Legislation to ease Medicaid coverage in other states for children with complex conditions has captured bipartisan support in Congress, but could fall victim to Obamacare politics.
It seeks to reduce problems that beneficiaries of Medicaid and the Children's Health Insurance Program—such as children with complex illnesses and disorders like leukemia and muscular dystrophy—sometimes encounter when they seek access to care across state lines. Since Medicaid and CHIP are state-based programs, non-emergency procedures tend to only be covered if they are provided within the state.
Under the ACE Kids Act, once a state volunteers for the initiative, eligible children would be assigned to a nationally designated children's hospital network. These networks would coordinate the full range of services these children need, including home, primary-, ambulatory-, acute- and post-acute care providers. Even with the states opting into the national framework, each participating state would continue to set payment rates, benefits and enrollment.
In a state where children with complex conditions already are enrolled in Medicaid managed care, one option would be for Medicaid plans to subcontract with the nationally designated children's hospital networks to provide comprehensive services for them.
Representatives from the Medicaid Health Plans of America said they are evaluating the legislation and declined to comment.
“The ACE Kids Act would form care networks across state lines, relieving families of the burdens associated with state-by-state Medicaid barriers to their child's care,” Peggy Troy, CEO of Children's Hospital of Wisconsin and chair of the Children's Hospital Association board of trustees, said in a written statement.
Nationally, roughly 2 million kids with severe illnesses are enrolled in Medicaid and they constitute 40% of Medicaid costs for children, according to the Children's Hospital Association. Advocates say that if the ACE Kids Act becomes law, it could potentially save Medicaid $13 billion over its first 10 years. It would achieve this savings through increased efficiencies, including reduced hospitalizations and emergency room visits. The legislation also provides an array of outpatient and community services needed by these children.
Similar legislation was introduced in the House last year but never got out of committee.
Reps. Joe Barton (R-Texas), Kathy Castor (D-Fla.), Anna Eshoo (D-Calif.) and Jaime Herrera Beutler (R-Wash.) reintroduced the bill Jan. 26. Days later, Sens. Chuck Grassley (R-Iowa), Michael Bennet (D-Colo.), Rob Portman (R-Ohio), Bill Nelson (D-Fla.), Roy Blunt (R-Mo.) and Sherrod Brown (D-Ohio) introduced a Senate bill. Last year, there was no Senate version of the ACE Kids Act.
“This bill is a creative idea to provide high quality, more efficient care for really sick kids through networks of providers who are willing to take responsibility for coordinating their care,” Grassley said in a written statement.
Even though the bill enjoys bipartisan support in both chambers, it likely will run into the partisan impasse over healthcare reform. “Any bills involving healthcare will be tied into the Affordable Care Act,” said Bradley Blakeman, a Republican strategist and principal at the 1600 Group, a consulting firm.
The ACE Act may become part of broader Republican-backed legislation to repeal the medical-device tax and change the definition of full-time worker for the purpose of determining which workers employers must cover in their health plans or face financial penalties. The White House already has said it would veto the measure changing the definition of full-time work.
“If Obama were smart, he would compromise on the fixes to the ACA as a condition to not repealing the whole,” Blakeman said.
Ford O'Connell, a Republican strategist, said the ACE Act has a good chance of becoming law if it actually would improve healthcare services for children and save money. “But the devil is in the details. How exactly will it do what it claims to do?” he said.
The White House did not respond to a request for comment.
“At this point, we haven't heard from the White House, nor have we made any overtures to the administration,” said Sean Brown, a Barton spokesman. “We continue to focus on building bipartisan support in the House and Senate. However, we are hopeful that once we get further along in the legislative process, the White House will be supportive.”
Follow Virgil Dickson on Twitter: @MHvdickson