Tuesday, July 3, 2012
“Last Thursday’s Supreme Court ruling is a clear and complete victory for health care reform. It affects all Americans, with special significance for children,” said Matthew Flaminio, President and Chief Legal Officer, Go Solutions Group, Inc. [GSGI]
The Affordable Care Act, as upheld by the Supreme Court, provides that:
• Current Children’s Health Insurance Programs [CHIPs] and Medicaid requirements must continue through 2019
The ACA includes a Maintenance of Effort (MoE) requirement that prohibits states from
cutting benefits or restricting Medicaid or CHIP eligibility requirements for children through 2019. This provision was designed to ensure the continuity of coverage for low-income children who could potentially slip through the cracks as the new coverage systems get up and running.
• CHIP is reauthorized through 2019
The ACA preserved and extended CHIP through September 30, 2019 with full funding
provided through 2015. CHIP provides coverage for approximately 7 million low-income
children who whose parents earn too much to qualify for Medicaid but not enough to purchase health insurance on their own. Together CHIP and Medicaid have been crucial for families during the recession, ensuring coverage for kids despite the downturn in the economy.
• No more pre-existing condition exclusions
The ACA ensures that no child can be denied health care coverage based on a pre-existing condition. Parents of children with cancer, children born with a birth defect, children with asthma, special needs kids, among others are able to get coverage for their children because of the ACA.
• Simplified enrollment measures
The ACA requires a “No Wrong Door” approach to enrollment that will streamline the process for getting people enrolled in the coverage that best fits their circumstances, whether it’s Medicaid, CHIP, or coverage in the new “health insurance exchanges” that were created by the ACA.
• Extended funding for outreach and enrollment grants
The ACA extended the CHIPRA outreach and enrollment grant program, which was funded at $100 million for FY 2009-2013, by providing an additional $40 million and making the funds available through FY 2015. The purpose of these grants is to increase the participation of eligible children in both Medicaid and CHIP.
• Federal fiscal support for states
Beginning in 2014, the ACA increases federal matching rates in CHIP, providing a 23 percent increase to ensure to that existing public coverage for children remains strong.
The ACA allows families to purchase child-only insurance packages in the exchanges, ensuring that children being cared for by grandparents, children with parents whose employers do not offer dependent coverage, and children in mixed immigrant status households are able to access coverage.
• Eliminated cost-sharing for preventive health services
The ACA requires insurers to cover, at no cost, comprehensive screenings and preventative care for children as defined by the “Bright Futures” standards issued by the American Academy of Pediatrics, including well-child visits. It is estimated that 14.1 million children (0-17) are no longer paying the cost of these basic preventive services.
• Extended dependent coverage
The ACA allowed parents to keep their dependent children health plan up to age 26. It is estimated that 2.5 million young adults already have gained health insurance coverage since the dependent coverage expansion up to age 26 took effect.
• Extended Medicaid for foster youth
Beginning in 2014, the ACA allows Medicaid coverage to all foster youth below the age of 25 who were formerly in foster care for a period of six months or more.
• Oral health
The ACA authorized an oral health prevention campaign, dental carries disease management, school-based dental sealant programs, and cooperative agreements to improve infrastructure and surveillance systems.
• Expanded Medicaid eligibility
In 2014, the ACA expands Medicaid at state options to all individuals under age 65 with incomes up to 133% of the federal poverty level (FPL). If implemented by the states, this provision would be enormously helpful for low-income parents who currently do not have access to affordable coverage.
• More affordability for low-income families in the new exchanges
Starting in 2014, the ACA provides refundable and advanceable premium credits to families with incomes between 133-400% (FPL) level to help buy insurance through the new health insurance exchanges.
Already in effect and improving the availability of health care services in communities across the nation, the ACA established a $200 million federal authorization program to support school-based health centers.
• Home visiting
The ACA includes $1.5 billion in mandatory funds for a new Home Visitation Grant Program. This program will support states efforts to develop and implement evidence-based maternal, infant, and early childhood visitation models.