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Showing posts from December 1, 2019

What to Know When Assisting a Consumer who has a Child or Youth with Special Health Care Needs

This fact sheet is intended to help Navigators identify what issues are unique to children and youth with special health care needs so that they can assist their families as they make decisions related to their healthcare coverage. Click here for a pdf version of this Fact Sheet Q1. What do I need to know about children and youth with special health care needs (CYSCHN)? A. “Special Health Care Needs” is a broad umbrella term that covers a broad range of children and youth with chronic health conditions and disabilities. The federal Maternal and Child Health Bureau defines CYSHCN as: “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” 1 According to the 2009/2010 National Survey of Childrenwith Special Health Care Needs (NS-CSHCN), more than one in five families (23%) has at least one child with special health care…

Coverage of Over-the-Counter Drugs in Medicaid

from NHLP:

Fact Sheet: Coverage of Over-the-Counter Drugs in Medicaid
Drug coverage is an important facet of the Medicaid program. Although it is an optional benefit, all states cover outpatient prescription drugs in their Medicaid programs. States have significantly more leeway, however, in whether they cover over-the-counter (OTC) drugs. In the last twenty years, more drugs that were once only available through a prescription, including many allergy medications and medication to treat reflux, have become available OTC. Thus it is particularly important for advocates to understand the circumstances in which Medicaid programs cover OTC drugs. This Fact Sheet provides an overview of Medicaid rules for OTC drug coverage and discusses a variety of state examples for Medicaid program coverage of OTC drugs.
Authors: Abbi Coursolle and Elizabeth McCaman Fact Sheet

Medical Supplies Benefits

This fact sheet is intended to help Navigators answer specific questions that people with disabilities might ask about medical supplies benefits when they are considering buying health insurance through the Marketplace Click here for a pdf version of this Fact Sheet
Click here for a pdf version of a 1 page summary of this Fact Sheet Q1. What are medical supplies benefits? A. Health plans available through the Marketplace must offer rehabilitation and habilitation services and devices as essential health benefits. While individual and small group plans sold in and out of the Marketplace are required to cover the broad category of “devices,” the federal government has not defined what specific devices, sometimes referred to as Durable Medical Equipment (DME), plans must provide. The federal government has also not indicated if and how “medical supplies” fit within the rehabilitation and habilitation services and devices category.  However, HealthCare.gov defines the term DME as “Equipment a…

Public Comment for proposed amendment to the Aged and Disabled waiver

In accordance with public notice requirements established at 42 CFR 441.301 the Indiana Family and Social Service Administration, Division of Aging intends to submit a proposed amendment to the Aged and Disabled waiver to the Centers for Medicare and Medicaid Services for consideration. This waiver amendment will allow DA to continue providing home and community-based services to individuals who, but for provisions of such services, would require institutional care. The anticipated effective date is May 3, 2020. The A&D waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. The waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other supports were not available. Waiver services can be used to help people remain in their own homes, as well as assist people living in nursing facilities return to community settings such as their own hom…

Prescription Medication Benefits

This fact sheet is intended to help Navigators answer specific questions that people with disabilities might ask about prescription medication benefits when they are considering buying health insurance through the Marketplace Click here for a pdf version of this Fact Sheet
Click here for a pdf version of a 2 page summary of this Fact Sheet Q1. What do I need to know about prescription drug coverage as I evaluate plans I am considering purchasing? A. Prescription drugs are included in the list of ten Essential Health Benefits (EHBs) that each individual and small group health plan must offer in order to participate in and out of the Health Insurance Marketplace. Health plans will help pay the cost of certain prescription medications. Health plans must offer either at least one drug in every treatment category, for example, antidepressant, anti-smoking or high blood pressure medications, or the same number of drugs in each category as the plan your state has selected as a guide, or benchmar…