Federal Policy

At Voices for Utah Children, we are closely following what happens to Medicaid. The majority of Utah’s Medicaid enrollees are kids. CHIP- the Children’s Health Insurance Program- could not exist without Medicaid. Medicaid is the cornerstone for children’s health. All kids need health insurance to be healthy and thrive,

But now Utah’s Medicaid program is under not just one but two threats. There are changes to Medicaid being proposed in Congress at the federal-level, and changes proposed by Governor Herbert and the Department of Health at the state-level.

Trying to understand these different changes and what they mean for Utahns? Here is a quick overview of the federal and state threats:

#1 Federal Cuts to Medicaid and Dismantling the Medicaid Program as We Know It

There are significant threats to Medicaid in the Republicans’ ever-changing ACA repeal efforts. The G.O.P. health care bill proposes massive cuts to Medicaid and a radical restructuring of the Medicaid program. Specifically, Congress has proposed two different state options; both would lead to major changes and cuts to the Medicaid program. 1) States can opt to cap funding through a per enrollee or per capita amount. This cap option would allow for the program to grow if new people enroll, but would limit the federal dollars available for states to meet demand and program growth. 2) Or states can opt for the block grant option, which is essentially a ‘lump sum’ amount. Under this option, even fewer federal dollars flow into the state’s Medicaid program, but the state has greater ‘flexibility’ to cut people or benefits from the program. Under the current Senate bill, certain children with special health care needs are exempt from the per capita cap option and all children are exempt from the block grant. Yet as many others have pointed out, these are not sufficient ‘fixes’ to the problem, since we know that children need healthy parents to thrive. Moreover, the bill still limits available state resources overall, which means vulnerable populations including children, seniors and people with disabilities, will be forced to compete for limited state dollars.

Jessie Pic 2 002

But unfortunately, those are not the only threats to Medicaid...

#2 State Changes to the Medicaid Program through a Waiver Request to the Federal Government: People Will Lose their Health Coverage

While Congress is considering Medicaid cuts, Utah’s state Department of Health is also proposing some unprecedented administrative changes to the Medicaid program. The Department wants to move forward with these changes regardless of what happens at the federal level.

The Utah Department of Health is planning to submit a request, or waiver, to the federal government to make the changes. States are not required to change their program- most aren’t. But a few states like Utah are seeking to increase restrictions and requirements in their Medicaid program. Why are states doing this now? Previous administrations did not allow for these changes. But the new Trump administration has indicated that they are open to increased Medicaid restrictions.

Utah is proposing several changes that will cause enrollees to lose care and more people to lose coverage. Learn more about the full scope of the changes and how to take action. Some changes include:

1) Health insurance time limits: The Department is proposing to limit the length of time a parent or individual can receive coverage through the Primary Care Network (PCN), or the time an adult without children can receive Medicaid. Even if the parent is working and on PCN, they will lose coverage after 5 years. This will be particularly harmful for those with chronic conditions or mental health needs who require some medication, but do not qualify for disability Medicaid.

2) Work requirements for Primary Care Network (PCN) enrollees: Work requirements mean more red tape and administrative requirements for enrollees. Added administrative requirements increase the likelihood that someone will miss a deadline or forget paperwork, and then lose their coverage entirely. What’s more, we already know that work requirements are not an effective way to improve coverage.

3) Penalties for non-emergency use of the ER: If an individual or parent goes to the ER for a non-emergency purpose, he or she will be charged a $25 penalty. The goal of this increased penalty is to decrease state costs. Unfortunately, many advocates believe this will simply deter vulnerable populations from accessing the care they need. What’s more, the Department is increasing penalties without any additional support for enrollees to receive care management or patient navigation support.

The Department of Health is currently accepting comments and public feedback about these proposed changes. Share your comments online by July 20th.

Or attend an upcoming public hearing on July 10th.

