State eligibility rules under separate state SCHIP programs--implications for children\u27s access to health care

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care

The Affordable Care Act, Medical Homes, and Childhood Asthma: A Key Opportunity for Progress

The medical homes provisions of the Affordable Care Act offer a major opportunity to advance high quality, cost-efficient health care for children with asthma. This policy brief examines evolving national medical homes policy in a childhood asthma context. Following a brief background that examines childhood asthma and explores the origins and evolution of medical homes policy (a concept developed with children in mind), the brief then describes how the Affordable Care Act can advance the implementation of medical homes policies to improve health outcomes for children with asthma

Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes

Childhood asthma is a serious and chronic health issue that affects one in seven U.S. children and their families, compromising their health and quality of life and placing a heavy financial burden on families as well as an enormous strain on the health care system. Treating, managing, and ultimately preventing and reducing the burden of asthma represents a critical test of the ability of the U.S. health system – health insurers, clinical care providers, and public health agencies – to work together. Our investigation found that, as a country, we already know enough to act and improve life for the millions of children living with asthma; we’re just not aiming high enough. If we did, the nation would create and put into place an array of policy reforms that together could translate into real change

An analysis of implementation issues relating to CHIP cost-sharing provisions for certain targeted low income children

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP plans

Projected Financial Losses Experienced by Community Health Centers under a Scenario of Major Cuts in Key Sources of Federal Funding: 2018-2022

Congress is currently considering options to significantly reduce federal funding for the Medicaid expansion and the Marketplace subsidies implemented under the Affordable Care Act (ACA). Separately, the Health Centers Fund, which currently accounts for 70% of all federal health center grant funding, is set to expire in September 2017. These potential changes in federal funding could have a dramatic impact on health centers and the communities they serve. The purpose of this brief is to simulate the potential combined impact of these major changes in federal funding that will directly affect community health centers. Secondarily, this brief also assesses the financial burden other state and federal programs would have to assume to help centers maintain services at their current capacity. Over the 2018-2022 time period, we estimate that under current law, and with primary care services expanding at the current pace, health centers would realize a total of $169 billion in revenues from all sources combined. Of that amount,$37.5 billion would come from funding streams that include Medicaid and private insurance, while some $10.5 billion would constitute federal grant funding from the Health Centers Fund. Using forecasting models based on historical revenue data from community health centers we project that health centers, operating at their current service levels, would have experienced a$48 billion shortfall over this time period, were the Medicaid expansion and Marketplace subsidies repealed and the Health Centers Fund not renewed. From the perspective of health centers and their communities, if alternative sources of funding are not found, this shortfall would equal 28.3 percent of the funding that would be required just to maintain services as projected under the ACA. The change in federal health center funding of the type considered in this simulation is also likely to further strain state budgets. Based on past trends, state and local governments would be expected to provide $14.5 billion in non-Medicaid grants and programs to help cover the shortfall, while discretionary federal grants would be used to offset part of the remaining gap. Given the shifting priorities in federal funding under the current administration, the burden on states may be higher than projected. Moreover, in the current fiscal environment, the likelihood of funding substitution at either the state or federal level is low. This suggests that health centers may have to scale back services, staff, and clinic sites in order to absorb financial losses

State Benefit Design Choices under SCHIP - Implications for Pediatric Health Care

This policy brief1 is the second in a series of reports focusing on the design of state SCHIP programs as they near full implementation. It examines the extent to which state agencies adopt conventional insurance norms or adhere to special principles of Medicaid coverage design for children in designing separately administered (or freestanding) SCHIP programs. The issue of coverage design is particularly relevant for children with low prevalence conditions and special health care needs. Increasingly, conventional insurance uses standardized coverage norms to limit coverage and treatment. These standardized norms take the form of across-the-board treatments and exclusions, limited definitions of medical necessity, and the use of irrebuttable, standardized treatment guidelines in determining when covered treatments will be available. All of these practices are impermissible under Medicaid, which uses exceptionally broad preventive standards to determine coverage of children; such standards favor coverage of children with low prevalence problems

Addressing the Challenges of Reporting on Childhood Asthma in a Changing Health Care System: Building Better Evidence for High Performance

