SPARC Webinar: Child Welfare and the Affordable Care Act
How Health Reform CanHelp Child Welfare Families An Early Look at Opportunities and Options for Action
SPARC WebinarFebruary 19, 2013 Olivia Golden, Institute Fellow Dina Emam, Research Assistant The Urban Institute
Trying to Understand How the ACAApplies to You….
Why Is It So Hard to Connect?Medicaid/ Health Child Welfaren Incredibly busy and n Incredibly busy and overwhelmed (ACA) overwhelmed (crises)n Thinking about functions n Thinking about that have to be in place populations. for health reform.n Don’t understand child n Don’t understand welfare and don’t have Medicaid/ ACA and don’t time to learn it. have time to learn it.n Cost-conscious n Advocate for services
Our Papern Goal: to bridge the gaps.n Reviewed available resourcesn Interviewed health and child welfare experts.n Intensive help from colleagues in Health Policy Center (but remaining mistakes are ours).n Final review and update going on now.n Paper will be available in March.
Plan for Todayn Why Does the ACA Matter So Much?n Three Major Opportunities: Parents, Children, and Youthn Today’s Focus: Foster Youth Aging Outn What Should You Do Right Away?
It takes a lot of effort to connect the child welfare and health worlds.Why is it worth it?WHY DOES THE ACA MATTERSO MUCH?
What Does the ACA Do?n Increases the number of people with health insurance.n Streamlines enrollment and renewaln Requires behavioral health as well as medical benefits.n Promotes innovation to integrate health care.n Provides coverage till age 26 for aging-out foster youth.
Why Do the Links Matter to ChildWelfare?n Parents, children, youth have major health and mental health needs.n Good treatment serves child welfare goals.n BUT today, they often don’t get help. q Parents/ youth lack insurance. q Children’s coverage is interrupted. q Health/ mental health care is hard to navigaten “Biggest social services change in decades”
Why Do the Links Matter to Health/Medicaid?n Child welfare agencies can find and bring in people who might otherwise not enroll.n Systems for enrollment are being redesigned right now, at mostly federal cost.n States may want to enroll high-need individuals promptly, to avert costs.n Helping maltreated children and preventing abuse and neglect may have wide appeal.
Parentsn Only 40% of parents of children reported for maltreatment report good or excellent health. (NSCAW II 2012)n 20% have had a major depressive episode in the past 12 months and 46% in their lifetimes (NSCAW II 2012)n Treatment could prevent maltreatment and promote reunification.n 3.3 million reports of maltreatment (ACF 2010)
Opportunities for Parents in the ACACoverage Caren State option to expand n Benefit package including Medicaid coverage to mental health and 133% of poverty substance abuse servicesn Streamlined enrollment, n Integrated care options whether or not state (i.e., health homes) expands
Forthcoming sources…..n Golden and Emam. How Health Reform Can Help Children and Families in the Child Welfare System: Options for Action. Washington, DC: The Urban Institute. Expected in March 2013.n Howell, Golden, and Beardslee. Emerging Opportunities for Addressing Maternal Depression under Medicaid. Washington, DC: The Urban Institute. Expected in February 2013.
Childrenn Major health, mental health, developmental needs. q Children reported and children in the system.n Most have Medicaid coverage now.n Areas for improvement: q Continuity of health insurance coverage q Quality and continuity of care q Maintaining/ improving current waivers or state- specific strategies
Opportunities for Children in theACACoverage Caren Streamlined eligibility n Integrated care options determination and n Home and community redetermination based care option n Home visiting programs
Foster Youth Aging Outn 29,000 youth age out each yearn Major health and mental health needsn 22.2% experience homelessness within a year of leaving foster care (Pecora et al. 2006).n 1.8 times as likely to have a child by age 26 as other youth (Courtney et al. 2011)
A Specific Provision in the ACACovers These YouthCoverage Caren States must enroll youth n Full Medicaid benefits aged out of foster care (not the “alternative and not yet age 26 in benefit plan”) Medicaid. n EPSDT benefits until agen Effective date 1/1/2014 21n Not affected by Supreme n Integrated care options Court decision. (as for all others)n CMS proposed rule makes cross-state coverage optional.
What It Will Take: Evidence fromState Experiences Under Chafeen States varied in how they enrolled youth.n More automatic enrollment meant more youth on Medicaid (month before their 19th birthday) q More youth involvement meant less enrollment.n Child welfare involvement in design was associated with more automated enrollment and integrated data.n Source: Pergamit et al. Providing Medicaid to Youth Formerly in Foster Care Under the Chafee Option. HHS/ ASPE, 2013. http://aspe.hhs.gov/hsp/13/ChafeeMedicaidReport/rpt.pdf
More on the Chafee Experiencen Important role of child welfare – Medicaid communication and leadershipn Challenges posed by lack of knowledgen Enrollment is the first step, not the final one.n Youth and social workers need to understand the coverage if youth are to use it.n Source: Pergamit et al. Providing Medicaid to Youth Formerly in Foster Care Under the Chafee Option. HHS/ ASPE, 2013. http://aspe.hhs.gov/hsp/13/ChafeeMedicaidReport/rpt.pdf
State Child Welfare Leaders: ActionSteps to Consider1. Engage with state Medicaid leaders to discuss: a) Enrollment for youth aging out now; b) Enrollment for youth who aged out in prior years; c) Automatic reviews to ensure continuity until age 26 (or move out of state); d) How enrollment and automatic redetermination will fit into system decisions being made NOW; e) Benefits available to youth, plans that would work best for them, potential demos or initiatives.
Actions to Consider, continued2. Gather and share information about foster youth aging out in your state. a) Data (needs, numbers) b) Policy goals (including future cost savings) c) Lessons learned from Chafee experience3. Inform cross-state choice (if state option).4. Consider focus groups with aged out youth, other outreach to help inform strategies.
Actions to Consider, continued.5. Design an active role for child welfare agency, including enrollment help, outreach, support to youth.6. Train child welfare agency staff and partners, soon and often.
Federal Child Welfare and HealthLeaders: Action Steps to Consider1. Joint technical assistance to states from ACF, CMS, and SAMHSA.2. Identify and disseminate best practices.3. Promote an effective cross-state framework.4. Track coverage for youth; support state data collection and tracking.5. Address specific challenging issues in ongoing policy and guidance.
Examples of Challenging Issuesn Youth moving from child welfare to juvenile justicen Youth in guardianship settingsn State arrangements that may not be foster caren Don’t let these slow you down!!
Philanthropy: Action Steps To Consider1. Amplify federal and state technical assistance and outreach to reach larger audiences. a) Advocates, community organizations b) Youth and families, broader public c) Direct service staff2. Create collaborative network of stakeholders – multiple states, multiple perspectives.3. Identify and disseminate best practices.4. Support advocates/ experts to track and report results, recommend improvements.5. Stay the course!
It’s a Marathon ANDa Sprint.Those we interviewed said thatgaining the benefits of the ACA forchildren, youth, and families involvedwith child welfare requires BOTHstarting now AND staying the course.