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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.
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.
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: Topic: Getting Kids Covered with HealthCheck Other Services
Miss today's live training webcast? Find it in the archive!
Today, March 15 ABC for Health hosted a training especially for CYSHCN Collaborators. If you missed our live webcast, you can watch the archived version at any time! Need help finding it? Email Adam!
When you watch the video archive, keep in mind the following learning objectives:
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Learn the basics of HealthCheck Other Services (EPSDT)
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Learn how to make a referral for HealthCheck other services
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Learn strategies for good case management
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Using HealthCheck to add sustainability--for your patients and for your organization
The Next Training: Trainings are the THIRD THURSDAY OF EACH MONTH, 10:30am!! Collaborators, stay tuned to the Update for information on the next training topic, which will include SSI-E!
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.
Why should you use this Referral Form? It helps keep YOU in the loop! By using the form, you agree to the language on the form that says you have "Verbal permission from parent/guardian to share information with ABC for Health." This allows us to communicate with YOU!
Analysis & Comment
DHS Presents New Proposal to the Joint Finance Committee
Continued from above: DHS Secretary Dennis Smith and Deputy Secretary Kitty Rhoades appeared to answer the Joint Finance Committee's questions on these new proposed changes to BadgerCare. Secretary Smith indicated that the negotiations between DHS and the Centers for Medicare and Medicaid Services (CMS) on the other elements of the waiver proposal are still ongoing. Thus, the Department will no longer seek an April 1 deadline to implement approved changes and will move to a July 1 deadline. "We are two months further behind schedule than where I had hoped we would be," noted the Secretary.
Smith also confirmed that DHS will give 60 day notice to anyone who may be affected by the new changes.
Based on the estimates provided by the Legislative Fiscal Bureau, approximately 10,241 adults will drop off of BadgerCare and Medicaid programs because of the higher premiums alone. When asked by Sen. Robert Jauch (D-Poplar) and Sen. Lena Taylor (D-Milwaukee) to speak to this impact, Secretary Smith defended the premium proposal, arguing that those affected would not be eligible for coverage in most other states, and that the DHS proposal tracks with the federal law. "If we are wrong about participation rates...then all of PPACA is wrong," Smith maintained.
Rep. Cory Mason (D-Racine) astutely observed that the 10,431 individuals estimated to lose coverage from these changes do not include those who will lose access to Medicaid and BadgerCare Programs if the full waiver is approved by CMS, nor does the proposal account for the "hidden tax" that everyone pays when those who lose their health care coverage must receive treatment in the emergency room.
Rep. Mason also asked the Secretary about co-payments and deductibles under the new alternative Benchmark Plan, to which Smith responded, "[DHS is] still in discussion with CMS."
The Democratic members of the Joint Finance Committee introduced a motion that, if adopted, would have rolled back the changes already approved by JFC, effectively ensuring no one would lose eligibility for Wisconsin's Medicaid programs. The motion, akin to the "BadgerCare Protection Act" introduced in the Senate on February 28, preserves the integrity of the BadgerCare program. The motion was defeated 4 to 12, along party lines.
In the end, the Joint Finance Committee voted 12 to 4, again along party lines, to approve the revised proposal with its new premium schedules for non-pregnant, non-disabled adults.
REMINDER: The current proposal does not reduce BadgerCare+ eligibility for children, and as of today, BadgerCare Plus coverage remains unchanged for children and families!
Headlines
Do 'Medical Home' Programs Save Money?
Stateline, Mar. 15, 2012
The aim of the "medical home" concept is simple -- improve primary care so fewer people need to go to the hospital. ... But what about the short run?
Give Young Adults Needed Privacy For Health
Opinion, Roll Call, Mar. 15, 2012
Under the 2010 health care overhaul, millions of young adults in the United States can access health care on a parent’s health insurance policy. That’s a good thing because it means they are more likely to get preventive care that can keep them from getting sick in the first place.
Hospitals Aren't Hotels
Opinion, The New York Times, Mar. 14, 2012
In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can’t, at the expense of what it should.
Eliminating Waste in US Health Care
JAMA, Mar. 14, 2012
The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility.
Senate OKs bill lifting Family Care cap
Wisconsin State Journal, Mar. 14, 2012
The Senate passed a bill in February that would allow Family Care to add new participants. The Assembly passed the bill early Wednesday but tweaked it to require the Legislature's budget committee to approve enrollment expansions.
