The Centers for Medicaid and CHIP Services (CMCS) finalized “CMS-2390-P” on Monday April 25, 2016, which is a set of rules that will be published in the Federal Register soon.
The rule applies to health insurers operating Medicaid managed care plans for the states and it is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It aligns key rules with those of other health insurance coverage programs; modernizes how states purchase Medicaid managed care services; and strengthens the consumer experience and key consumer protections.
As Families USA says in their news email, “The new rule is a big deal in part because it affects so many people: There are more than 72 million people enrolled in Medicaid. Three quarters of them are in managed care plans across 39 states. States can—and many already have—gone above and beyond these new standards in many areas. For other states, it will require substantial work to come into compliance. For many provisions (of the rule), CMS has given states (and managed care plans) a long implementation timeline.”
The final rule, when published, will be posted in the Federal Register: https://www.federalregister.gov/ It is currently available in PDF only, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09581.pdf
For more information on CMS-2390-P, a summary of its key provisions, guidance documents, technical assistance documents, and information about state managed care programs, visit the federal Medicaid Agency’s Managed Care website: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html
Statements from the Centers for Medicare and Medicaid Services (CMS) and national organizations on CMS-2390-P
From the CMS Blog of April 25, 2016:
From the National Association of Medicaid Directors (NAMD):
Press Release April 26, 2016
NAMD Statement on Medicaid Managed Care Final Rule
From Families USA:
Families USA’s take on New Medicaid Managed Care Rules
CMS final rule strengthens access to mental health and substance use disorder benefits for millions of beneficiaries who receive services through Medicaid managed care organizations, Medicaid alternative benefit plans or CHIP. Final rule released March 29 2016 by the CMS.
States and plans must be in compliance no later than 18 months after publication of the final rule, which will be published in the Federal Register March 30.
For more information the executive memo is at https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity.
Long-time NAME member Larry Charny (NC) who worked for many years as the Director of the Medicaid Special Projects Unit for the New York City Department of Education, has collaborated with the New York State Association of School Business Officials (www.nysasbo.org ) to publish an article in a recent issue of their journal, The Reporter.
His article, “Leadership Strategies for Success with School-Based Medicaid Claiming-and Why it Matters”, reminds the readers that not just administrators of special education and Medicaid coordinators, but school business officials need to understand and actively participate in their district’s Medicaid school based services claiming program. NAME thanks the NYSASBO for their permission to share the article with our members.
To read Larry’s article <Click Here>
A recent case study on the implementation of the Affordable Care Act and the impact the increased number of students now eligible for Medicaid has on the Medicaid School Health Services Program.
In addition one of the sources for the study was the 2013 NAME Biennial Survey. The full survey can be viewed on the Members Only page, once logged in and then following link. http://www.medicaidforeducation.org/members/name-national-surveys
Drawing on data from the U.S. National Survey of Children’s Health, a recent study in the Journal of the American Medical Association (JAMA), compared experiences of children with private and public health insurance and found that those with Medicaid and Children’s Health Insurance Program (“CHIP”) coverage were more likely to receive preventative medical and dental services as well as less likely to incur out-of-pocket costs. This study found that caregivers’ experience with Medicaid coverage was at least as positive, and sometimes more positive, than their experience with private insurance.
The Centers for Medicare and Medicaid Services (CMS) announced a new grant opportunity to help enroll children in Medicaid and CHIP. A total of $32 million will be available for cooperative agreements ranging in size from $250,000 to $1 million over a two-year period. CMS will hold the first of two conference calls for prospective applicants on November 19, 2015. The second call will be on Monday, November 30, 2015. More detailed information is on their website at http://www.insurekidsnow.gov/professionals/funding/index.html
A Brief Summary
The 13th Annual NAME Conference greeted a record-shattering 330 attendees as they arrived in Baltimore, Maryland, October 4-7, 2015.
