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Questions on this Answer?
Still not sure? Have another question? Send us an email! We may address emailed questions in the next edition of the Update Newsletter.
Events of Interest:
Finding Your Way: A Navigation Guide for Wisconsin Families Who Have Children and Youth with Special Health Care Needs and Disabilities has been published. Download a pdf version of the booklet here.
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
Covering Kids & Families’ webcast, The Future of BadgerCare+, will take place Thursday, February 16th at 1:00pm with DHS Secretary Dennis Smith and WCCF Research Director Jon Peacock. Visit http://bit.ly/zAIgww to view the webcast. No software or log-in information is needed. The webcast will be archived at www.ckfwi.org for later viewing.
February 17-18, March 30-31. Parents in Partnership: A Leadership Development Opportunity for Parents of Children with Disabilities. 4:30 to 8:30 p.m. on Friday and 9 a.m. to 3:30 p.m. on Saturday at Paradise Shores Conference Center, 26364 County Hwy. M, Holcombe, WI. Parents and guardians must attend all five sessions. For more information, contact Ruth Adix at 715-864-3014 or raadix2@yahoo.com.
Registration is open for an upcoming free telephone workshop - Section 504 and Americans with Disabilities Act (ADA) sponsored by WI FACETS, taking place Tuesday, February 21, 2011 from 12-1PM. The workshop will feature presenter Charlotte Price and contain basic information on Section 504 of the Rehabilitation Act of 1973. Register online. To register by phone or email, contact Sandra McFarland at WI FACETS - (877) 374-0511. Sandra will mail/email to you all workshop materials and provide you with the toll-free number to call in for the workshop.
February 24-25, April 20-21. Youth in Partnership with Parents for Empowerment. 5 p.m. Fridays ending by 3 p.m. on Saturdays at the Tundra Lodge Resort & Conference Center, Green Bay, WI. Youth, parents and guardians must attend all five sessions. For more information, contact Martha DeYoung at 800-862-3725.
April 16. Parent to Parent of Wisconsin's Support Parent Trainings are held periodically throughout the State. Trainings are held in small group settings (8-15 participants). Registration is required for all trainings. The next training will be held on Saturday, April 16, 2012 from 9:00 am to 3:30 pm at the Children’s Hospital of Wisconsin Corporate Center (999 North 92nd, Milwaukee, WI). Call or email to register: 715-361-2934.
WI Youth Leadership Forum is accepting applications for its 2012 Leadership Forum event. The YLF is a FREE program for high school students with disabilities who would like to take part in a unique and fun week long leadership development program. Participants will sharpen their leadership and self-advocacy skills, develop their career awareness, experience college life, meet successful speakers from across the state with similar disabilities as theirs and develop their own Personal Leadership Plan that they will implement when they return home. The YLF will be held June 17 – 22, 2012 on the Edgewood College campus in Madison, WI. The APPLICATION DEADLINE is April 16, 2012. The YLF is a competitive process. Applicants must complete the application, submit a brief response to 2 essay questions and obtain 3 letters of recommendation.
April 26-27. Circles of Life Conference 2012: a statewide conference for the families of children and youth with disabilities and the professionals who support them. This year's conference will be at the Madison Marriott Hotel. Fore more information, click here.
Is there an event missing from our list? Let us know! Email us with events, directions and details other collaborators may like to attend.
A Training Announcement for All CYSHCN Collaborators: Thursday, February 16, 10:30-11:30am
Topic: "All in the Family - Coordinating Benefits for CYSHCN, Siblings and Parents"
Tune in this Thursday February 16 at 10:30am for a LIVE training presented especially for CYSHCN collaborators. Changes in health care coverage programs can disrupt coverage for an entire family. This scenario-based training will identify strategies for getting coverage for CYSHCN and mechanisms for maintaining coverage for CYSHCN and the rest of the family. We will look at a variety of coverage options, discuss opportunities for dual eligibility, and answer commonly asked questions about CYSHCN and sibling coverage dynamics.
Participants will benefit from the following learning objectives:
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Review coverage options for children and families, focusing on CYSHCN
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Learn the impact of new coverage or coverage changes on an entire family
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Gain talking points for discussing dual coverage dynamics with families
Referrals to ABC: CYSHCN Collaborators, click the "Referral Form" image at right to be directed to the printable version of the CYSHCN Client Referral Form! Use this handy tool in directing a family to ABC for Health for services. Not able to join the live web cast? Don't worry, email Adam to get information on how to view the new webcast archive.
January's Web Conference on the National CSHCN Survey Now Available
The multimedia streaming archive of the January 19, 2012 DataSpeak web conference, "Findings from the 2009-2010 National Survey of Children with Special Health Care Needs" is now available! Over the course of the program, four speakers discussed the purpose, methodology, key findings, and ways to access both state and national data of the 2009-2010 NS-CSHCN. Click here to view this multimedia archive. Additional resources can also be found on the HRSA website.
