Magazine article Behavioral Healthcare Executive

Important Messages for State Leaders

Magazine article Behavioral Healthcare Executive

Important Messages for State Leaders

Article excerpt

As Medicaid reform advances on states' agendas, it is more critical than ever that the needs at children and adolescents with emotional and substance use disorders move to and remain in the forefront of policy. Advocates for children's behavioral health services have an opportunity in the coming months to help state leaders understand the impact-and potential unintended consequences-of any actions they consider as they change their programs or attempt to contain costs. In any system changing as rapidly as Medicaid, key priorities need to stay in focus. One of the most important is caring for children-particularly those with or at risk of emotional disturbances who can benefit from early, timely, and appropriate interventions.

The Deficit Reduction Act

The Deficit Reduction Act (signed into law in February) has significant implications for Medicaid, many of which are not yet clear or understood. States have been granted new power through the DRA to experiment with reforms to their Medicaid programs. While flexibility and innovation are being touted as the law's foundation, there is concern that cost alone may be the driving factor in much decision making. For each of the DRA's provisions, it will be important to help state leaders understand how their decisions affect children and adolescents with emotional and substance use disorders.

Benchmark plans. The DRA grants states the flexibility to amend their state plans to provide alternative benefit packages to beneficiaries without regard to certain traditional Medicaid requirements (such as plan comparability, statewide application, or freedom of choice). These benchmark plans are the same types of plans in the State Children's Health Insurance Program (SCHIP).

Many changes to state plans-some of them dramatically different from current plans-have been approved in record time. Kentucky, Florida, Missouri, Tennessee, Vermont, and West Virginia are among states that have changed plans or are considering changes (at press time). A Center on Budget and Policy Priorities analysis estimates that in West Virginia about three-quarters of the beneficiaries affected by the state's plan (which took effect July I ) are children.1 (Editor's note: For more on changes to Medicaid in West Virginia, see page 32.) Advocates need to help state officials understand that appropriate Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandates must be wrapped around all benchmark plans to ensure that children get the care they need.

Copays and deductibles. The DRA provides state Medicaid agencies with a new option to impose premiums and cost sharing upon certain Medicaid recipients, including cost sharing tor nonpreferred prescription drugs and for nonemergency use of a hospital emergency department. This provision has caused concern that Medicaid recipients-particularly children-could lose access to essential services if they cannot afford new copays and premiums.

A June 16 letter to state Medicaid directors from the Centers for Medicare and Medicaid Services (CMS) clarifies that no cost sharing may be imposed on services for individuals less than age 18 who are required to receive Medicaid services under section 1902(a) (the state plan for medical assistance). The letter adds that states may not impose premiums on mandatory beneficiaries with a family income above 100% but at or below 150% of the federal poverty level (FPL), and cost sharing for these beneficiaries may not exceed 10% of the cost of the item or service. Total cost sharing for these individuals, including that for prescription drugs and nonemergency use of emergency departments, may not exceed 5% of the family income. Yet diese still are financial barriers that likely will force beneficiaries out of the program or serve as deterrents to seeking care.

Proof of citizenship. The DRA requires proof of citizenship for both Medicaid eligibility and recertification (effective July 1). In the past, self-attestation of citizenship was sufficient. …

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