What the Health Reform Law Means for Kids

With the enactment of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, more children and their families now have access to vital health care services to support their development. From infants to young adults, the health reform law set into motion efforts to support healthier communities across the nation.

Child advocates must continue to play an instrumental role in ensuring that these additional first steps are implemented correctly. The various new opportunities offered under the health reform law will support the healthy development of nation’s future workforce – our children. However, even with these most important first steps, we will still fall short of achieving health equity for all children.

Building on the success of Medicaid and the Children’s Health Insurance Program (CHIP): Medicaid and CHIP have helped bring down the uninsured rate among children. Particularly for children of color, these programs have helped reduce the overall uninsured rate. The health reform law builds on the effectiveness of these two programs to provide children and families with access to comprehensive health services.

• States have made significant investments in their Medicaid and CHIP programs in an effort to ensure that children have access to health care services. Health reform preserves the gains made by states by requiring states to maintain Medicaid and CHIP coverage and enrollment procedures that are in place as of March 23, 2010.
• The health reform law offers U.S. states the option to expand the federal Medicaid floor at 133 percent of the federal poverty level, which is approximately $24,400 for a family of three. A number of states already provide coverage for children under this eligibility level through either Medicaid and/or CHIP. Under the law, parents who are eligible for Medicaid coverage and apply to enroll will be required to enroll their children first.
• The health reform law provides an additional two years of funding for the very successful CHIP program through September 2015. It also provides additional funding to support outreach and enrollment grants to reach children that are eligible.
• For children aging out of foster care, Medicaid coverage will be extended to those young adults who have “aged-out” of the system, up to age 26.
• Allows children who are enrolled in either Medicaid or CHIP to receive hospice services without foregoing curative treatment related to a terminal illness.
• To ensure access to primary care doctors, the federal government will provide 100 percent funding in 2013 and 2014 to bring state Medicaid reimbursement rates up to par with Medicare levels for primary care services.

Insurance Market Reforms: Insurance carriers will have to follow new federal requirements. Highlights of those requirements affecting children’s coverage are provided below.( Please note for additional information on these requirements, a hyperlink directing you to information provided on the federal government’s health reform website, healthcare.gov, is embedded within the text.)

• Young adults, under the age of 26, will be able to continue to receive coverage under their parents plan. This is particularly important as the largest percentage of the uninsured population falls between the ages of 19 to 24. Effective as of Sept. 23, 2010.
• The health reform law prohibits insurers from excluding coverage of pre-existing conditions for children. This new requirement will not be in place for adults until 2014; however, it is currently in place for children as of Sept. 23, 2010.
• Insurers are prohibited from imposing lifetime limits or “unreasonable” annual limits for any beneficiary. Effective as of Sept. 23, 2010.
• Insurers are prohibited from rescinding coverage to an enrollee once an enrollee has been covered under a plan, unless fraud is committed. Insurers will no longer be able to drop coverage due to illness. Effective as of Sept. 23, 2010.

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• Insurers are required to provide the  following preventive services, as they  relate to children, with no cost-sharing requirements, effective as of Sept. 23, 2010:
  • Those that have received rating of “A” or “B” in current recommendations of the United States Preventive Service Task Force (USPSTF).
  • Immunizations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunizations Practices.
  • Evidence-informed preventive care and screenings supported by the Health Resources and Administration (aka Bright Futures) for infants, children and adolescents.
• Insurers required to provide “essential health benefits” which includes pediatric services.

Exchanges: A new component of the country’s health care system, health exchanges will require that health insurance plans sold under the exchanges comply with certain consumer protections.

• To ensure that the purchase of health care coverage is affordable, the federal government will offer tax credits to individuals and families based on income.
• Allows for the purchase of child-only health insurance policies in the exchanges.
• Requires that insurance plans offered under a state exchange include oral care for children. Bars insurance plans operating under the exchange from charging out of pocket expenses for preventive services, including preventive pediatric oral health services.

Making Enrollment Easier: Families will be able to apply for and enroll in Medicaid, CHIP or the exchange through state-run Web sites. These programs are required to coordinate enrollment procedures resulting in a seamless enrollment process for individuals and families.

Improves Quality of Care for Children by expanding demonstration projects to improve children’s quality measurement and reporting.

School-based Health Centers: More than one million children and adolescents across the country gain access to high quality, comprehensive medical care, mental health services, preventive care, social services, and youth development through school base health centers.

• The new law establishes a federal grant program in the amount of $200 million to establish new school-based health centers. The Secretary of Health and Human Services will give preference in awarding these grants to establish facilities that serve a large percentage of uninsured and Medicaid and CHIP-eligible children.
• The law also authorizes a grant program to support school-based health that serve children and adolescents that reside in a “medically underserved area” or “health professional shortage area.” The law provides authorizing language to appropriate funding to support this grant program.

Investments in the Health Care Workforce: New resources have been dedicated to expand the health care workforce, including pediatricians, pediatric nurse practitioners, pediatric oral health professionals, pediatric specialists, and providers of mental and behavioral health services to children and adolescents through the provision of scholarships and loans. The new law also promotes the training of a diverse workforce and increasing cultural competency of health care professionals.

Childhood Obesity: Provides $25 million to support the Childhood Obesity Demonstration Project. The Secretary of HHS will award grants to develop a comprehensive and systematic model for reducing childhood obesity.

Oral Health Care Prevention: The health reform law authorizes the Centers for Disease and Control Prevention to launch a five-year national, public education campaign that is focused on oral healthcare prevention and education, including early childhood caries. The new law also will award grants to each of the 50 states and territories and Indian tribes and organizations to support school-based dental sealant programs. Currently, only 16 states receive grants to support these programs.

Youth Pregnancy Prevention: For FY 2010 through 2014, states are eligible to receive Personal Responsibility grants to support both abstinence and contraception teenage pregnancy and sexually transmitted prevention programs.  Seventy-five million per year has been appropriated to support this grant. In addition funding for abstinence education was restored at $50 million per year through FY 2014.

Nursing Mothers: Amends the Fair Labor Standards Act of 1938 to require that employers provide a reasonable break for an employee to express breast milk for her nursing child and to provide a place, other than a bathroom, that is shielded from view and free from intrusion of coworkers and the public.

Emergency Medical Services: Reauthorizes the Wakefield Emergency Medical Services for Children Program to support the improvement and expansion of emergency medical services for children needing trauma or critical care treatment.

Investments in Community Health Centers: Community health centers provide access to comprehensive, culturally-competent, high-quality primary care services in medically underserved communities.  In 2008, of the total patient-base served, 36 percent were children under the age of 19, 28 percent African-American and 33 percent Hispanic/Latino. The percentage of African-Americans and Hispanic/Latinos served was more than twice the proportion reported in the overall U.S. population. Over the next five years, community health centers will receive $11 billion.

Investments in Home Visiting: Home visiting programs have proven to be effective in linking expecting and new parents, particularly those residing in at-risk communities, to resources, tools and trained professionals to improve the health and well-being of children. For the first time, federally mandated funding will be provided to the states to support voluntary, preventive home visitation services. The new measure authorizes $1.5 billion over five years for Maternal, Infant, and Early Childhood home visiting programs.