The NAME 2015 Conference program was full of changes this year. To keep costs down, it was designed with one less day than many of the previous Conferences; it had no traditional breakout or nugget sessions; and it began on a Sunday evening, versus Tuesday afternoon. There was a large number of people who had arrived in time to attend the first session of the week, The NAME Academy: Introduction to School Based Medicaid.
Monday morning began with the 3rd Annual Anysia Drumheller Memorial Scholarship 5k Run. Congratulations to the first place winners; Alexandria Fogarty(CO) in the Women's and Brian Mooney (IL) in the Men's. The conference general sessions began with NAME President Rena Steyaert (MT), Conference Chair Mark Smith (OH) and NAME Executive Director John Hill (KY) welcoming all participants, special federal agency welcomes were delivered by Timothy Hill, Deputy Director of the Center for Medicaid and CHIP Services in the Centers for Medicare and Medicaid Services (CMS); and Mary Louise Dirrigl, Director of the Office of Policy and Planning in the Office of Special Education and Rehabilitation Services. Attendees then heard an informative presentation related to the recently issued guidance from CMS on Free-Care and Third Party Liability. This session was presented by Jean Close from the Center for Medicaid and CHIP Services.
For the full 2015 conference summary and access to the conference presentations, NAME Members can log into the Members Only section of the NAME website.
If you are not a member of NAME and are interested in joining, please click on Join NAME found on the menu above.
As the beginning of another school year approaches, the National Alliance for Medicaid in Education (NAME, Inc.) encourages “M-edu-caid” stakeholders to recognize 2015 as a milestone year in the history of Medicaid and Special Education.
On July 30, 2015, Medicaid turns 50! You can find a photo of President Johnson’s 1965 signing of legislation that created Medicaid and Medicare, as well as additional historical information, at the federal government’s web sites at http://www.medicaid.gov/medicaid-50th-anniversary/overall-medicaid/overview-medicaid-anniversary.html and http://cms.gov/Outreach-and-Education/Look-Up-Topics/50th-Anniversary/Medicare-and-Medicaid-50th-Anniversary.html.
To pay tribute to the accomplishments of students with disabilities in the 40 year anniversary of the passage of the Individuals with Disabilities Education Act (IDEA), the U.S. Department of Education is also posting articles on its web site, for example, http://www.ed.gov/edblogs/osers/2015/04/idea-changes-lives-look-whos-going-to-college/. Similarly, the U.S. Justice Department’s home page at http://www.ada.gov/ celebrates 25 years of removing barriers and empowering people following enactment of the Americans with Disabilities Act (ADA) in 1990.
Members and friends of NAME, Inc. may find this discussion of links between Medicaid coverage of children and long term educational benefits an interesting read in this “milestone” summer: http://www.cbpp.org/blog/medicaid-at-50-covering-children-has-long-term-educational-benefits.
Connecting Kids to Coverage
Non-Traditional Partners Can Help Increase Medicaid & CHIP Enrollment
You may find unique enrollment partners where you least expect them! Many non-traditional partners have proven to be excellent sources to help identify and connect with uninsured families and children. Because of the unique roles and relationships that potential partners such as child care, financial, and housing organizations have cultivated in communities, they can be the perfect partners for your Medicaid and CHIP enrollment efforts. By creating and fostering relationships with non-traditional partners, you may be able to reach even more potentially eligible families and children, further your organization’s reach, and boost program enrollment.
Our recent webinar featured a number of non-traditional partners engaged in Medicaid and CHIP outreach. And explore our webinar archive here for additional outreach ideas! We also invite you to contact us via email or Twitter (and use #Enroll365 in Tweets!) to share your Medicaid and CHIP enrollment successes, including best practices partnering with non-traditional partners.
Campaign in Action
The partnership between healthcare and child care is an important connection to make for the education, health, and overall well-being of children and families. There is an estimated 12 million children under the age of six in some form of care, including informal care settings. The Office of Head Start's 2013-14 Program Information Report indicated that more than 1 million children received Head Start or Early Head Start services that year. Child Care Aware of America promotes affordable child care for families and advocates for healthier environments for children in child care facilities, which includes making the link to healthcare access.