HealthWatch Analysis & Comment
New Health Reform Regulations
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On February 9, the Feds unveiled a final rule implementing Affordable Care Act (ACA) requirements that health plans provide consumers with short, easy to understand summaries of benefits and coverage, called "SBC." Often compared to mileage stickers on automobiles or the energy rating on appliances, the SBC will provide a ready reference for consumers who are comparison shopping for insurance. In his article, "Implementing Health Reform, the Summary of Benefits and Coverage," Timothy Jost explains that the "consumers" the feds are watching out for "could be consumers in the individual market, but also could be small business owners looking for a small group policy. It could be employees of large employers trying to decide which of the plans offered by their employer is best for them, or whether they should sign up for the coverage their employer offers or that offered by their spouse’s employer." The theory behind SBC is to allow comparison shopping to promote competition--the "free market" if you will, among insurers, increasing the value of the insurance policy while containing cost. The SBC helps consumers identify coverage and cost components and the overall scope of the policy. Above all else, it makes insurance coverage easy to read and understand. This is a good thing for consumers--from both sides of the aisle politically. In fact, 88% of Democrats and 76% of Republicans responding to a poll were in favor of the "easy to understand" summaries of insurance policies. Insurance companies are to comply by March 23, 2012. This deadline is important: consumers should be used to seeing this type of plan summary before health insurance exchanges are operational.
Update on Medical Loss Ratio Waiver Request
Since early November, HealthWatch has closely watched Commissioner of Insurance Ted Nickel's request to waive Affordable Care Act provisions that require insurance providers to spend 80% of premiums on health costs. DHHS acknowledged the request in a letter on January 9th, 2012, which requested further action in providing necessary information by Nickel's office and opened a 10 day public comment period.
On the morning of February 9, the federal government informed WI that they would need an additional 30 days to review the MLR waiver request. While we wait for their final determination, take some time to read the numerous comments submitted during the 10 day open comment period.
Headlines
Obama Administration's Unprecedented Fraud Fighting Pays Off
Healthcare.gov, Feb. 14, 2012
The Departments of Justice and Health and Human Services (HHS) released an updated annual report showing that, for the second year in a row, anti-fraud efforts have recovered more than $4.1 billion in fraudulent Medicare payments. Compare this to just $2.14 billion recovered in FY 2008. Prosecutions are way up too: the number of individuals charged with fraud increased from 821 in fiscal year 2008 to 1,430 in fiscal year 2011 – nearly a 75 percent increase.
Health centers growing more slowly than expected
Journal Sentinel, Feb. 14, 2012
Federal health care reform initially allocated $11 billion over five years to expand community health centers. The goal was to prepare for a projected increase in demand from tens of millions of people becoming insured after 2014. Community health centers, located in low-income urban neighborhoods and rural areas, were expected to double in size in five years. That target now seems unlikely. The centers are expanding but at a slower pace than initially planned. Federal budget cuts in the face of massive government deficits have reduced money available for expansion by $3 billion over five years.
U.S. seniors missing out on $20 billion of benefits
Reuters, Feb. 14, 2012
The $20 billion was based on estimates of the collective population eligible for benefits but were not receiving them, said Brandy Bauer, a spokeswoman for NCOA. According to data from the Centers for Medicare & Medicaid Services, there are 1.7 million people who are eligible for Medicare but not receiving Part D Extra Help, which has an annual average value of $4,000. People failing to file for that benefit alone leave $6.8 billion on the table, Bauer told Reuters.
People with Disabilities and Medicaid Managed Care: Key Issues to Consider
Kaiser Commission on Medicaid and the Uninsured, Feb. 13, 2012
This issue brief looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities. Drawing on existing research on Medicaid managed care and people with disabilities, the brief highlights policy considerations related to setting plan payment rates, developing adequate provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight.
Hospitals flout charity aid law
New York Times, Feb. 12, 2012
The state’s Department of Health acknowledges systemic problems, including the need for better reporting and enforcement, a spokesman, Michael Moran, said. A group of patient advocates and hospital administrators is being convened to develop a better system, he said, and the department is engaged in “a comprehensive data integrity project that will include the retention of an outside auditor.”
Study: Total Health Care Costs Fall When Poor Are Provided Insurance
Huffington Post, Feb. 10, 2012
The study -- which focused on uninsured people in Richmond, Virginia who fell 200 percent below the poverty line -- found that over three years, health care costs fell by almost 50 percent per participant, from $8,899 in the first year to $4,569 in the third after they received insurance. Participants who enrolled in health coverage made fewer trips to the emergency room, which are notorious for running up patient bills. Instead, insured participants went for more primary care visits.
