Hogarth, whom you may remember from our November family story, recently joined the Family Voices Colorado team as the new Pediatric to Adult Health Care Transitions Navigator. In addition to learning the ropes of the Family Voices approach to family navigation support, Susan took a lead role in planning for Hearts on Fire 2013.

Susan was first introduced to Family Voices in April 2008, through the Arc of Jefferson County’s Mobilizing Families training program. She explains, “We were struggling with insurance denials for therapy for our son, Jake, and classification of developmental delay. The staff at Family Voices helped during the appeal process, attending conference calls with insurance agents and human resources. Family Voices provided the resource of an attorney who worked pro bono, resulting in the case being overturned and re-classification of disability such that all services were covered.”

In July 2012, Susan sought the help of Family Voices once again, this time with the application for the Medicaid Buy-In for Children with Disabilities, as Jake was on the CES waiver waitlist and not receiving Medicaid. He was approved for the Buy-In, and now receives the benefits of Medicaid coverage – including several therapies and other services not previously available – for a relatively low monthly premium.

Susan’s professional background is as a consulting actuary, but her passion was to leave that 20-year career to work with a non-profit, helping families of children with special healthcare needs. That dream came true in January 2013, when Family Voices hired Susan as a Transition Navigator. She tells us,

“The combination of my professional background as an actuary in the pension and healthcare benefits arena, and my personal experience as a mother of a disabled child with special healthcare needs, served as a perfect fit.  I have battled with insurance companies, spent hours in the hospitals, doctors office, therapy visits, durable medical equipment fittings, moved to other states thinking it was ‘better somewhere else!’ (which is a misconception as Colorado is one of the most well-educated states, and providing state of the art services including a high level of knowledge for technology), spending hours with the schools and IEPs, etc., just like many of the families we serve.

“I hope to provide some comfort to families that there is hope, and I can help them navigate the systems that all parents of children with special health care needs have to face on a daily basis. Colorado is stepping up to the plate, showing their support for the disabled community through the recent news relating to legislative budgets to include additional funding for individuals with disabilities currently on waitlists.

“It is exciting to work for Family Voices during this time, watching it grow into leader of navigation support in the community.”

We are glad to have Susan on board! Stay tuned for an announcement coming very soon about a new tool for families, health care providers, and other professionals: a Transition Guide that offers resources and tasks for each stage from age 10 through mid-20s!

Counting what counts

Stories vs. Numbers

In our work to improve access to and quality of health care for children and youth with special health care needs and their families, we spend a lot of time telling stories: the stories of obstacles and challenges that real families face as they try to navigate the often confusing systems that are supposed to provide the services they need, from public and private health insurance to social security, disability services, and education, as well as their triumphs and joys.

Stories are powerful: they can paint a picture, convey struggle and emotion, and invite participation. But once we have a listener’s attention – whether a legislator, reporter, grantmaker, donor, or professional partner – with what would rightly be termed “anecdotal evidence,” we also have to know what the data says. In spite of the pithy statement attributed to Albert Einstein that “Not everything that can be counted counts, and not everything that counts can be counted,” in this era of empirical verification and accountability, numbers are essential. AND we have to make sure that we pay attention to the measures that really matter when it comes to families’ experiences.

Within the last week or so, three new reports have been released that offer new data – and some stories – relating to (1) children’s overall health and wellbeing in our state, (2) consumer perspectives on how the Healthy People 2020 goals relate to children and youth with special health care needs, and (3) the number of families of children with special needs and Family Voices’ impact as the federally funded Family-to-Family Health Information Center for Colorado.

Links to view the reports themselves:

Some significant findings

KIDS COUNT 2013:

Economic Security

  • In 2011, children were the age group most likely to be living in poverty in Colorado. Colorado children were 1.4 times as likely to live in poverty as adults between the ages of 18 to 64 and 2.6 times more likely to live in poverty than Colorado seniors.
  • More than one in six Colorado kids lives in poverty (approximately 217,000 children), according to the most recent estimates.
  • The number of children living in extreme poverty (family of four with income below $11,500) has increased 160% since 2000; the number of children living in families above 200% FPL has decreased from 68% to 60%.

Health – starts p. 26 of the .pdf

  • Throughout most of the 2000s, Colorado’s rate of uninsured children was consistently above the national average. Between 2005 and 2010, however, the number of uninsured children in Colorado declined by 31%, according to the Current Population Survey. In 2010, only 9% of Colorado kids (approximately 113,000 children) under 18 were uninsured. With positive momentum behind us, the finish line to covering all Colorado kids is within reach.
  • While Colorado has made great strides in getting more children covered, children in poverty and in low-income families remain much more likely to be uninsured than their peers in economically stable families. Colorado has historically ranked poorly when it comes to insuring children in poverty, but we have seen steady improvement during recent years. In 2010, Colorado ranked 42nd in the nation, with 19% of all children in poverty uninsured (approximately 43,000 kids). Among children in low-income families (between 100 and 200% of the federal poverty level), 18% were uninsured in Colorado in 2010.
  • Medicaid and the Child Health Plan Plus (CHP+) are important factors in the race to the finish line of covering all Colorado kids. As public health insurance programs administered by the Colorado Department of Health Care Policy and Financing and funded jointly by the federal and state government, Medicaid and CHP+ help kids get the preventive care they need to stay healthy and ensure they can see a doctor when they are sick or injured. Medicaid covers children in families with incomes up to 133% of the federal poverty level (approximately $30,600 for a family of four in 2012), and CHP+ covers children in families with incomes that are too high to qualify for Medicaid but are below 250% of the federal poverty level (about $57,600 for a family of four in 2012).
  • During times when our economy struggles, enrollment in Medicaid and CHP+ typically grows as unemployment rises and many parents lose their income and benefits. The latest recession was no different. In FY 2011-12, 30 percent of all Colorado kids ages birth to 18 (about 393,000 children) were enrolled in Medicaid at some point during the year, a 28% increase since FY 2007-08.
  • During the same time period, enrollment in CHP+ grew by 64%, with 10% of all Colorado kids ages birth to 18 enrolled in FY 2011-12 (approximately 133,000 children). In addition to the effects of the recession, eligibility for CHP+ was expanded as a result of House Bill 09-1293, the Hospital Provider Fee bill. Many policies were put in place to improve administration and remove barriers to enrollment, which also contributed to the large increase in enrollment.