Their project Healthy Child Care-Healthy Communities, funded by the Robert Wood Johnson Foundation, promotes healthy, active living practices in child care through advocacy and state plan implementation. Child Care Aware is working with partners to support nutrition, physical activity, and screen time initiatives by best practice sharing and development of training materials. A Healthy Child Care-Healthy Communities toolkit is also in the works replicating the model for improving children’s health.
The U.S. Department of Housing and Urban Development (HUD) Indianapolis Regional Office regularly works with vulnerable populations to promote fair and stable housing and positive health outcomes, which means connecting families with healthcare coverage. The office partners with local nursing organizations to implement a grocery coupon program and conducts healthy cooking lessons in public housing areas that have a large, eligible audience. In addition, the HUD office participates in on-site outreach events on housing and healthcare with a Health-Net clinic (federally qualified health center) and YMCA fitness center.
These programs provide families with skills and resources in addition to information and enrollment assistance to eligible families. Connect with your regional HUD office to learn more about their existing programs by visiting the “State Info” page at portal at hud.gov or connecting with your regional HUD office through the “Contact My Local Office” option.
Integrating healthcare enrollment through community financial centers is the innovative way that Insure Central Texas, a Foundation Communities program, has been connecting kids to coverage. Insure Central Texas, offers enrollment at two community financial centers and combines enrollment with tax preparation (VITA), cash for college, and financial coaching. Through their integrated program, Insure Central Texas has enrolled more than 4,500 individuals for healthcare benefits in 2016.
The Children’s Partnership in California has found that small businesses can play a critical role in connecting families and their children to coverage. The organization offers small businesses easily comparable options and affordable insurance plans and provides information about how their employees and their families can enroll in individual insurance through their state channels by reaching out directly to business owners and associations offering and distributing print materials to their target audience. The Children’s Partnership has found success using direct mail pieces and sharing fact sheets in both English and Spanish. By creating user-friendly tools and resources -- and taking the time to follow up with businesses, they were able to get owners on board to provide further information and coverage to their employees and their families.
3 Ways to Stay Connected with the National Campaign
Share our materials widely. We have an ever-growing range of excellent resources available to use in outreach and enrollment efforts.
Follow the Campaign on Twitter. Don’t forget to re-tweet or share our messages with your network or use our #Enroll365 hashtag in your posts.
The Connecting Kids to Coverage National Campaign Notes eNewsletter is distributed throughout the year and provides updates on Campaign activities. If a friend or colleague forwarded this email to you, sign up to receive this eNewsletter directly to your inbox.
Many thanks to all NAME Voting Members who participated in the annual Election of Officers, which was held earlier (in May) this year to allow more time for transition planning.
Please join the 2015 Nominating Committee in congratulating the following successful candidates whose terms of office will begin immediately following this year’s October 4-7 NAME Conference in Baltimore:
Melinda Hollinshead (Arizona)
Region 3 State Medicaid Agency Representative
Shannon Huska (Colorado)
Region 2 State Education Agency (SEA) Representative
Anne Glass (Florida)
Region 2 Local Education Agency (LEA) Representative
Kathleen Merry (Michigan)
Region 1 Local Education Agency (LEA) Representative
Charles Tyler, Jr. (Maryland)
At-Large State Education Agency (SEA) Representative
Mark Smith (Ohio)
Additionally, on October 7, 2015, Dario Avila (Texas), who has been appointed by the Board of Directors in accordance with NAME’s Bylaws, will fill the State Medicaid Agency At-Large Representative vacancy (from October 7, 2015 through the close of the 2017 NAME Conference). He will fulfill the unexpired term of Shannon Huska as a result of her election to a new 3-year term as the Region 3 State Medicaid Agency Representative.
Please join the Nominating Committee in congratulating these newly elected and appointed officers; and please consider volunteering to help carry out the work of the organization through service on a NAME committee. Log in to the Member Only section of NAME’s website and click “Committees” for more details, and watch for announcements about NAME leadership opportunities in the NAMEtag and on NAME’s website.