Waivers of Medicaid Requirements – A Quick Review

Executive Summary

In a companion piece to Background to Medicaid and Section 1115 of the Social Security Act, Legal Director Jane Perkins and Managing Attorney of the DC office Mara Youdelman provide a brief review of how certain Medicaid requirements may be waived. They conclude, in part, that “Section 1115 of the Social Security Act gives the Secretary of HHS limited authority to approve Medicaid waivers.”

Defending Medicaid

Medicaid’s guaranteed-enrollment for those who meet eligibility requirements makes the program vulnerable to attacks at both the federal and state levels.  NHeLP actively defends Medicaid against these threats, protects the rights of beneficiaries to receive the services to which to which they are legally entitled and works to ensure that states meet their obligations under the Medicaid Act.

NHeLP’s Protect Medicaid Webinar Series

Proposals to drastically cut federal Medicaid spending through per capita caps and block grants would fundamentally alter and undermine Medicaid. NHeLP’s Protect Medicaid webinar series examines the harmful impact of these proposals on key features of the Medicaid program, including: services and benefits geared for vulnerable populations; affordability and cost sharing protections; advances under the ACA’s low income adult expansion; and consumer protections and due process guarantees.

Click the links to watch the videos, which will appear in a new window.

Click to download PDFs:

 

Click on the links below to register for these upcoming webinars:
Friday, April 7
Noon-1 p.m. EDT – Section 1115 authority

Friday, April 28
2 p.m. EDT – Rulemaking, Agency Authority, and the Administrative Procedures Act – An Overview

A Young Person’s Guide to Health Care Transition | NCWD/Youth

Source: A Young Person’s Guide to Health Care Transition | NCWD/Youth

A Young-Persons-Guide-to-Health-Care-Transition is about making the transition from pediatric to adult health care. This brief will review topics youth should consider around transitioning to adult health care, living a healthy lifestyle, and paying for health care. Youth need to be a part of conversations about health care. Most youth rely on their parents to handle decisions about their health care and health coverage. Before you know it, you may be expected to make these decisions on your own, if you are not doing so already. This brief will provide some information and help you think about ways you can start planning now for your transition from pediatric to adult health care.

Taking charge of your health care transition goes hand in hand with helping you achieve your career and life goals. Managing your health and wellness as a young person is the first step necessary for going to school, transitioning to work, and living the life you want. To make your dreams and career goals a reality, start learning about your health, health insurance, and health care transition planning at a young age. Make it a habit to manage your health and well-being as a young person, and you will carry this skill throughout your life.

Download the PDF

New 2017 Transition Coding and Reimbursement Tip Sheet Available

Got Transition and the American Academy of Pediatrics released a new 2017 Transition Coding and Reimbursement Tipsheet 2017 to support the delivery of recommended transition services in pediatric and adult primary and specialty care settings. The new tip sheet includes a list of updated transition-related CPT codes, including the new code for transition readiness assessment, and current Medicare fees and RVUs for these services.  It also includes a new set of seven clinical vignettes with recommended CPT and ICD-10 codes. HERE for the tip sheet.

National Center on Improving Literacy

Evidence-based resources for improving outcomes for students with literacy-related disabilities, including dyslexia.

About Us

The National Center on Improving Literacy is a partnership among literacy experts, university researchers, and technical assistance providers, with funding from the United States Department of Education.

Our Mission

To increase access to, and use of, evidence-based approaches to screen, identify, and teach students with literacy-related disabilities, including dyslexia. Download our handout.

Developing Culturally Responsive Approaches to Serving Diverse Populations: A Resource Guide for Community-Based Organizations

Michael López, Kerry Hofer, Erin Bumgarner, and Djaniele Taylor

Cultural-Competence-Guide

A changing population According to 2013 U.S. Census data: • 48 percent of children under the age of 18 were members of racial/ethnic groups other than nonHispanic white. • Of this group, Hispanics represented the largest racial/ethnic group (24 percent), followed by nonHispanic blacks (14 percent) and non-Hispanic Asians (5 percent). • Hispanics also are a fast-growing racial/ethnic group, almost tripling as a share of the U.S. population between 1980 (9 percent) and 2013 (24 percent). a Across that culturally and linguistically diverse population, however, there is great variability within any given racial/ethnic group. Understanding the variability within and across racial/ethnic subgroups is an important step any organization must take to ensure its services are culturally responsive to the needs of its targeted population.

http://www.hispanicresearchcenter.org/wp-content/uploads/2017/03/Cultural-Competence-Guide.pdf

EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents

JUNE 2014

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html

Produced in collaboration with the National Health Law Program under subcontract to NORC at the University of Chicago www.NORC.org

EPSDT’s goal is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.

“The Medicaid program’s benefit for children and adolescents is known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT. EPSDT provides a comprehensive array of prevention, diagnostic, and treatment services for low-income infants, children and adolescents under age 21, as specified in Section 1905(r) of the Social Security Act (the Act). The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. The goal of EPSDT is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.”

Ten Ways the Affordable Care Act Helps Older Adults and People with Disabilities

Source: Ten Ways the Affordable Care Act Helps Older Adults and People with Disabilities

Executive Summary Ten Ways ACA Helps Older Adults

NHeLP Senior Policy Analyst David Machledt  provides a succinct examination of the ways the Affordable Care Act is improving the lives of older adults and people with disabilities. For example, the ACA bars health plans from discriminating against those with pre-existing conditions and since its enactment 3.6 million people with pre-existing conditions have gained health care coverage.

What Makes Medicaid, Medicaid? — Access

By Abbi Coursolle, David Machledt, Wayne Turner

Executive Summary

In the fourth paper in our “What Makes Medicaid, Medicaid?” series, NHeLP experts explain the provisions and protections that ensure Medicaid beneficiaries gain access to quality health care services. Senior Attorney Abigail Coursolle, Senior Policy Analyst David Machledt, and Senior Attorney Wayne Turner write, “Medicaid is designed to include many protections that ensure that beneficiaries get more than a coverage card. Medicaid ensures that beneficiaries have access to a range of services specifically designed for their needs.”

Source: What Makes Medicaid, Medicaid? — Access – DOWNLOAD PUBLICATION

Key Takeaways
  • Under current law, states have tremendous flexibility in designing their Medicaid programs to determine low-income people eligible and enroll them in coverage.
  • Medicaid operates efficiently by ensuring that low-income people are enrolled into coverage when they need it.
  • Medicaid coverage is designed to provide continuous coverage for pregnant women and newborns.
  • Medicaid ensures that beneficiaries can get to their medical and specialty care appointments through transportation assistance.
  • Medicaid contains protections designed to get beneficiaries who need prescription medication access to their treatment quickly.
  • Medicaid gives beneficiaries the right to access the providers they need to treat their health conditions.

Disability Rights – National Health Law Program

Medicaid provides health coverage and protections for persons with physical, intellectual and developmental disabilities. NHeLP works with state health advocates and litigates when necessary to protect the rights of vulnerable persons, making sure persons with disabilities receive the care they need and are legally entitled to, as well as protecting their rights when care is denied, terminated or reduced without notice or a hearing.

Source: Disability Rights – National Health Law Program