CKSN UPDATE for JUNE 15, 2003			ABC for Health, Inc.

IN THIS ISSUE:

1. Case Tip:  Private Insurance Denials
2. TAARA Program
3. Governors' Task Force Fails to Back Medicaid Proposal
4. Waiting in Wisconsin Bulletin
5. HealthWatch News


1. CASE TIP:  PRIVATE INSURANCE DENIALS

Private insurance denials can be a stress to navigate especially when a parent is juggling many different issues.  The communications from insurance companies are often intimidating and confusing.  Here are some things to keep in mind: 1. You have the right under federal and state law to a written explanation of the denial with specific references to the health plan document; 2. You have a right to a copy of the plan document upon which the denial is based. 3. The Insurance Company cannot legally deny coverage based on policy language in your plan document that is confusing, ambiguous or contradictory.  Rather, both state and federal insurance law requires that such language will be construed strictly in your favor and against the insurer.  Remember, your health plan is just a contract between you (or your employer) and your insurer; therefore, the written plan document will determine what coverage is available.  For further information, you can reference ABC for Health's Health Insurance Guidebook which can be downloaded free of charge, at www.abcforhealth.org



2. TAARA PROGRAM

Starting August 1, 2003 The Trade Adjustment Assistance Act (TAARA) will pay 65% of the cost of health insurance if purchased from specific sources. There are 3 groups of eligible people: Workers who lost either their jobs, their group health insurance or both due to plant relocation or cheaper imports because of trade agreements;  'Alternative Trade-Displaced Older Workers' - people at least 50 years old who, within 26 weeks of having lost jobs, got new ones but are being paid less now and; Retirees between ages 55 and 65 who receive any benefits from the Federal Pension Benefit Guaranty Corporation.  For more information contact the US Department of Labor.  For further information, visit their website at www.dol.gov/ebsa/


3. GOVERNORS' TASK FORCE FAILS TO BACK MEDICAID PROPOSAL

A bipartisan task force appointed by the National Governors Association (NGA) to work with the Bush Administration on proposed changes to the Medicaid program has failed to reach agreement, denying the White House a critical endorsement of its Medicaid plan.

At issue are changes that have been widely opposed by advocates for people with disabilities. The Bush proposals would cap federal funds for Medicaid. The plan would also allow states to substantially reduce benefits, including coverage of mental health services, and to cut people from the program.

In a letter dated June 10, the five Republican governors on the task force-Dirk Kempthorne of Idaho, Jeb Bush of Florida, John Rowland of Connecticut, John Hoeven of North Dakota and Robert Ehrlich of Maryland--sent a letter to US Health and Human Services Secretary Tommy Thompson urging the Administration and Congress to move ahead with such changes. Missing from the letter were the signatures of the task force's five Democratic governors-Paul Patton of Kentucky, Frank O'Bannon of Indiana, Tom Vilsack of Iowa, Bob Holden of Missouri and Bill Richardson of New Mexico.

Without a bipartisan endorsement from the NGA task force, advancing the White House Medicaid proposal through Congress will likely become more difficult.

More Information Available Online For more information on the administration's plan, see these resources:

Action Alert: Fight Bush's Assault on Medicaid (May 6, 2003) http://www.bazelon.org/takeaction/alerts/5-6-03medicaid.htm  Making the Right Choices, a Bazelon Center issue brief* http://www.bazelon.org/issues/medicaid/publications/choicesforweb.pdf 

(Source:  Monday Morning in Washington, D.C., Inclusion Research Institute, 2003)


4. WAITING IN WISCONSIN BULLETIN

The May/June edition of Waiting in Wisconsin is now available on the
DAWN website.  You can read this edition by going to:
http://www.dawninfo.org/advocacy/index.cfm
This edition covers the recent actions of the Joint Finance Committee on the state budget and their implications for people with disabilities in Wisconsin.

To read previous 2003 editions of this bulletin go to:
http://www.dawninfo.org/advocacy/issues/waiting_list.cfm#info

(Source:  Wisconsin Council on Developmental Disabilities DAWN Alert)


5.  HEALTHWATCH NEWS

The next Southern Regional HealthWatch will be held on Thursday, July 17 from 11:30 - 1:00 pm at the Harambee Center, 2202 South Park Street, Madison.  For more information, and to RSVP, contact Dana McElmury, 608-261-6939, ext.208 or email, danam@safetyweb.org

If you are interested in joining your regional HealthWatch committee, or want more information about their work, please contact the following people:

Southern Region:  Barbara Katz, ABC for Health, Inc., 608.261.6939 ext 207, barbk@safetyweb.org
Southeastern Region:  Brad Holman, Children's Hospital of Wisconsin, 414.266.3189,
bholman@chw.org
Northern Region:  Deb Blackstone, Family Resource Connection, 715.365.8030,
dblacks@shsmh.org
Northeastern Region:  Steve Gerczak, St. Vincent Hospital, 920.433.8154,
sgerczak@stvgb.org
Western Region:  Rose Marsh, Chippewa County Dept of Public Health, 1-800-400-3678, rmarsh@co.chippewa.wi.us



ARE YOU SHARING THE UPDATES WITH FRIENDS OR COLLEAGUES?  

We need your help to better track the distribution of the CKSN update.  Please let us know the names and email contact info of people you forward the email to so we can send them the update directly.  Direct replies to barbk@safetyweb.org 

The CKSN Update is a bi-weekly electronic newsletter of the Covering Kids with Special Needs project that ABC for Health, Inc. is implementing with its partners, the Title V Children with Special Needs Regional Centers and Family Voices - Wisconsin.  If you would like to submit news and information in future CKSN Updates, please send it to the attention of Barbara Katz.  All submissions should be limited to 150 words.

Barbara Katz, moderator
Parent Consultant
ABC for Health, Inc.
608.261.6939 ext. 207
barbk@safetyweb.org