New Wisconsin DHS building policy restricts public access
The Isthmus, Feb. 9, 2012
It's all part of a security plan that's been in the works for two years, says Beth Kaplan, spokeswoman for the Department of Health Services. The Department of Health Services and Department of Administration building, she adds, are the "only two state agency buildings that still do not have this type of security plan in place."
Health Reform to Require Insurers to Use Plain Language in Describing Health Plan Benefits, Coverage
DHHS, Feb. 9, 2012
The marketing materials that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying. The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage. The new rules will also make it easier for people and employers to directly compare one plan to another.
Democratic Sen. Vinehout enters governor's race
Wisconsin State Journal, Feb. 9, 2012
State Sen. Kathleen Vinehout, D-Alma, is joining former Dane County Executive Kathleen Falk in the contest to replace Gov. Scott Walker, should his recall become a reality.
Audit committee probes Medicaid problems
The Tomah Journal, Feb. 8, 2012
Medicaid is the largest single program in state government. BadgerCare, Family Care and other health programs provide vital health care to one in five Wisconsinites. Yet a recent audit showed serious problems with accountability and transparency. The questioning of state officials by Audit Committee members centered on such problems as an antiquated state accounting system, a lack of management information available to lawmakers and a 'shadow agency' run by contractors.
Republican bill forces women to anticipate a need for abortion coverage
Rep. Berceau, Feb. 9, 2012
“AB 154 bans insurance companies that offer plans with abortion coverage from participating in Wisconsin’s health care exchange. Women will be forced to buy separate insurance coverage solely for abortion services from insurance companies that are not in the exchange. The entire purpose of insurance is to protect people from the unexpected. We don’t require people to anticipate their health care needs in advance and purchase riders that cover cancer, heart disease, or even pregnancy."
Most of Obama's "Controversial" Birth Control Rule Was Law During Bush Years
Mother Jones, Feb. 8, 2012
In December 2000, the Equal Employment Opportunity Commission ruled that companies that provided prescription drugs to their employees but didn't provide birth control were in violation of Title VII of the 1964 Civil Rights Act, which prevents discrimination on the basis of sex. That opinion, which the George W. Bush administration did nothing to alter or withdraw when it took office the next month, is still in effect today—and because it relies on Title VII of the Civil Rights Act, it applies to all employers with 15 or more employees. Employers that don't offer prescription coverage or don't offer insurance at all are exempt, because they treat men and women equally—but under the EEOC's interpretation of the law, you can't offer other preventative care coverage without offering birth control coverage, too.
Quinn wants $2 billion in state Medicaid cuts (Illinois)
Chicago Sun-Times, Feb. 8, 2012
Gov. Pat Quinn said he plans to cut the state’s Medicaid spending by $2 billion as a painful but necessary way to attack the state’s budget crisis.
Democrats call on walker to lift Family care cap
Wisconsin State Journal, Feb. 7, 2012
The four Democrats in Wisconsin's congressional delegation have sent a letter urging Republican Gov. Scott Walker to lift the enrollment cap on the state's Family Care program that helps keep the elderly and disabled out of nursing homes.
Rejecting money for health reform a gamble [Editorial]
Post Crescent, Feb. 7, 2012
"Wisconsin is among the states fighting the constitutionality of ObamaCare. It looks like Walker's administration is betting the major health care reform passed in 2010 will either be deemed illegal or that a Republican president will be elected this year and overturn it. ... If those scenarios backfire, we'll all end up paying. And where does it end? Will this Republican administration send back all federal grants from a Democratic president, and could a future Democratic governor send back funds issued by a Republican president? It's counterproductive to a system where federal dollars are sent to help ease states' financial burdens. We hope it stops soon."
Accountable Care Organizations in Medicaid: Emerging Practices to Guide Program Design
Center for Health Care Strategies, Inc., Feb. 6, 2012
To help guide Medicaid stakeholders in developing safety-net ACOs, CHCS interviewed state Medicaid leaders, ACO stakeholders, and health plan officials in states that are pursuing ACO models, as well as key federal officials. This brief highlights emerging best practices from state ACO activities across the country and summarizes safety-net ACO programs being developed in five states. It outlines key issues for federal and state agencies, health plans, providers, and communities to consider in designing ACO programs to serve low-income beneficiaries, with a focus on:
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Core capabilities;
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Financial models;
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Design issues; and
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Fit within the existing delivery system.