Children and Youth with Special Healthcare Needs in Healthy People 2020: A Consumer Perspective

The Genetic Alliance has a helpful overview of the background and goals of this report

The Basics: Who are CYSHCN?

Children and youth with special healthcare needs are defined as “those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”

How many are there?

  • Approximately 10.2 million children in the U.S. – 15 percent of all people under the age of 18 – have special healthcare needs.
  • More than a fifth of U.S. households with children have at least one child with special needs.

What are the Core National Performance Measures for CYSHCN?

  1. Families of children with special healthcare needs partner in decision-making at all levels.
  2. Children with special healthcare needs receive coordinated, comprehensive care through a medical home. (A medical home is not a location; it is an approach to care centered on partnership between family and providers of all services.)
  3. Families of children with special healthcare needs have adequate health insurance and financing to pay for needed services.
  4. Children receive early and continuous screening for special healthcare needs.
  5. Community-based services are organized for easy use by families.
  6. Youth with special healthcare needs receive the services necessary to transition to adult healthcare, work, and independence.

Family Voices Colorado Data Brief 03-20-2013

  • In Colorado, there are approximately 167,524 children and youth with special health care needs age 0-17.
  • Family Voices Colorado reached approximately 10,400 of these families, and nearly 3,600 professionals from June 2011 to May 2012.
  • Among families of CYSHCN who have insurance, 44.8% report that their current insurance is inadequate.
  • 29.2% of families report that their child’s condition causes financial problems for the family (46.1% of families without adequate insurance).
  • 25.9% of families report that their child’s condition has led to family members cutting back or stopping work to care for their child (37.5% of families without adequate insurance).

Among families served by Family Voices Colorado who completed a follow-up survey,

  • 98.5% report being better able to partner in health care decision-making as a result of that assistance;
  • 98.6% report being better able to find and/or learn about community services; and
  • 95.5% report more confidence in getting health care and services needed by their child.

Your story matters

In short, the need is tremendous, and we are doing all that we can to make sure that families of young people with special needs are not alone as they face the challenges of securing the health care and related services that their children need. If your life includes a child with special health care needs, please feel free to call us for help navigating these systems and services: 303-733-3000 or 800-881-8272.

And if you have been helped by some part of our work at Family Voices Colorado, we invite you to consider sharing your story or giving back in whatever way you are able.

Health Care Law Updates

If you’ve been listening to the federal budget discussion and the “sequestration” that is now in effect, applying spending cuts across the board, you may be wondering what that means for health care. The good news is that certain important programs, like Medicaid, Social Security, and SNAP (food stamps) are exempt from the cuts. The not-so-good news is that Medicare provider payments will be cut 2% on an annualized basis. Of course, this could all change if Congress can agree on a way forward for federal deficit reduction.

Federal grant funds, like the Family-to-Family Health Information Center Grant that supports some of our work at Family Voices Colorado, will see some cuts, but we are still waiting to find out exactly how those will be applied. At this point we are not planning to reduce staffing or services, but please contact us if you have any questions.

The Patient Protection and Affordable Care Act, also known as health care reform, Obamacare, or ACA, will be rolled out fully as of January 1, 2014. The law is wide-reaching in its implications for health insurance companies and for individual and family consumers. Here are a few resources that might be helpful as you or people you know are trying to understand the big picture more fully:

HealthCare.Gov: Learn about health insurance basics, sign up for email or text message updates, read about the coming Health Insurance Marketplaces, and find out how the new federal law might affect you. http://www.healthcare.gov/

Connect for Health Colorado: Formerly called the Colorado Health Benefit Exchange, this is our state’s Health Insurance Marketplace. Information and resources are available now, but the insurance plan research and application functions will go live this fall. http://www.getcoveredco.org/

The Health Care Law 101.  National Family Voices is offering a presentation on the main provisions in the Affordable Care Act and how to access care in your community in English on March 7 at 1pm EST/11am MST, and in Spanish on March 19 at 3pm EDT/1pm MDT. (Note that we switch to Daylight Savings Time this weekend, March 10, 2013.)

Frequently Asked Questions about ACA Implementation.  CMS has posted a set of frequently asked questions about Medicaid and CHIP (State Child Health Insurance Program – CHP+ in Colorado) issues related to the ACA, including changes in Medicaid eligibility (under the “Eligibility Policy” category.)