New study shows holes in pediatric benefits under Obamacare for special needs kids.

Here is what you need to know in the easy to read Kidmunicate friendly way.

  • Pediatric services is one of 10 benefit classes required in the Affordable Care Act (ACA also know as Obamacare) that must be covered in all health insurance plans sold in the individual and small-group markets.
  • Despite being over 2,000 pages long, like many things in this hastily prepared bill that was rushed through congress, regulations for pediatric essential health benefits (EHB) were not clearly defined beyond oral health and vision care.
    • Like Nancy Pelosi said, they had to pass it to see what was in it. And of course what is not in it.
  • Catherine Sebelius, former Secretary for the Health and Human Services (HHS) had the ability to define the benefit standard at a national level, but chose to give the states discretion.
  • This has led to state-to-state variations in coverage for children under Obamacare for special needs. For example:
    • 25 states cover treatment for congenital defects.
    • 24 states include autism.
    • 13 states exclude services of children with learning disabilities.
    • 10 states exclude speech therapy for developmental delays and stuttering which they deem not medically necessary.
  • The study suggests four potential policy changes.
    • No pediatric treatment limits or exclusions based on mental disability or developmental conditions.
    • Medical necessity should be clearly defined in the pediatric EHB.
    • The EHB standard for pediatric services should be revised to cover children with special needs and provide an actuarial value (the percentage that a parent would be expected to pay).
    • Obamacare for special needs kids should use CHIP plans as a benchmark for pediatric services.
      • Chip provides low-cost health coverage to children in families that earn too much money to qualify for medicad.
      • Chip covers
        • Routine check ups
        • Immunizations
        • Doctor Visits
        • Prescriptions
        • Dental and vision care
        • Impatient and outpatient hospital care
        • Laboratory and X-ray services
        • Emergency services
        • Some states might provide more check with your state here.
      • FYI – CHIP funding has not been extended beyond 2015 yet.
        • If funding were not extended, up to 8 million children would enter the market place for insurance coverage.
        • HHS is expected to review the benchmark plan approach for 2016 and may define a national standard.
      • Of course, everything can change with the newly elected Republican majority in both houses of the US Congress and with the sweeping victories by Republicans in the individual state houses and governorships.
      • The analysis was conducted by Children’s National Health System in Washington, DC, Children’s Hospital of Philadelphia, Johns Hopkins Bayview Medical Center, and the Milken Institute School of Public Health at George Washington University.

The Kidmunication Point

Now is the time to call your congressman to tell them that children with special needs, need special coverage.