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Published in News & Blog

Congress’ health plan bill, the American Health Care Act, proposes a major restructuring to the Medicaid program. The proposal would cap the federal funding states receive on a per-Medicaid beneficiary basis, starting in 2020. Using retrospective data, Voices for Utah Children investigated the impact of these changes on Utah’s state budget, had they been enacted a decade earlier.

The chart below illustrates the Utah budget impact of the Medicaid per capita cap allotment, if it had gone into effect a decade ago. The scenario is based on the American Health Care Act and state Medicaid annual reports. Given inflation and rising health care costs, Utah could expect the budget gap for the coming years to significantly exceed what it would have been in the past.

AHCA budget projection Utah

The proposed Medicaid caps would be based on states’ per-beneficiary spending, set in fiscal year 2016, and would rise annually to match growth in the medical care component of the Consumer Price Index (M-CPI). States are already locked into their capped amount. However, according to Congressional Budget Office forecasts, Medicaid costs per beneficiary are expected to rise 0.2 percentage points faster each year than the capped amount.

Consequently, states would get less federal funding than under current law and could expect to see cuts growing each year.

States would be expected to make up any excess costs or cut benefits to enrollees. Any unanticipated health care cost growth, such as a Zika outbreak or a new opioid treatment drug, would not be accounted for in the federal per capita cap amount. 

As retrospective data illustrate, Utah consistently would have less available funding for health care costs. Today over 200,000 children rely on Medicaid coverage, including children with special health care needs. The majority of Medicaid enrollees (63%) are children. The Congressional proposal would create situations where state lawmakers choose which health services vulnerable children are eligible to receive, and which services or benefits they will not be eligible to receive. These are decisions best left up to health care providers, not politicians.

The American Health Care Act puts children’s health care and coverage at risk. Changes to Medicaid’s financing structure through a per capita cap would create large shortfalls in Utah’s state funding. These shortfalls would inevitably lead to limits placed on the program, such as a reduction in benefits, cuts to provider payments or fewer children covered. This unprecedented restructuring of the Medicaid program puts Utah children’s health care and coverage at risk.


LUGU Logo 1March 30, 2017 is Love UT Give UT!

It’s a day for Utahns to give to the nonprofits that make Utah special. Every donation to Voices for Utah Children through Love UT Give UT gives Voices a chance to win matching grants and prizes—and gives you a chance to win a car!

And you don't have to wait!  Donate now at http://bit.ly/loveUTchildren.

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express for sponsoring our 30th Anniversary Year. Amex

Published in News & Blog

It’s time to start preparing for the 2060 Presidential election. No, I’m serious. Today, somewhere in Utah, there are children who could run for President of the United States in 2060 and beyond.

I hope they are nurtured by parents who are economically secure and prepared to parent to the best of their ability. I hope they have stable, affordable, effective health care and have health insurance so they don’t worry about whether they can access care. I hope they have access to quality preschool if they need it so they are ready to learn when they start kindergarten. I hope they are taught by teachers who are valued; who are paid a wage that recognizes the important, valuable influence they have on a child’s intellect and ability to succeed. I hope they live in a community that supports them throughout their lives, that makes sure that all children in the community have what they need to succeed, not just those living in certain zip codes. I hope they live in communities that recognize that care for our environment means healthier, happier kids. And I hope they live in a society that values all life, all nationalities, all humanity. Because that kid could be the hero we need to bring a nation together.

Unfortunately, many kids don’t live this life in Utah today. As Diposh Navsaria said “We fail kids, long before they fail us.” Too many live below poverty in our state, 120,155 to be exact. If you want a visualization, that’s enough kids to fill the Huntsman Center, Vivint Smart Home Arena, Smiths Ballpark, Rice-Eccles Stadium, the Maverick Center, and the Dee Events Center at one time. And we don’t always provide these at-risk kids with the support they need.

