In this month’s Lessons from California, we highlight how NHeLP is working with advocates in California to ensure the state is following the federal guidelines from CMS on providing Behavioral Health Treatment to children with Autism Spectrum Disorders and that children receive the treatment they need under Medi-Cal.
In July, 2014, the Centers for Medicare and Medicaid Services (CMS) issued guidance clarifying that evidence-based treatments for children with autism spectrum disorders (ASD), including behavioral and communication approaches to treatment, are eligible for federal financial participation under three State Plan authorities. CMS explained that states are obligated to cover these services for children under 21, even if they are not covered for adults under the State Plan, when they are medically necessary.In September, 2014, CMS issued an FAQ, further explaining states’ obligation to cover services for children with ASD. This fact sheet provides a brief overview of CMS's guidance, and provides considerations for state advocates working to ensure that children with ASD have access to the services they need.
NHeLP provides the following comments on IRS Temporary and Proposed Rules allowing married persons who experience domestic abuse or spousal abandonment to file their federal income taxes separately. The proposed IRS rules allow such individuals to be deemed to have satisfied the Affordable Care Act’s joint filing requirement to obtain Premium Tax Credits (PTCs) and Cost Sharing Reductions (CSRs)
A Quick and Easy Method of Screening for Medicaid Eligibility under the Pickle Amendment. Courtesy of Gordon Bonnyman, Tennessee Justice Center.
Emergency department care, one of the most frequently cited drivers of health care costs, has become a major target for cost sharing policies. The stereotypical “frequent flyer” who uses the emergency department (ED) for every cough and sniffle has become a powerful, but unwarranted symbol of inefficient spending driven by poor patient decision-making. Though often used to justify higher cost sharing on ED use, the common perception that ED overutilization drives wasteful spending is likely overblown, while the “solution” of raising copays does little to address the systemic factors contributing to the ED’s expanding role in our health care system. This issue brief reviews some of the problems related to ED co-pays, especially in the Medicaid context, and evaluates the efficacy of promising alternatives states have implemented to successfully reduce ED utilization while improving care coordination and quality.
NHeLP is pleased to offer these comments on the proposed rule for Coverage of Certain Preventive Services Under the Affordable Care Act (CMS-9940-P), from the Department of the Treasury, Department of Labor, and Department of Health and Human Services published in the Federal Register on August 27, 2014. NHeLP works to ensure that all people in the United States—including women—have access to preventive health services. The Patient Protection and Affordable Care Act (“ACA”) similarly recognizes that preventive health care services are critical to individual and community health, and that cost is often a barrier. By explicitly requiring that health insurance plans cover women’s preventive health services without cost-sharing, the ACA further acknowledges the critical role that a woman’s health plays in the health and well-being of her family and community, as well as her disproportionately lower earnings.
Hearing loss affects many low-income children in the United States. Despite the proliferation of hospital-based newborn hearing screening programs, a significant number of children with possible hearing loss are not receiving prompt diagnosis and treatment. The Medicaid program, which offers low-income children a comprehensive array of preventive, diagnostic, and treatment services, called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), is in a unique position to address the problem. This NHeLP issue brief discusses: (1) the scope of the problem of hearing loss in children; (2) standards and guidelines for screening children for hearing loss; (3) the EPSDT benefit; (4) how states are implementing EPSDT requirements related to hearing screening; and (5) recommendations for improving children’s access to hearing services through the EPSDT benefit.
Arkansas recently proposed amendments to its premium assistance Medicaid expansion demonstration, the Health Care Independence Program. These are NHeLP's comments to the proposed amendments, which include new premium and cost sharing provisions, limitations to nonemergency medical transportation, and a health care expenses account for premium assistance enrollees.
Under Medicaid and some Children’s Health Insurance Programs (CHIP), youth are eligible to receive the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which includes coverage for medical screening. Federal law requires each screen to include five required components. One component is age-appropriate health education, which should include sexuality education from infancy through age 20 (the age when EPSDT ends). This issue of the Health Advocate will focus on the content of the required medical screening and how these screens can and should include sexuality education.
Over the years, Medicaid beneficiaries have asserted claims under the Supremacy Clause of the U.S. Constitution and 42 U.S.C. § 1983 in litigation to enjoin state violations of the Medicaid Act. This Fact Sheet will summarize the history of § 1983 and Supremacy Clause enforcement, provide current point-in-time assessments of Medicaid Act enforceability, and conclude by offering recommendations for lawyers who are considering asserting Medicaid claims in federal court. Of particular import, the Supreme Court has just granted certiorari to decide whether private individuals can bring a claim under the Supremacy Clause to enjoin state actions that are inconsistent with the federal Medicaid Act.