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Affordable Care Act

Overview
 
The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to endorse the health care law. The Affordable Care Act is a federal statute aimed at decreasing the number of uninsured Americans and reducing the overall costs of health care. Many of its provisions significantly impact children and youth with special health care needs, a population important to the purpose of the Southeast Regional NBS & Genetics Collaborative.

 

Key Features
 
·    Children under the age of 19 can no longer be denied insurance for pre-existing conditions. Young adults up to the age of 26 can now stay on their parents insurance plan. Elimination all lifetime maximum limits. Millions of uninsured Americans will gain access to affordable coverage through Affordable Insurance Exchanges and improvements in Medicaid and CHIP.
 
·    Preventive Care Is Covered: Many insurers are now required to cover preventive services at no cost to you. This includes new preventive benefits for mothers and vaccinations for kids. Insurance Companies Are Held Accountable: Your premium dollars must be spent primarily on health care, not advertising or bonuses for executives. And insurance companies must now publicly justify any unreasonable rate hikes.
 
In addition, beginning in 2014, all health plans must:
 
·    Stop denying coverage for all people with pre-existing conditions. Eliminate annual limits on “essential benefits” like prescription drugs. In the law however, “essential benefits”  do not apply to self-funded plans currently regulated by ERISA (the Employee Retirement Income Security Act of 1974).
 

 

Resources for the Affordable Care Act (ACA)

Resource Title

Description

Clickable state information

Clickable state information

CHIP program

CHIP program

The Affordable Care Act and Children with Special Health Care Needs: An Analysis and Steps for State Policymakers [PDF, 48 pages]

This report is designed to help inform state policymakers' decisions in implementing health care reform. Developed for the Catalyst Center by the National Academy for State Health Policy (NASHP), the report reviews and analyzes key provisions of the ACA and their potential impact on CYSHCN and their families.

 

The Affordable Care Act: A Side-by-Side Comparison of Major Provisions and their Implications for CYSHCN [PDF, 16 pages]

A companion piece to the publication described above, this brief offers a concise description of select provisions in the ACA with a side-by-side analysis of what they may mean for CYSHCN and their families.

 

Are Families of Medicaid-enrolled Children with Disabilities Eligible for Subsidized Marketplace Coverage? [PDF, 3 pages]

An overview of Marketplace coverage for children with disabilities who receive Medicaid due to family income, waiver eligibility, or Family Opportunity Act Medicaid buy-in. This question was answered in detail in the December 2013 issue of Catalyst Center Quarterly.

 

Presentation Slides: The ACA and Genetic Conditions: Opportunities and Challenges [PDF] This webinar was a collaboration between HRSA Genetic Services and the Catalyst Center on June 19, 2013.
The Affordable Care Act, Section by Section The complete text of the ACA is available at healthcare.gov.
Kaiser Family Foundation State Health Facts - Health Reform indicators

State Health Facts provides free, up-to-date, and easy-to-use health data for all 50 states, the District of Columbia, the United States, counties, territories, and other geographies. Data come from a variety of public and private sources, including Kaiser Family Foundation reports, public websites, government surveys and reports, and private organizations.

 

Insure Kids Now national outreach and enrollment campaign

InsureKidsNow.gov provides information about Medicaid and CHIP services for families who need health insurance coverage. These programs are designed to be affordable for families who are not able to afford health insurance coverage in the private market or do not have coverage available to them. Even if you've been turned down in the past, you may be able to get health coverage for your child now.Learn more about health coverage programs in your state.

 

Healthcare.gov

The national portal to the State Health Insurance Marketplaces - choosing your state from the drop-down menu will bring you to your state's Marketplace website, if it has one, or link you directly to eligibility, cost and enrollment information.

 

The Center for Consumer Information and Insurance Oversight

The Center for Consumer Information and Insurance Oversight (CCIIO), under the Centers for Medicare and Medicaid Services (CMS), oversees the implementation of the ACA provisions related to private health insurance.

 

Maternal and Child Health Library at Georgetown University A compilation of resources on the ACA for MCH professionals

 

Medicaid and CYSHCN

Resource Title

Description

Public Insurance Programs and Children with Special Health Care Needs: A tutorial on the basics of Medicaid and the Children's Health Insurance Program (CHIP) [PDF, 56 pages] An online, self-directed overview of the Medicaid and CHIP programs, the many different populations these programs serve, and how these programs are changing as a result of the ACA. It provides suggestions to help readers think about opportunities for Title V programs, family leaders, and others to work together with Medicaid and CHIP in their states to improve the financing of care for CYSHCN.
Fact Sheet: Medicaid and Children with Special Health Care Needs/Disabilities [PDF, 2 pages] An overview of the importance of Medicaid in covering children with special health care needs and disabilities.
Fact Sheet: The Children's Health Insurance Program and Children with Special Health Care Needs [PDF, 2 pages] An overview of the importance of CHIP in covering children with special health care needs.
Infographic: Medicaid & CHIP: What's the Difference? [PDF, 1 page] An at-a-glance comparison of Medicaid & CHIP, with an explanation of what the differences might mean for a child with special health care needs.
Your Questions About the Medicaid Expansion Provision of the Affordable Care Act Answered [PDF, 6 pages] The Supreme Court's June 28, 2012 decision made the Medicaid expansion optional for states. This brief discusses the implications of that decision for youth and young adults with special health care needs.
State Health Fact Sheets

The State Health Facts pages of the Kaiser Family Foundation provides updated health insurance and health reform data for each state. Use this interactive map to create customized fact sheets to compare one state to the U.S. average or to compare two states to each other.

 

Medicaid Waivers

This CMS (Centers for Medicare & Medicaid Services) website provides information about the different types of Medicaid waivers (the specific conditions under which a state can petition CMS in order to provide specific services to defined populations. See the waivers that are pending, in effect, or expired in your state.

 

 

SERC Highlights
February 2017

SERC/GMDI announces Nutrition Management Guidelines for MSUD

SERC/GMDI announces Nutrition Management Guidelines for MSUD

Management Guidelines cover the evaluation, assessment, and management of patients known to have a particular condition. SERC and GDMI partnered to develop nutrition management guidelines based on our rigorous DNDF methodology. The creation of the nutrition management guidelines has been a multi-year project to develop evidence and consensus based guidelines of inborn errors of metabolism (IEM).   This is the first publicly available MSUD guideline to all metabolic dietitians, physicians and other clinicians. The portal utilizes a tool for development of guidelines of genetic metabolic disorders for which there is little published scientific evidence. The practice recommendations are an effort to increase standardization of care and enable outcomes studies within and across centers. When warranted by developments in MSUD research and clinical practice, these guidelines will be updated periodically and will be maintained through a Dynamic process.

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