S.D. Restricts Coverage, HHS Looks Other Way [Registration required]
Politico Pro, Mar. 14, 2012
The state is South Dakota, and the provision is a small but popular one -- a ban on insurers denying coverage for kids because of their health status or excluding coverage for pre-existing conditions. The fact that HHS hasn't done anything about it has some consumer advocates worried about how it will affect states that flout the law after more health care reform provisions take effect in 2014. "When the state responds to the needs of their market by undermining a provision that is as central to the Affordable Care Act as ending health discrimination against children, then people should sit up and take notice," said Sabrina Corlette, a National Association of Insurance Commissioners consumer representative. ... In September 2010, the South Dakota Department of Insurance issued regulations that allow insurers to continue denying coverage to children under 19 or excluding coverage for their pre-existing conditions if the policies are sold outside an open-enrollment period where insurers must cover all comers (Feder, 3/14).
State Budget Committee Set to Debate Medicaid Changes
Wisconsin State Journal, Mar. 14, 2012
The original proposal from Gov. Scott Walker's administration would have resulted in 65,000 poor adults and children leaving state health insurance programs, either because they would no longer be eligible or they could no longer afford coverage. Under the new plan, about 23,000 people would lose coverage.
Senate OKs bill lifting Family Care cap
Wisconsin State Journal, Mar. 14, 2012
The Senate passed a bill in February that would allow Family Care to add new participants. The Assembly passed the bill early Wednesday but tweaked it to require the Legislature's budget committee to approve enrollment expansions.
Medicare Program; Revisions to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Safeguards
Federal Register, Mar. 14, 2012
This final rule removes the definition of “direct solicitation” and allows DMEPOS suppliers, including DMEPOS competitive bidding program contract suppliers, to contract with licensed agents to provide DMEPOS supplies, unless prohibited by State law. It also removes the requirement for compliance with local zoning laws and modifies certain State licensure requirement exceptions.
Canadian Hospitals that Spend More On Patients Get More
Bloomberg, Mar. 14, 2012
Under Canada’s system of universal health care, patients at high-spend hospitals had longer lengths of stay and more specialist visits, the study found. That’s because the health plan in Canada, where per capita health expenditures are 57 percent of those in the U.S., better allocates expensive specialists and technology, Stukel said.
Health Officials Look for Savings from Long Term Care Program
Wisconsin Public Radio, Mar. 13, 2012
State health officials need to find nearly $80 million in savings from a popular program that keeps the elderly and disabled out of nursing homes. The administration wants to know what assistance friends and family are giving so that care isn't replaced by Medicaid services.
State Participants selected for Medicaid Emergency Psychiatric Demonstration
CMS, Mar. 13, 2012
The CMS Innovation Center will provide up to $75 million in federal Medicaid matching funds over three years to 11 States—Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia— and the District of Columbia, to enable private psychiatric hospitals, also known as “institutions for mental disease” (IMDs), to receive Medicaid reimbursement for emergency care provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment. Historically, IMDs are not reimbursed under Medicaid for these services without an admission to an acute care hospital first.
Ambitious health care blueprint stresses state flexibilty, sets up huge logistical challenge
Washington Post, Mar. 13, 2012
Experts say it’s anybody’s guess how the national rollout will go. If a state is not ready, the law requires the federal government to step in to run its exchange. But the Obama administration’s request for $800 million to operate federal exchanges has gotten a frosty reception from congressional Republicans.
Is the health care law already running a deficit?
Washington Post, Mar. 13, 2012
"We fully concede that, in the context of ten years of budgets, some of these numbers are rounding errors. But just as it was silly for Democrats to claim the health care law would reduce the deficit, it is a fool’s errand for Republicans to keep trying to prove it does not."
CBO: Obama's health to cost less, cover fewer people than first thought
Healthwatch, Mar. 13, 2012
The revised estimate of the law's coverage provisions shows about 2 million fewer people gaining coverage by 2016, reducing the number of uninsured Americans by 30 million instead of the 32 million projected a year ago. That would leave about 27 million people uninsured in 2016, two years after the law's insurance exchanges go online.
Study Finds High-Spending Canadian Hospitals Do Better
Capsules, Mar. 13, 2012
At first glance, this conclusion would seem to contradict the world view of the Dartmouth Atlas, which maintains that American hospitals that throw more resources at patients — more specialists, tests, procedures — don’t get better results. The Obama administration is a fan of this philosophy, which it wove into parts of the federal health law, the Affordable Care Act. But the paper explains that Canadian hospitals have far fewer resources than do American ones. On a per capita basis, the U.S. has three to four times as much specialized technology as does Canada, which spends 57 percent of what the U.S. does on health care.
Governor's budget ammendment would beef up KanCare plan
Kansas Health Institute, Mar. 13, 2012
Gov. Sam Brownback has asked the Legislature to amend his original budget recommendations for the coming fiscal year to include an additional $3.4 million to beef up his administration's Medicaid makeover plan.
Ron Johnson presses his case against health care law
Journal Sentinel, Mar. 12, 2012
Johnson, who ran against the health care law when he got elected in 2010, contends the administration is vastly understating the number of people likely to lose their employer-based health care under the new law. He argues that employers will have a powerful financial incentive under the law to stop offering coverage to employees. The result will be ballooning government costs, Johnson says.
