Category Archives: Policy Updates

Health Care News Roundup

Infographic: what matters to consumers in the new Colorado Health Benefits ExchangeColorado’s Health Exchange: What Consumers Want

As full implementation of the Affordable Care Act draws nearer, advocates and policymakers across Colorado are hard at work developing plans for the state’s new Health Benefits Exchange. Michael Booth at the Denver Post takes a look at the results of recent community forums that asked consumers what features or qualities are important to them in a tool that is supposed to help them understand their options and choose a health insurance plan. Click on the image at left to see the infographic larger.

Share Your Health Insurance Story (CCHI)

Is your insurance unaffordable? Have your rates increased unreasonably? Tell us about it! The Colorado Consumer Health Initiative, an advocacy organization that works for barrier-free access to quality healthcare, wants to hear your story. We are building a storybank – a collection of real peoples’ experiences with the healthcare system – so that we can better inform the media, elected officials, and our fellow Coloradans about important issues. We want to help you make your voice heard. Click here to share your story! 

Upcoming Events

On Tuesday, January 22, 12:00 – 1:30pm MST, health care providers and administrators are invited to a webinar hosted by the National Wraparound Initiative: Using Medicaid Health Homes with Wraparound to Serve Youth Populations with Complex Behavioral Health Needs. Click to register. This webinar will provide an overview of the Medicaid Health Home provision of the Patient Protection and Affordable Care Act (PPACA) and its application to children with serious and complex behavioral health needs. Learn what administrative, workforce, and practice level strategies states can adopt within the Health Home model to implement a high quality wraparound and intensive care coordination approach for these youths and their families.

The 5th Annual Jewish Disabilities Awareness Day and Family Resource Fair, Finding Ability in Disability: Promoting Understanding and Inclusion, is on Sunday, January 27, 2:00 – 5:00pm at the Elaine Wolf Theatre and the Robert E. Loup Jewish Community Center, 350 South Dahlia Street in Denver. Free and open to the public.

PEAK Parent Center’s Conference on Inclusive Education is coming up, February 7-8, at the DoubleTree by Hilton Denver.  Parents, teachers, special educators, school administrators and other school professionals will all find something of interest in the speakers, workshops, and break-out sessions. There’s still time to register, but hurry, since the event may sell out!

Firefly Autism is having an intensive Social Skills Camp for children with Autism from March 25-29.  We want to get the word out and would appreciate your support in letting your families know, and the Autism Community at large.  Please refer any questions to Jenny Blankenship, Director of Outreach & Social Skills Services, at jblankenship@fireflyautism.org (303-759-1192, x12).

Medicaid expansion is good news for Colorado

Last week, Governor Hickenlooper announced that Colorado will move forward with the Medicaid expansion called for under the Affordable Care Act. Family Voices Colorado joins The Colorado Health Foundation and other health care advocacy groups in applauding the decision to increase health care coverage for thousands of currently uninsured Coloradans.

Colorado has been actively preparing for Medicaid expansion since the Colorado Health Care Affordability Act (HB 09-1293) passed in 2009, with a Hospital Provider Fee contributing funds toward Medicaid and drawing down additional federal funding to support health care services for additional low-income populations. But last week’s announcement is the first official assurance that an additional 160,000 adults whose incomes are below 133% of the Federal Poverty Level (currently $14,856 for an individual or $30,657 for a family of four), will become eligible for Medicaid in 2014, since the Supreme Court ruled in June that the federal government could not compel states to expand their Medicaid programs. Eric Whitney summarizes the legislation and potential impact well in this article for Kaiser Health News; Jeff Bontrager and Megan Lane raise some additional questions in the Colorado Health Institute’s blog.

Family Voices Colorado believes that all people deserve access to quality health care. And although eligibility for health insurance (public or private) is not the same as access to care, lack of insurance coverage is often a primary barrier to accessing family-centered, comprehensive, coordinated care in a medical home. Therefore, we support this expansion of public health insurance coverage in our state, as an opportunity to improve health outcomes and opportunities to thrive for vulnerable Coloradans.

Family Voices staff work with many families who rely on Medicaid for health care coverage, whether solely for a child with a disability or for the entire family. If you have questions about whether your family may be eligible for Medicaid or CHP+, please call us at 303-733-3000 or 800-881-8272. And know that we will continue to speak up on behalf of children and youth with special health care needs and their families as health care reform is implemented.

Essential Health Benefits and the Affordable Care Act

Family Voices (National logo)

This article reposted with permission from National Family Voices.

Affordable Care Act: Essential Health Benefits & Habilitative Services 

by Brooke Lehmann and Janis Guerney

The Department of Health and Human Services (HHS) recently issued a proposed regulation that, among other topics, addresses the “Essential Health Benefits” that must be included in certain health plans pursuant to the Affordable Care Act (ACA).  The proposed regulation raises serious concerns about the availability of “habilitative” services-therapies and devices that help individuals to acquire or maintain skills or function.

BACKGROUND: The ACA requires that a package of “Essential Health Benefits” (EHB) be covered in all health insurance plans sold in Exchanges and in all non-grandfathered individual and small group policies for plan years beginning in or after 2014.

ACA Essential Health Benefits List:

Girl receiving injection from female doctor
Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net
  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive/wellness services and chronic disease management
  • pediatric services, including oral and vision care

The Department has proposed that each state establish its own set of EHBs, based on a “benchmark” plan selected from one of four types of plans sold in that state (e.g., largest small group plan, largest HMO).  If a state fails to select a benchmark, then the default will be the largest small group plan in the state.  About half of the states have already identified their benchmark choices, which must be made by December 26.

HABILITATIVE BENEFITS:  With respect to habilitative services, the proposed rule is quite troublesome.  If the state’s benchmark plan does not include any habilitative services, the state would be able to define that benefit.  But HHS does not provide guidance about how states should do so.

If a state declines to define habilitative services, then insurance plans will determine the benefit.  Each plan must either provide habilitative services that provide parity with rehabilitative services, or establish its own set of habilitative benefits and report them to HHS.

If insurers get to define habilitative services without any parameters, each one will have an incentive to provide minimal benefits, so that its plan will not attract a disproportionate number of people who need costly habilitative services.

Family Voices and other groups will be submitting comments on the proposed regulation and we urge others to provide public comments on benefits that are important to CYSHCN.   Submit comments by 12/26 at
http://www.regulations.gov/#!docketDetail;D=CMS-2012-0142.
Contact the FV Policy Team with any questions:
Brooke Lehmann, MSW, Esq.: blehmann@familyvoices.org or 202-333-2770
Janis Guerney, Esq.: jguerney@familyvoices.org  or 202-546-0558

Learn more about Essential Health Benefits at this page.