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.

Season’s Greetings! A note from Tom Rose, Executive Director

Dear Friends, Colleagues, Advocates, and Supporters,dancing snowman in a snow globe

The weather has finally turned colder, we’ve seen a couple dustings of snow lately, and as we move through the holiday season, we here at Family Voices Colorado are counting our blessings:

First, thank you to all who donated on Colorado Gives Day! Our individual giving increased by 18% over last year, and we are grateful for the support. Your gift makes it possible for us to continue providing services to families and professionals free of charge. There is still time to make a tax-deductible contribution before the end of the year; just visit http://givingfirst.org/familyvoicesco and click on Donate Now.

Second, we have come through a year of change and transition that was challenging at times, but has positioned Family Voices well to continue to grow and evolve in the future. We have plans for new programs and services, including some funding possibilities, that we are very excited about. As soon as those are a little more settled, I look forward to sharing more information with you.

Over the last couple months, we have worked with The Colorado Health Foundation to reach out to different media about the Medicaid Buy-In for Children with Disabilities, resulting in a TV interview in Grand Junction and an article in the Denver Post. We are very pleased to have our work with families highlighted, as well as raising public awareness of the new Buy-In program as one of many ways that Medicaid helps support families in our state.

Last week’s tragic news from Connecticut continues to weigh heavy on my heart. I hope this holiday season brings you peace and joy even in difficult times, and know that whatever you are going through, you are not alone. Although our office will be closed December 22 – January 1 so staff can enjoy time with their families, we are checking voicemail each day in case of urgent messages. If we can help you access resources, navigate systems, or advocate for a child with special health care needs in your life, please let us know.

Happy Holidays, and best wishes for the New Year!

Warmly,

Tom Rose, Executive Director

Read our full December newsletter.

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.

Making Colorado a better place for children and youth with special health care needs