CISWH Project Resources

The Catalyst Center created two interactive worksheets for Title V program staff, family leaders, and other stakeholders. These worksheets provide an overview of Title V, and Medicaid and the Children’s Health Insurance Program (CHIP). Each worksheet includes resources you can use to find and insert state-specific information to help demonstrate the importance of Title V, Medicaid and CHIP for children with special health care needs (CSHCN). The worksheets were created as companion materials to the Catalyst Center’s Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP).

Every state has a Newborn Screening (NBS) Program which screens newborns for a variety of health conditions, including selected inborn errors of metabolism (IEMs) and other genetic disorders. Individuals with genetic conditions identified through NBS programs often require Modified Low Protein Foods (MLPFs), medical foods, dietary supplements, or other dietary treatments as well as enteral feeding supplies. Due to the wide-ranging funding mechanisms across states, coverage for these categories of products and supplies varies based on type of insurance coverage (e.g., public or private), type of health plan (e.g., individual, group, HMO), and any coverage and or related services that Title V or other state programs may fund.

This resource provides information about state-specific legislation that mandates the coverage of medically necessary foods by employer-sponsored health insurance and Medicaid, and coverage and related services funded by other state programs such as Title V or relief funds. It also details the covered services as well as any benefit limits or age and income restrictions. This report builds on a 2008 report of the same name by Alissa Johnson, and an update to that report from the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks (NCC) published in 2016.

In English
Desarrollado por el National Center for Medical Home Implementation de la Academia Americana de Pediatría y el Catalyst Center de la Escuela de Salud Pública de la Universidad de Boston

An hour-long webinar held on June 20, 2016 to “get acquainted” with the tutorial, Health Care Coverage and Financing for Children with Special Health Care Needs: A Tutorial to Address Inequities. MCH staff from Alaska and Michigan share strategies they use to work towards health equity for CSHCN in their states.
View detailed webinar description

The Patient Protection and Affordable Care Act of 2010 (ACA) contains provisions that are designed to improve major gaps in the health care coverage, financing and delivery system that prevent children and youth with special health care needs (CYSHCN) from accessing health care services or which impose significant financial hardship on their families.  The law is designed to increase coverage, improve benefits and provide important new insurance protections for all Americans. Many of the law’s provisions will impact children, including CYSHCN, and all will be implemented over time. This fact sheet offers a concise description of some of the provisions under ACA that directly impact CYSHCN and offers some thoughts about the role of State Title V MCH and CYSHCN programs in realizing their promise.

The Maintenance of Effort (MOE) provisions under the Affordable Care Act (ACA) requires states to keep the eligibility criteria for their Medicaid and Children’s Health Insurance Program (CHIP) that they had in place on March 23, 2010, the day the ACA was signed into law. Under MOE, states cannot make it more difficult to enroll in or renew Medicaid or CHIP coverage. For children in Medicaid and CHIP, the MOE provisions are in effect until September 30, 2019. States who violate the MOE provisions risk losing their federal funding match.

Section 2703 of the ACA describes a state plan option to provide health homes for Medicaid-enrolled individuals with at least two chronic conditions, one chronic condition and the risk of developing a second, or one serious and persistent mental health condition. This presentation, given at the 2014 AMCHP conference, provides and overview of this provision of the ACA, highlights strategies states have used to include CYSHCN in their Medicaid Health Homes, efforts for sustaining the Health Home after the two years of enhanced funding ends, and lessons learned.

En español
Created by the National Center for Medical Home Implementation and the Catalyst Center, these four plain language fact sheets, “Your Child’s Health and the Affordable Care Act,” explain specific provisions of the Affordable Care Act which benefit children and youth with special health care needs.

On July 20, 2015, experts from the Catalyst Center and the National Center for Medical Home Implementation shared information on how ACA provisions outlined in the above fact sheets can help families raising children with special health care needs. 

The implementation of the ACA shifted the structure and design of public and private health care delivery and payment systems. In order to curb health care spending and improve quality of care and health outcomes, there has been tremendous attention to value as a criterion for health insurance options offered by payers. Value-based purchasing strategies, primarily (1) pay-for-performance (P4P); (2) accountable care organizations (ACOs), and (3) bundled payments, are geared towards achieving value by reducing costs while improving quality based on a predetermined set of performance standards including quality and cost measures. These strategies are discussed in this policy brief. 

Efforts to reduce health care costs and promote quality have led to new ways to pay for health services. This glossary can help Title V staff, family leaders, policymakers, providers, advocates, and others become familiar with alternative payment strategy definitions.