Childhood asthma is a serious and costly chronic disease that burdens children and families as well as the health care systems that serve them. A key element to improving asthma outcomes is access to timely and useful data that can improve the quality of care and inform programs and policies to best serve those communities most burdened by asthma. This Policy Brief examines the nation’s data collection framework for childhood asthma and considers steps that might be taken to strengthen it, including the development, collection and refinement of community-level data to inform local health care systems. Through a review of the public health surveillance system related to childhood asthma, including a specific look at existing asthma data, this brief lays out the challenges to the current system and identifies opportunities to develop responsive and timely data collection, monitoring and surveillance systems, harnessing health information technology (HIT) applications to address the many challenges of childhood asthma. This brief includes recommendations for improvements in public health reporting systems including standardization of measures and a focus on the development of real-time local surveillance and mapping technologies to best inform communities working to lessen their childhood asthma burden

How Could Repealing Key Provisions of the Affordable Care Act Affect Community Health Centers and their Patients?

Analyses of repeal of the Affordable Care Act (ACA) have tended to focus on coverage. This study, which gauges the potential effects of repealing certain ACA provisions, looks at the question of primary health care access itself, with a focus on medically underserved communities. A survey developed and fielded in early 2017 asked community health centers to estimate the impact of ending the Health Centers Fund established under the ACA as well as ending expanded Medicaid coverage and subsidies designed to make private insurance affordable for lower income patients. Forty-one percent of health centers responded; 69 percent were located in Medicaid expansion states and 31 percent in non-expansion states. Responses were weighted to ensure representativeness

Community Health Centers: Recent Growth and the Role of the ACA

Community health centers are the nation’s largest source of comprehensive primary care for medically underserved communities and populations. Under the Affordable Care Act (ACA), increased patient revenues due to the expansion of Medicaid and private health insurance, along with substantially increased direct federal investment in the program, have led to growth in the number of health centers and their capacity to provide services. This brief draws on 2015 federal data on health centers and our 2016 Survey of Health Centers’ Experiences and Activities under the Affordable Care Act to provide a snapshot of health centers and their patients, analyze recent changes, and compare the experience of health centers in Medicaid expansion and non-expansion states. This information is germane to the impending debate on the ACA and the potential impact of changes on coverage and access to care for low-income Americans and financing for safety-net providers. Key findings include: Health centers are a core source of primary care in the U.S., particularly for Medicaid beneficiaries and uninsured people. In 2015, 1,375 health centers provided care to 24.3 million patients, including 1 in 12 U.S. residents and nearly 1 in 6 Medicaid enrollees. Almost three-quarters of all health center patients had income below the poverty level. Health center patients are increasingly insured, primarily due to the ACA Medicaid expansion. In 2015, 76% of health center patients were insured (49% through Medicaid), up from 65% in 2013, the year before the ACA coverage expansions took effect. State Medicaid expansion decisions made a large difference in coverage. Over half of health center patients in expansion states had Medicaid, compared to one-third in non-expansion states. About 1 in 5 health center patients in Medicaid expansion states remained uninsured, compared to 1 in 3 in non-expansion states. The Medicaid expansion strengthened health center finances and capacity. Health centers in Medicaid expansion states reported higher total operating revenues than those in non-expansion states, and Medicaid provided a larger share of their revenues. On average, health centers in expansion states served 40% more patients than those in non-expansion states, reported higher staffing ratios for oral and behavioral health care, and were more likely to report increased capacity to provide services. Workforce recruitment and retention are leading challenges for health centers, especially in Medicaid expansion states. Health centers report increased numbers of insured patients who are unable to pay their deductibles and cost-sharing. Nearly two-thirds of health centers in non-expansion states reported an increase in insured patients who could not afford their deductibles and cost-sharing, and over half reported an increase in the share of their privately insured patients who pay sliding fees. The share of health centers in expansion states reporting these trends, though significantly smaller, was also substantial. Federal grant funding remains essential to support health centers. In 2015, federal grants provided close to 20% of health center revenues. This funding enables health centers to finance care for uninsured patients, subsidize insured patients unable to afford their deductibles and copays, and finance services not covered by insurance. Over 70% of federal health center grant funding is from the health center trust fund set up by the ACA. If the ACA were repealed, ending the Medicaid expansion and the health center trust fund, health centers would be challenged to sustain their operations. Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels. The contraction of health centers would likely leave the most medically underserved urban and rural communities in the nation – for which the health center program was created – with reduced access to comprehensive primary health care

The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases

The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article