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.
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.
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.
EPSDT 2013 Oral Health Performance - Selected Measures of all 50 states
In this month's Lessons from California, we highlight landmark legislation, the Contraceptive Coverage Equity Act (SB 1053, Mitchell), the state just enacted that requires that Medi-Cal managed care organizations (MCO) and most private insurers cover all FDA-approved methods and strictly limits MCO medical management techniques. These important new state law protections will ensure that each woman in California can make her own contraceptive decisions and serve as a model for states throughout the country.
In certain counties, Medi-Cal managed care is operated by a single County Organized Health System (COHS). In COHS counties, a single plan serves all Medi-Cal beneficiaries who are enrolled in managed care. Unlike other Medi-Cal managed care plans, COHS plans are not required to obtain Knox Keene licensure for their Medi-Cal lines of business, and unless they choose to obtain a Knox-Keene license, they are not directly regulated by the DMHC. Consumer advocates should be aware of the differences in the protections available in COHS plans from those provided by the Knox Keene Act licensed plans, in order to understand the rules and consumer protections that are available within the plans and to know what regulatory agency is responsible to monitor and enforce compliance.
Summary of the recent accomplishments of NHeLP, including protecting the ability of Tennesseans to access the health care they need, training for health care advocates and protecting access to birth control.
Comments to HHS regarding Indiana's HIP and HIP 2.0 section 1115 demonstrations to implement the Medicaid expansion. NHeLP's comments focus on the need to implement Medicaid expansion without waivers that eliminate core Medicaid protections.
In 1965, when the Medicaid program was created, American health care bore little resemblance to the complex system we have today. One of the most significant changes has been the expanding role of managed care. In its early years, Medicaid was almost exclusively a fee-for-service system in which providers were reimbursed directly by state Medicaid agencies for each service provided. Now, nearly three quarters of Medicaid beneficiaries receive services through some type of managed care arrangement. Nearly all state Medicaid agencies now contract with managed care entities, which can reimburse providers, perform utilization review, respond to patient and provider complaints and set standards for coverage of services.