New Health Reform Rules Issued as Supreme Court Review Nears
PBS Newshour, Mar. 12, 2012
According to Health and Human Services Secretary Kathleen Sebelius, the final exchange regulations give states "the flexibility they need to design an exchange that works for them." She also reiterated the administration's belief that the exchanges will boost competition in the individual and small-business marketplace and will give both groups "the same purchasing power big businesses have today."
Policies gives states more flexibilty to establish Affordable Insurance Exchanges
HHS, Mar. 12, 2012
Policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
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Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
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Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
Rules for New Insurance Marketplaces Give Insurers Clout
Kaiser Family Foundation, Mar. 12, 2012
Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, under final rules for the marketplaces issued by the Department of Health and Human Services.
Affordable Insurance Exchanges: Choices, Competition and Clout for States
Healthcare.gov, Mar. 12, 2012
The final rule released today offers a framework to assist states in setting up Affordable Insurance Exchanges. The framework preserves and, in some cases, expands the significant flexibility in the proposed rules that enables states to build an Exchange that works for their residents.
HHS issues final rule on health insurance exchanges
Modern Healthcare, Mar. 12, 2012
The rule outlines details of the exchanges, or insurance marketplaces, which are scheduled to launch Jan. 1, 2014. They will offer insurance plan options for individuals and small businesses, as well as federal subsidies for premiums.
Health Care reform: States may test HHS power
Politico, Mar. 12, 2012
For the resistant states, obstruction wouldn’t require lifting a finger. To block the federal exchange, they could just do nothing. And if they don’t make the legally required changes in state programs — such as Medicaid — to coordinate with the federal exchange, the federal exchange can’t work.
ANALYSIS: Ripple effect of 'cost-shifting' uncompensated medical care
iWatch, Mar. 12, 2012
It is people who have decided not to buy coverage — but who nevertheless get sick or injured and seek medical care when they do, even if they don’t have the money to pay for it — that make health insurance so expensive for the rest of us. And it is why the cost of coverage has become completely unaffordable for millions of other Americans.
Small-Picture Approach Flips Medical Economics
New York Times, Mar. 12, 2012
A.C.O.’s, as they are known, are collections of medical providers who band together under one business umbrella. The organization can include primary care doctors, specialists, social workers, pharmacists and nurses. The difference is in how these providers are paid: Instead of an insurance company or the government reimbursing each provider for each service provided to each patient, the A.C.O. is paid simply to care for a group of patients.
Health law faces its biggest test
Politico, Mar. 11, 2012
For Republicans, a ruling striking the individual mandate would validate their two-year drumbeat against “Obamacare” and allow them to charge Obama — a former constitutional law professor — with pushing his policies through unconstitutional means. For Democrats, a ruling upholding the law would serve as the ultimate stamp of approval on their landmark health reform law and allow them to accuse Republicans of wasting two years fighting a law that is constitutional. For the public, it’s a question about who had the right leadership judgment, said Robert Blendon, a Harvard School of Public Health expert on public opinion and health policy.
As U.S. health care changes near, stte Medicaid cost still unknown
Journal Sentinel, Mar. 10, 2012
How the federal law will affect Wisconsin's budget arose again late last month when Gov. Scott Walker told The Washington Post that federal health reform would add to the cost of the state's Medicaid budget. His contention conflicts with projections by the previous administration. It also is based on assumptions on how the federal government will implement the law.
Richards, Erpenbach Urge Budget Committee to Act Now on BadgerCare Protection Act
NEWi Progressive, Mar. 8, 2012
The BadgerCare Protection Act:
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Prohibits DHS from implementing higher cost sharing requirements and other changes to BadgerCare that will result in tens of thousands of Wisconsin families losing coverage;
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Repeals a new tax loophole created in the state budget that allows large corporations with subsidiaries to retroactively claim business losses to lower their tax liability for up to 20 years, costing state taxpayers about $40 million annually;
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Takes $17.1 million from closing the corporate tax loophole to protect BadgerCare and deposits the balance into the general fund to help close the budget deficit; and
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Prohibits DHS from requiring government issued photo IDs as the sole source for verifying state residency for BadgerCare eligibility purposes.
Hospital Groups Will Get Bigger, Moody Predicts
New York Times, Mar. 8, 2012
While hospitals have always looked to mergers as a way of becoming larger, partly to demand higher payments from insurers, they are now also looking for ways to become more efficient. Hospitals are expecting to see lower reimbursements from Medicare and to find it increasingly difficult to persuade private insurers to pay more for care.
Health Insurance Transparency Under the Affordable Care Act
Kaiser Family Foundation, Mar. 8, 2012
With so much attention devoted to the ACA’s controversial requirement that individuals be insured and debates at the state level of whether to set up health insurance exchanges, the variety of provisions that would promote health insurance transparency have perhaps been somewhat lost in the shuffle. Implementation of some of these provisions is underway, while others await action.