All-day kindergarten is not available to all kids; quality, affordable preschool is not available to all kids; we have the lowest per pupil expenditures in the nation in a state where student population increases every year; we have one of the highest rates of uninsured kids in the nation, and we do have the highest rate of uninsured Hispanic kids.

Nationally, we continually fight to keep food stamps from being cut, we worry about cuts to the Children’s Health Insurance Program, we wonder if families will be torn apart in the same breath that we say how much we value families. And everywhere, across this nation and in Utah, sometimes your zip code determines if you succeed or fail. When will be learn that when our children succeed, our city, community, nation, and society succeed.

When will we understand that supporting children and families IS economic development. Because when we support our children, when we raise capable, loving, experienced children they become the bedrock and the foundation, of a successful society.

At Voices for Utah Children we always ask the question, “Is it Good for Kids?” when working on policies affecting children and families. We collect data, we do research, and we share information with experts across the United States. I want to be able to say that the future President of the United States from the great state of Utah could be any child in the state, not just the lucky ones born to the right parents, born in an affluent neighborhood, and born with the best chance of success. When asked “Is it good for the 2060 candidate for President”, I want our state to be able to say “yes, we did the best we could for all our children.” All our children had the opportunity to succeed. Hail to the future Chief!

 


LUGU Logo 1March 30, 2017 is Love UT Give UT!

It’s a day for Utahns to give to the nonprofits that make Utah special. Every donation to Voices for Utah Children through Love UT Give UT gives Voices a chance to win matching grants and prizes—and gives you a chance to win a car!

And you don't have to wait!  Donate now at http://bit.ly/loveUTchildren.

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express for sponsoring our 30th Anniversary Year. Amex

Published in News & Blog

Congress’ New Health Care Repeal Bill Cuts Medicaid, Harms Kids.

We have made enormous progress in making sure Utah kids have health insurance coverage. Speaker Ryan and the House Republicans have released a plan that will take us backwards. The plan would harm the health of kids and families in Utah and across the United States by drastically cutting Medicaid, the cornerstone to children’s health care, and repealing the ACA.Taking away her phone wont help

Medicaid CHIP vulnerable Utah childrenOver the last several years, thanks to the collective impact of the ACA, CHIP and Medicaid working together, we have seen a significant decline in the number of uninsured children in our state. But of these programs, the biggest insurer for kids is Medicaid. Medicaid insures over 200,000 children; the ACA covers an estimated 38,000 children.

Now Congress is reversing this progress. The proposed repeal act threatens the health and well-being of Utah children and families.

By proposing to place a fixed cap allotment on the Medicaid program, the proposal places arbitrary, harmful limits on the amount of care a vulnerable child can receive. Caps inevitably lead to cuts in care. The children that will bear the burden of these cuts are our kids with special health care needs and chronic conditions: kids with cancer, asthma, or cystic fibrosis

A Medicaid cap shifts costs to the state and creates more instability and volatility to a program that has worked for over 50 years.UtahMedicaidCHIP 2

In addition, while the proposal retains the provision in the ACA that allows children to stay on their parents’ health care to age 26, which we support, it phases out parallel language that allows children in foster care to retain their Medicaid coverage to age 26 through presumptive eligibility. Children aging out of foster care are some of our nation’s most at-risk kids. This proposal would leave vulnerable transition-age youth without coverage.

There are other dangerous provisions in the proposed bill, including cuts to Planned Parenthood and a rollback of essential health benefit protections. As more details emerge in the coming days, we will provide updates and analysis about the impact on kids and families.

But the bottom line is clear:

Congress’ repeal plan will hurt our most vulnerable children and families, drive up costs for families, and reverse the gains we have made for children’s health coverage and care.

Our families need a strong health care foundation now. Cuts to the Medicaid program will ripple throughout our health care system and hurt Utah families now and into the future.

For more information about how ACA repeal tax credits will affect families, see the Kaiser Family Foundation analysis.

Take Action!

Sign this petition.


