Medicaid Coverage & Benefits
Lack of Comparability Between CHIP and ACA Qualified Health Plans
by Margaret A. McManus and Harriette B. Fox, July 2014.
This fact sheet provide a detailed examination of comparability between separate CHIP programs and child-only qualified health plans in Colorado, Georgia, Oregon, Texas, and West Virginia for children with family incomes between 134% to 300% FPL. It examines cost-sharing requirements, including deductibles, copayments and coinsurance, and out-of-pocket limits, and benefit coverage and treatment limitations in 28 benefit categories. Implications for CHIP reauthorization are also discussed.
Many Low Income Older Adolescents Likely to Remain Uninsured in 2014
by Harriette B. Fox, Margaret A. McManus, and Annalia G. Michelman, October 2013.
This fact sheet identifies the states in which adolescents ages 19 and 20 living at or below the poverty level are likely to remain without health insurance protection in January 2014, despite the passage of the Affordable Care Act. It examines several avenues to state Medicaid coverage: optional Medicaid eligibility for “Ribicoff Children” up to age 21, Section 1115 demonstration waivers covering childless adults, and the ACA’s optional Medicaid expansion for uninsured individuals ages 19 through 64. It also describes the obstacles these older adolescents confront in securing private health insurance coverage through employment and in exchanges.
State EPSDT Policies for Adolescent Preventive Care
by Harriette B. Fox, Katherine K. Rogers, and Margaret A. McManus, September 2011.
This fact sheet presents findings from an analysis of state policy documents that establish guidelines for providers delivering EPSDT preventive services to adolescents. It examines state Medicaid policies including the EPSDT periodicity schedule; comprehensive health history and developmental assessments; physical examinations, laboratory tests, and immunizations; health education; and referrals. Particular emphasis is given to the early identification of problems related to nutritional health, mental health, sexual behavior, substance use, and violence and injury potential and to health education for key topics under Bright Futures. Also examined are state policies regarding adolescents’ private time with providers.
The Public Health Insurance Cliff for Older Adolescents
by Harriette B. Fox, Stephanie J. Limb, and Margaret A. McManus, April 2007.
Drawing on data from multiple sources, this fact sheet examines Medicaid and SCHIP eligibility policies affecting older adolescents -- those ages 19 and 20. Included are mandatory coverage pathways, such as parents and pregnant women, and optional pathways, including Ribicoff children, medically needy, adolescents formerly in foster care, and the working disabled. The fact sheet examines states’ use of the available options and income eligibility levels applicable to older adolescents
Preliminary Thoughts on Restructuring Medicaid to Promote Adolescent Health
by Harriette B. Fox, Stephanie J. Limb, and Margaret A. McManus, January 2007.
This issue brief examines state Medicaid benefit and payment policies affecting adolescents and concludes that they are inadequate to support the type of care that adolescents require. It includes a proposal for an enhanced set of health promotion and primary care benefits designed specifically for adolescents that can be offered through EPSDT or as an alternative benefit package under the Deficit Reduction Act and suggestions for possible changes to payment policies to support comprehensive preventive and primary care service delivery for adolescents.