I hope that you will be able to join us and help spread the word about a very important Twitter chat this week for Speak Now for Kids.
Speak Now for Kids is an advocacy campaign of the National Association of Children’s Hospitals (N.A.C.H.) designed to engage child advocates in communicating with Congress before they cut funding for two key children’s health care programs: Medicaid, which funds health care coverage for one in three children in the U.S. and the Children’s Hospital Graduate Medical Education (CHGME) program which funds pediatric residency training.
Who better to be a child advocate than us – moms! Children often cannot have a voice in making their needs known. We ARE that voice on their behalf.
Join us to learn more about how you can help at the…
Speak Now for Kids Twitter Chat
When: Wednesday, November 16th from 2:00 to 3:00 p.m. ET
5 (five) winners will each receive a $50 Walmart gift card for helping us Speak Now for Kids. Join us for your chance to win!
About the National Association of Children’s Hospitals
The National Association of Children’s Hospitals (N.A.C.H.) is the public policy affiliate of the National Association Children’s Hospital Related Institutions, a trade association of children’s hospitals. N.A.C.H. supports children’s hospitals in addressing public policy issues that affect their ability to fulfill their missions to serve children and their families.
MEDICAID SPENDING AND CUTS
As the nation’s safety net provider of medical care for low-income, uninsured children, the nation’s ailing economy has had a tremendous impact on the growth of Medicaid enrollment over the past few years, highlighting the role it plays when individuals become uninsured during an economic downturn. Because Medicaid is administered by state government rather than federal government, states are being forced to make cost-cutting decisions to combat increasing enrollment. Even though states make decisions about what services should be cut, the ramifications are typically much greater than they appear because the federal government matches a portion of a state’s spending on Medicaid. For example, every $1 cut by the states produces a $0.57 reduction in spending for the federal government so a $1 cut really reduces spending by $1.57.
This year’s cuts to state Medicaid funding are in addition to cuts that were enacted during the past few years to address historic funding shortfalls that resulted from the significant increases in enrollment, states experienced with the economic downturn. Additional federal reductions in Medicaid will only worsen states’ budget shortfalls and severely limit their ability to meet their constitutional obligations to balance their budgets.
MEDICAID CUTS IMPACT ON CHILDREN’S HOSPITALS
Medicaid is the largest provider of health insurance for children in the United States, and children’s hospitals provide approximately 45 percent of the hospital care required by children covered by Medicaid. Each year since 2009, more than two-thirds of states have implemented a provider rate cut or freeze. State budgets for this year include provider rate cuts in 33 states and freezes already poor rates in 16 states.
Examples of this year’s provider rate cuts include:
- Arizona’s hospital reimbursement rates are being cut by 5 percent
- California’s hospital rates are being cut by 10 percent
- Maryland cut Medicaid payments to hospitals by $250 million
- Massachusetts has set specific Medicaid spending targets that will be achieved primarily through cuts to providers
- South Carolina cut Medicaid provider rates between 2 and 7 percent
Children’s health care costs have not been the major cost drivers in Medicaid, despite enrollment growth. Although children, including those with disabilities, represent 50 percent of Medicaid enrollees, they only account for 25 percent of Medicaid spending. Per capita, Medicaid spending for adults and the elderly is more than twice and nearly five times higher, respectively, than for children. It is essential that children’s health services do not disproportionally bear the burden of Medicaid spending reductions.
INNOVATIONS TO CURB SPENDING
Spending can be controlled through policies that help control the growth of Medicaid costs through improvements in the quality and integration of health care, rather than through policies and spending cuts that simply shift costs to states, patients, providers and other payers. Children’s hospitals are already using innovative solutions and making improvements in the quality and efficiency of care they provide. Some solutions that protect children and reduce spending are:
- Medical Home Programs for Medically Complex Children: These programs coordinate all of the care for children who have conditions that are difficult to manage, ensuring less overlap and more communication between providers.
- Pediatric Accountable Care Organization (ACO) Demonstrations: The Affordable Care Act included authorization of a pediatric accountable care organization demonstration. Although funds were not specifically provided for the demonstration, children’s providers, including children’s hospitals, have been pursuing pediatric ACOs and similar demonstrations, such as medical homes for children with complex chronic conditions noted above, through CMS and the Center for Medicare and Medicaid Innovation.
- Quality Transformation: The National Association of Children’s Hospitals and Related Institutions operate the Quality Transformation Network, a group of children’s hospitals joining forces to improve care and outcomes for high-impact clinical issues.
IMPORTANCE OF CHILDREN’S HOSPITAL GRADUATE MEDICAL EDUCATION (CHGME)
In the 1990s, the number of pediatric subspecialty residents in children’s hospital residency programs was declining. This decline highlighted the need for the Children’s Hospitals Graduate Medical Education (CHGME) program, which was passed in 1999. The CHGME program began with the goal of providing freestanding children’s hospitals with graduate medical education funding similar to the funding that other teaching hospitals receive through Medicare. President Obama proposed to eliminate funding for CHGME in his 2012 budget. However, Congress is working to restore funding to the program through a bill that has currently passed the House and is being considered by the Senate.
SUCCESS OF CHGME
The CHGME program has enriched the training experiences of pediatric subspecialty residents, providing greater community-based opportunities in underserved urban and rural areas, increasing the chances that residents will practice in medically underserved areas – both urban and rural – and increasing children’s access to care.
- Since the introduction of CHGME, children’s hospitals have increased the number of residents trained by 35 percent.
- More than 40 percent of general pediatricians, 43 percent of all pediatric specialists and the majority of pediatric researchers are now trained at children’s hospitals.
WHAT IF THE CHGME PROGRAM IS NOT REAUTHORIZED?
Not reauthorizing the CHGME program would be a major step backward for pediatrics and children’s health care and could result in a break in the pediatric-care pipeline that would impact generations of our nation’s children. It would also undermine the goals of expanding primary care and ensuring access to care for America’s children.
Without the CHGME program, we will return to the failed system that led to declines in pediatric residencies and the national shortages we face today.