See Legislative news below from our friends at the Colorado Center on Law and Policy! Have a great weekend!
CCLP Heads-Up recaps and previews developing issues of interest regarding the health, economic security and well-being of low-income Coloradans. The newsletter is published regularly by the Colorado Center on Law and Policy, a nonprofit, nonpartisan organization that advances the health and economic security of low-income Coloradans through research, education, advocacy and litigation.
|Medicaid issues warrant notice
Three bills that were recommended and developed by CCLP and the Colorado Cross-Disability Coalition (CCDC) will be considered by Colorado legislators next week. House Bills 1126 and 1143 are scheduled to be heard by the House Public Health Care & Human Services Committee, Feb. 14 at 1:30 p.m. at the State Capitol. A related measure, Senate Bill 121, is slated to be reviewed by the Senate Health & Human Services Committee’s on Feb. 16 at 1:30 p.m.
The bills, which received bipartisan sponsorship, are intended to address shortcomings in client correspondence and notifications when Medicaid benefits are about to be changed or terminated. An interim committee held three hearings about Medicaid correspondence last summer, which included testimony from CCLP, CCDC, and the Colorado Department of Health Care Policy and Financing.
Currently, Medicaid recipients are supposed to receive notice with information about how to appeal changes or termination of their benefits if they believe the action is unjustified. In practice, however, these notices are often vague and confusing. Most do not specify why benefits are being terminated or reduced, so Medicaid clients don’t always know whether they should challenge the decision. Furthermore, without proper notice, those who appeal may be unable to fully prepare their case.
Sponsored by Rep. Jessie Danielson, D-Wheat Ridge, and Sen. Larry Crowder, R-Alamosa, HB 1126 would ensure that an administrative law judge reviews the sufficiency of Medicaid termination notices at the beginning of an appeal hearing. The bill also requires the judge to inform the client of his or her option to receive an improved notice with the possibility of maintaining benefits, or proceed with their hearing.
Sponsored by Rep. Lois Landgraf, R-Fountain, and Sen. Crowder, HB 1143 would direct the state to audit communications with Medicaid clients. These audits would review the notices for legal sufficiency, clarity and accuracy. Audit findings, conclusions and recommendations will be presented to legislative committees, which can then consider whether the results warrant further reforms.
Finally, SB 121, sponsored by Sen. Kevin Lundberg, R-Berthoud and Sen. Crowder, requires the Colorado Department of Health Care Policy and Financing to engage in a process to improve Medicaid client communications – including client letters and notices – that addresses denial, reduction, suspension, or termination of Medicaid benefits.
Collectively, these proposals will help ensure that Medicaid clients do not lose access to health care due to the shortcomings in the current notification process.
Children and young adults with special health care needs are those who require higher-than-average use of the health care system due to a health condition such as diabetes, epilepsy, cerebral palsy, autism, cancer, sickle cell disease, traumatic brain injury, or other illness or disabilities. The Affordable Care Act (ACA) includes a number of provisions that are extremely important to CYSHCN and their families. Among the most important of these are:
- A prohibition on refusing to insure or charging more for coverage of children with pre-existing conditions, or excluding coverage for services related to that condition. Before the ACA, children could be denied insurance, charged more for insurance, or denied coverage for the services they needed most because they had a pre-existing condition such as a congenital heart defect, cerebral palsy or asthma. Without insurance for their children, many families could not afford the expensive medications, medical care, and hospitalizations their children needed, forcing them into medical bankruptcy.
- Elimination of annual and lifetime benefit caps. Before the ACA, a very sick premature infant might reach on his or her lifetime cap on coverage before even leaving the hospital, sometimes leading to the family’s bankruptcy. Children with chronic conditions who needed expensive medications or frequent therapies might reach their annual cap every year.
- Habilitation services and devices, other critical health benefits. Before the ACA, many insurance plans did not cover “habilitation” services – therapies needed by many children with developmental disabilities to acquire and maintain skills (e.g, physical therapy for those with cerebral palsy so they can learn to walk, speech therapy for those with hearing impairments). The ACA also ensures that children get critical oral and vision care and behavioral health services.
- Allowing young adults to stay on their parents’ insurance policies until age 26, and providing Medicaid to former foster children until age 26. These provisions help many young adults with chronic illnesses or disabilities who do not have access to employer-sponsored insurance but are not eligible for Medicaid, and provide a parallel benefit to former foster children, including those with special health care needs.
- No-cost preventive care for children based on the “Bright Futures” recommendations of the Maternal and Child Health Bureau and the American Academy of Pediatrics. No-cost check-ups and screenings help to ensure that health or developmental problems are detected and addressed early in a child’s life, helping to avoid more expensive treatment or special education later on.
- Medicaid expansion to all individuals with incomes up to 138% of the federal poverty level. This provision helps young adults and others with chronic illnesses or disabilities who do not have access to employer-sponsored insurance and are not otherwise eligible for Medicaid.
Medicaid is a vital program for children and youth with special health care needs (CYSHCN) – children who have any of a broad range of chronic illnesses and/or disabilities (e.g., cerebral palsy, epilepsy, diabetes, autism). Approximately 15 million, nearly 20 percent, of all U.S. children have special health care needs. Over 44 percent of these children rely in whole or part on Medicaid or CHIP to cover the costs of their care.
Over 11 million CYSHCN – 35.9 percent — rely completely on public insurance to get the services they need. Another 8.2 percent have a combination of private and public insurance. In those cases, Medicaid helps families pay for out-of-pocket costs, and may serve as “wrap-around” coverage to supply services or devices not covered by their private plans. For example, some medical equipment and assistive devices (such as hearing aids) may not be covered under traditional insurance plans but are available through Medicaid.
Accordingly, Medicaid can save families from bankruptcy that might otherwise result from high medical bills. In many cases, it also allows parents to continue working by supplying caretaking services for their children.
In addition, Medicaid helps to prevent or ameliorate disabilities, since children on Medicaid have access to Early and Periodic Screening, Diagnosis and Treatment (EPSDT). Early screening and diagnosis means that developmental or health problems can be identified early in a child’s life, and necessary treatment can be provided before a condition develops or becomes more severe. As a result, some children can avoid the need for special education services.
If not for Medicaid —
- Santina – a teen from Pennsylvania with Rett Syndrome and epilepsy – could lose access to her medication. And, her single mother would probably have to quit her two jobs if Medicaid’s safety net were not there to provide a caretaker for her daughter.
- The family of Joshua – whose life-saving liver transplant was paid for by Oregon Medicaid — would not have the means to pay for the 22 medications he must take every day.
- Jason, from Ohio – who has developmental delays that leave him unable to speak, walk, or use his hands in a coordinated fashion – would lose the early intervention, speech, occupational, and physical therapies that will one day allow him to walk, speak and use his hands.
In short, millions of vulnerable children and their families rely on Medicaid to help them obtain and pay for critical medical care and related services.
Please send me your stories about how Medicaid or CHIP has helped your family.
Tom Rose email@example.com