LUGU Logo 1March 30, 2017 is Love UT Give UT!

It’s a day for Utahns to give to the nonprofits that make Utah special. Every donation to Voices for Utah Children through Love UT Give UT gives Voices a chance to win matching grants and prizes—and gives you a chance to win a car!

And you don't have to wait!  Donate now at http://bit.ly/loveUTchildren.

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express for sponsoring our 30th Anniversary Year. Amex

Published in News & Blog

Why We Care About Medicaid “EPSDT” Benefits
and So Should You

While threats to the Affordable Care Act (ACA) may seem the most imminent in our current political landscape, Medicaid is also under attack. Congress and the new administration are discussing deep cuts and changes to the Medicaid program, through Medicaid block grants or per capita program caps. The new administration recently said they will be proposing block grants

Medicaid block grants result in funding cuts and fewer people receiving coverage. Utah has long been recognized as a leader in health care innovation, but our ability to innovate will be severely impaired if we experience cuts to our foundational health care safety-net system through block grants. Medicaid is the cornerstone to children’s health coverage in Utah.

In a recent letter to Congress on January 13th, the Governor and state officials weighed in on a number of health reform proposals, including Medicaid. We saw many areas for concern in our state leaders’ letter; one brief recommendation in particular jumped out at us, because it would have significant and long-lasting consequences for children and families:

“Reevaluate the EPDST (Early Period Screening, Diagnosis and Treatment) benefit for children. EPDST requires states to provide comprehensive and preventative health services for Medicaid beneficiaries under the age of 21 with few limitations.
Consider limiting benefits to what is available in the private market. Currently, children on Medicaid have more access to services and benefits than children who are covered under good commercial plans.”

So, what is EPSDT?

Early, Periodic Screenings, Diagnosis & Treatment

Utah Medicaid Long TermThe EPSDT benefit, known in Utah as “CHEC” or Children’s Health Evaluation and Care, is one of the hallmarks of the Medicaid program. The Medicaid Act currently requires states to provide children with a comprehensive scope of services. For decades, EPSDT has allowed providers to catch potential health problems early, when they are easiest to treat and children stand the best chance of developing to their fullest potential. Covered EPSDT services include basic preventative care, such as dental and vision services, plus services needed to address acute, long-term, and disabling conditions, such as physical, speech and behavioral health therapies and in-home nursing. The EPSDT benefit is considered the gold standard for children’s pediatric benefits. It helps doctors determine the best level of care for their patient.

EPSDT has helped millions of children, especially children with special health care needs, receive the level of the care they need. In fact, many families in the private insurance market will turn to Medicaid coverage for their children with special health care needs-- because they cannot afford such comprehensive benefits in their “good” commercial plan.

We Need to Protect EPSDT

Medicaid is the cornerstone for children’s health coverage in our state, and serves over 20% of our most vulnerable families. If we roll-back the EPSDT benefit, we will see a surge of parents no longer able to afford care, particularly for children with special health care needs.
EPSDT protects families; it assures families that they can receive a minimum level of coverage and have access to services that meet prevailing standards of care. For many higher-income families, Medicaid may seem unconnected to their day-to-day lives. But one of the core tenets of our health care safety-net is that it is there for families when they need it.

There are many improvements needed to our Medicaid program. But the EPSDT benefit package is not one of them. So why fix what isn’t broken? Instead, for example, Medicaid mental and behavioral health services should be better integrated and aligned with physical health benefits.
Instead of trying to raise health care standards for all kids, our state and federal leaders are instead looking to dilute standards. It is perverse logic to limit progress and roll-back gains, in order to achieve equality. Instead we should advance the progress made so all children can achieve affordable, comprehensive coverage.

We urge our state and federal leaders:

Do not limit benefits for children and weaken our existing standards.
Build on the progress we have made.
Strengthen coverage and care for all Utah children.


For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. Amex

 

Published in News & Blog