Where are states today? Medicaid and CHIP eligibility levels for children and non-disabled adults
Kaiser Family Foundation, Mar. 8, 2012
Today there is significant variation across groups and states in their Medicaid and CHIP eligibility levels. As such, Medicaid expansion will have differential impacts across groups and states. This fact sheet provides an overview of Medicaid, CHIP, and state‐funded coverage eligibility levels for non‐disabled children and adults today and how this coverage will be impacted by reform.
County measure puts brakes on new mental hospital
Journal Sentinel, Mar. 7, 2012
Milwaukee County was on track to hire a consultant to help with designing the new building, with six finalists selected from a group of architectural design firms that responded to a county request for proposals. That effort could continue, but with the understanding that the county hasn't quite figured out when, how and even whether to build something new.
Needed: Health Professionals to Treat the Aging
New York Times, Mar. 7, 2012
Given the enormous number of retiring baby boomers, the problems are worrisome. Prestigious organizations like the Institute of Medicine have warned of a looming scarcity of medical professionals equipped to deliver coordinated treatment of elderly health problems.
Prices of drugs commonly used by elderly rose faster than inflation
LA Times, Mar. 7, 2012
The price of drugs widely used by elderly Americans grew by almost double the rate of inflation from 2005 to 2009, according to a new study by the AARP.
1 in 3 Americans is Having a Hard Time Paying Medical Bills
NPR, Mar. 7, 2012
During the first six months of 2011, 1 in 3 people lived in a family that had trouble paying its medical bills within the previous year; was currently paying a medical bill over time; or currently had a medical bill the family was unable to pay at all.
Judy Faulkner: Health Care's Low-Key Billionaire
Forbes, Mar. 7, 2012
Faulkner founded Epic in 1979, with the original name of Human Services Computing. A computer scientist, she wrote the code for those early patient databases, and built the company without outside capital.
Health reform law ends lifetime limits for 105 million Americans
HHS, Mar. 5, 2012
While some plans provided coverage without dollar limits on lifetime benefits, 105 million Americans were previously in health plans that had lifetime limits. HHS estimates that 70 million people in large employer plans, 25 million people in small employer plans, and 10 million people with individually purchased health insurance had lifetime limits on their health benefits prior to the passage of the Affordable Care Act. The Whitehouse has also provided state-by-state statistics.
The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks & Considerations for States
Kaiser Family Foundation, Mar. 5, 2012
This brief assesses the potential benefits and drawbacks to states from newly implementing a Basic Health Program (BHP) under the Affordable Care Act. The law gives states the option of creating a BHP, using federal tax money to subsidize insurance coverage for low-income residents who would otherwise be eligible to purchase coverage through a state exchange. Such a program would give states the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid levels. Wisconsin already has BHP options with BadgerCare Plus (Medicaid + CHIP) and HIRSP.
Department of Health Services to Hold Town Hall Meetings on Long Term Care Sustainability Initiatives
DHS, Mar. 2, 2012
The Department of Health Services is seeking input from consumers, community partners, integrated health systems, and providers on its Long Term Care Sustainability Initiatives. Individuals who are interested in speaking will have up to five minutes to share their ideas at the forums. Those who would like to share their ideas and do not wish to speak are encouraged to submit their written feedback at the meeting or through the Department’s online survey. This link also includes background information on the proposals.
Ryan: Repeal and replace health care reform
The Business Journal, Mar. 2, 2012
U.S. Congressman Paul Ryan believes the future of U.S. health care, and by extension, the economy, is doomed unless national health care reform is repealed and replaced.
Health care fix critical to nation, Ryan says
Journal Sentinel, Mar. 2, 2012
Rep. Paul Ryan sums up the importance of remaking our health care system this way: "If you get health care right, so many other problems that we have in this country, our economy and our fiscal situation improve themselves." Much of the discussion focused on how to "get health care right." The question often centers on the most effective ways to slow the rise in health care spending and expand coverage to people who can't afford health insurance: The increased regulation of the federal health care reform law or proposals that would rely on the marketplace.
Secretary Dennis G. Smith Welcomes Assembly Comittee Passage of Bill Lifting Family Care Enrollment Cap
DHS, Feb. 28, 2012
"With the vote to send AB 477 to the Assembly floor today, and recent passage of SB 380 in the Senate, legislation to again enroll Wisconsin's eligible elderly and individuals with disabilities in the Family Care program moves closer to reaching Governor Walker's desk. We look forward to the opportunity to allow our citizens to access coordinated long term care services and supports that help them live well in their communities. We appreciate Rep. Knodl's efforts to move this legislation forward from the Committee on Aging and Long Term Care to the full Assembly.
CLICK HERE to keep reading Articles and Opinions.
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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