Wisconsin offers new health care, day care deductions
Wisconsin State Journal, Feb. 5, 2012
Wisconsin residents who use health savings accounts or who have children in day care will be able to take advantage of new tax breaks as they fill out their 2011 income tax returns this year. Companies that create jobs in Wisconsin also are in line for new benefits.
State's health administrator should be more qualified [Editorial]
Journal Sentinel, Feb. 4, 2012
Karen McKeown, is an oncology nurse from Texas, was recently appointed as administrator of the state's Division of Public Health. The Journal Sentinel comments, "Health Secretary Dennis Smith lauded McKeown's abilities in the press release announcing her appointment. He said she is a strong and effective leader and brings a wealth of knowledge that spans the spectrum of health policy. ... While no degree is a guarantee of expertise, an advanced degree, long experience and the publication of scholarly research imply familiarity with the broad issues which government handles. Writing white papers is not the same as proper research, and we could find no evidence that McKeown has published any."
MPS wins special needs education lawsuit
Journal Sentinel, Feb. 3, 2012
The ruling tossed out the settlement the Department of Public Instruction reached with Disability Rights Wisconsin in 2008, saying that DPI's settlement required more of the district than DPI had the statutory right to demand, a position on which MPS had long held firm.
Komen drops plans to cut Planned Parenthood funds
Associated Press, Feb. 3, 2012
Komen had adopted criteria excluding Planned Parenthood from grants because it was under government investigation, notably a probe launched in Congress at the urging of anti-abortion groups. Komen said it would change the criteria so it wouldn't apply to such investigations.
Strategies for Building Seamless Health Systems for Low-Income Populations
Center for Health Care Strategies, Inc., Feb. 3, 2012
The ACA offers numerous opportunities to stabilize coverage and care for beneficiaries as their incomes fluctuate, and states can reduce the impact of churn with design and purchasing strategies that promote seamlessness. This brief explores the challenges for states in creating seamless health coverage for low-income populations. The brief provides a roadmap for states as they consider options for building seamless health systems. Key issues for states to consider include managing subsidy fluctuations through carefully designed eligibility and enrollment strategies and ensuring stable coverage and care by creating seamlessness across benefits, providers, and health plans.
Health reform law saves $2.1 billion for 3.6 million Americans with Medicare
DHHS, Feb. 2, 2012
The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics. Wisconsin seniors alone saved $38 million with healthcare reform.
Local Focus Stays the Same
Susan G. Komen for the Cure South Central Wisconsin, Feb. 2, 2012
Currently, Planned Parenthood in South Central Wisconsin does not receive funding from our Affiliate. None of the current funding from Komen South Central Wisconsin for vital services in our area in South Central Wisconsin has been impacted.
President Obama and Kathleen Sebelius – soon overtaking Wisconsin’s healthcare insurance review
Rep. Petersen, Feb. 2, 2012
"Wisconsin’s healthcare insurance companies have been advised that because AB 210 stalled, Wisconsin will no longer be in compliance with the federal review process. Consequently, a department under the umbrella of the U.S. Department of Health Services will take over the appeals process in Wisconsin. Codifying Obamacare requirements into state statute won’t influence the arguments before the Supreme Court on Obamacare. ... By not taking action to maintain as much state control as possible prior to and after the federal lawsuit against Obamacare, and just handing over our state’s requirements to the federal government is essentially letting President Obama and Kathleen Sebelius run Wisconsin’s healthcare insurance market."
Audit Co-chairs Assess Future of Medical Assistance
Joint Audit Committee, Feb. 1, 2012
DHS has taken steps to address concerns and control costs by: providing for independent
review of all administrative contract amendments for funding availability and verification of
purchasing authority, rebidding existing contracts as they come up for renewal, and working with
counties to implement a more efficient, “regionalized,” income maintenance program for
determining Medicaid eligibility.
Seeking Legal Interns for Summer 2012
ABC for Health is seeking volunteer, work-study eligible, or students on public interest fellowships for this summer! The position requires admission to law school. Students will provide legal research and writing support for firm attorneys that may include client interviewing and follow-up, drafting letters and memos, assisting on court filings and briefs, and facilitating projects with other agencies and legislators. Other duties include interviewing clients at intake, client counseling, and investigation of health benefits denials. Legal research and writing experience are desired, as are proficiency in Microsoft Word for Windows and a background in health care. Ability to speak Spanish and/or Hmong is a plus. To apply, please email a cover letter and resume to Brynne McBride, Assistant Director.
Support Our Efforts!
2011 was a difficult year for many, including ABC for Health. Over $300,000 in funding and funding opportunities were eliminated from our budget. Consequently, our ability to serve Wisconsin families was greatly diminished. Please consider a tax-deductible donation to ABC for Health to keep advocacy, legal services, and projects like HealthWatch Wisconsin sustainable for years to come. Thank you!
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