Skip to main content


Showing posts from July 8, 2018

Administration Stops Risk Adjustment Payments to Insurers: Another Act of Sabotage?

July 11, 2018   Edwin Park On July 7, the Centers for Medicare and Medicaid Services  announced  that it would indefinitely delay making “risk adjustment” payments owed to insurers participating in the individual and small group markets. In the short-run, this would result in many insurers not receiving payments they are expecting this year as scheduled. That would adversely affect these insurers’ bottom line as well as their cash flow, as they assumed they would receive those payments as scheduled, when setting their past premiums for 2017. This delay could also provoke substantial uncertainty among insurers about whether risk adjustment payments will be made, as they assumed for 2018 and 2019. That could result in some insurers revisiting their 2019 premiums (and increasing them) as well as their overall decisions to participate in the individual markets inside and outside the marketplaces both in 2019 and in future years. Under the Affordable Care Act, all insurers offering

Video: These Parents of Medically Complex Kids Explain Why Medicaid Matters to Their Families

July 11, 2018   Adam Searing If you want to know about kids, listen to parents. Sometimes in the health policy and political worlds, it’s easy to forget this simple piece of advice – and sometimes politicians and policymakers are too focused on the latest bill or political win to remember it. Over the last year, we’ve spent a lot of time talking about Medicaid with parents of children with complex medical needs. The parents featured in this video know more about Medicaid than just about anyone because their childrens’ lives depend on it.  The families we interviewed are simply amazing, loving, dedicated and resilient. They know Medicaid first hand. Their concerns should be given serious consideration when policymakers debate cuts or changes to Medicaid. And Medicaid is not only important to children with complex medical needs, it is a crucial lifeline for millions of children and parents. Did you know that  half of Medicaid beneficiaries are children . Cut or cap Medicaid an

Guide to Medicaid Appeals, including Managed Care

This background brief provides a comprehensive look at the appeals process for the Medicaid program, which differs significantly from those available through the Medicare program and private health insurance. The Medicaid appeals process provides redress for individual applicants and beneficiaries seeking eligibility for the program or coverage of prescribed services, but the process is multi-layered and can be complex to navigate. The guide describes Medicaid’s appeals system, including the fair hearing process and the appeals process required for Medicaid managed care organizations. As coverage expands under health reform and efforts proceed to integrate services for dual eligibles, who are enrolled in both Medicare and Medicaid, protections through the appeals process will be increasingly important. Guide to Medicaid Appeals by Family Voices Indiana on Scribd

FSSA Appeals in Indiana

What are appealable actions? Listed below are some examples of appealable issues: • The amount of your TANF or Food Stamp (SNAP) benefit. • The effective date of Medicaid coverage. • The amount of your Medicaid spend-down or patient liability to be paid to a health care facility • A delay by the Division of Family Resources in making an adjustment in the amount of your benefits. • A decision that benefits have been paid in error and must be repaid. You may represent yourself at the hearing or you may authorize someone else to represent you such as a lawyer, friend, relative, or any other person. If you want a lawyer but cannot afford one, Indiana Legal Services may be able to help. Their website is Their phone number is  (317) 631-9410 . If you choose to represent yourself at the hearing, you might find it helpful to write down your reasons for appealing so that you will remember to cover all of the points you wish to raise. It is importa

Q & A on Customized Employment: Parent Questions Answered!

by Katherine Inge, Ph.D., O.T.R.   “ To Work or Not to Work? ” … may be a question asked by parents and guardians as they begin to think about their sons and daughters going to work.  This Q & A on Customized Employment addresses concerns that family members may have and provides answers to address the concerns .   Please visit Virginia Commonwealth University’s Disability and Rehabilitation Research Project (DRRP) on Customized Employment at [ ] for more information on customized employment. Question:  Ho w do I know if my son / daughter with a disability is ready to work in the community? Answer:  If your son or daughter wants to work, customized employment may help him / her achieve that goal.  A key aspect to customized employment is finding a job that matches the job seeker’s interests and skills. Using this approach, a  representative, usually referred to as an employment specialist, works closely with your son or daughter to negotiate

For Parents: Preparing for the School Year

Contributed by:   Dr. Cathy Pratt, BCBA-D Director, Indiana Resource Center for Autism Anticipating the beginning of the school year can create anxiety for both family members and for their sons/daughters on the autism spectrum. Concerns surround whether your son/daughter will be successful in school, and if the new staff will have a solid understanding of autism spectrum disorders and of your son/daughter. At times, you may know staff and have a good working relationship with them. At other times, staff is unknown and expectations for your son/daughter are unclear. Below are a few tips to help you become a proactive and positive advocate for your son/daughter. Many teachers may not have previous experience with students on the autism spectrum or may only have had experience with students quite different from your son/daughter. The IRCA website at  has several articles that can help educators better understand ASD, including learning characteristics assoc

Upcoming Webinars and Calls

UPCOMING WEBINARS AND CALLS NEW  Redesigning Health and Social Systems for the Cheyenne River Sioux Tribe Using Community-Engaged Decision-Making Wednesday, July 11, 12:00-1:00 ET Systems for Action National Coordinating Center   NEW  Messages and Audiences Wednesday, July 11, 2:00-3:00 ET CDC's Crisis & Emergency Risk Communication (CERC)   NEW  Exploring Applications of the Child Opportunity Index Wednesday, July 11, 2:00-3:00 ET Children's Hospital Association   NEW  Marketplace Assister Webinar Wednesday, July 11, 2:00-3:30 ET Centers for Medicare and Medicaid Services (CMS)   Leveraging Digital Tools to Treat Patients along the Continuum of Care Wednesday, July 11, 2:00-3:00 ET FierceHealthCare/Appian (one presenter is from Nemours Children's Hospital)   NEW  Hearing: Examining the Importance of Paid Family Leave for American Working Families Wednesday, July 11, 3:00 ET   U.S. Senate Committee on Finance The Committee