Tag Archives: health exchanges

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.)

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).

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.