For the past two years, the Children’s Mental Health Campaign has held 19 forums on mental health needs of kids across the Commonwealth.  While each forum has been different, one statistic universally resonates with all audiences and brings home the importance of the issue: Suicide is the third leading cause of death among children between the ages of 10 – 24; of those who commit suicide, 90% (90%!) have a diagnosable and treatable mental illness at the time of their death.

It’s not so much that 90% of young people who commit suicide have a mental illness – it’s that the illness is treatable that makes the current situation so terrible. 

Maybe if mental health was not such a taboo subject - maybe if we were able to openly discuss disorders of the brain - more young people would realize that there is another way to deal with their pain. 

The brain is part of the body.  We need to treat it as such and not be afraid to talk about how we can make it better when it doesn’t work the way it should. 

The time is NOW!

Thursday, the legislature’s Joint Committee on Health Care Financing will hear two key bills affecting young people:

• S.39 / H.188 – An Act to Assure Continuity of Health Coverage For Children, and
• S. 609 - An Act Relative to the Qualifying Student Health Insurance Program.

The hearing will be at 11:30 am in State House Room A-1, on Thursday, December 3 .

S. 39/H. 188, introduced by Senator Flanagan and Rep. Story, is a legislative priority of the Children’s Health Access Coalition and HCFA. This bill would provide 12-month continuous eligibility for children enrolled in MassHealth. Currently, children can lose their MassHealth coverage if his or her family’s income rises above 300% of the poverty level (FPL) at any point after they are deemed eligible. It is not uncommon for the income of a family living close to 300% FPL to fluctuate over the course of a year. When this happens, children cycle on and off of their public program and have intermittent coverage, which as you can imagine, is never a good thing.

The federal government allows states to establish 12-month continuous eligibility under these programs. The Commonwealth should join the 29 other states that have already implemented this policy, including Maine, New York, New Jersey, and Pennsylvania. We think this bill is budget neutral and good policy in tough financial times like these.

S. 609, filed by Senator Richard Moore, would require all student health plans to meet the state’s minimum creditable coverage standards. As it stands, some plans offered through colleges and universities do not cover preventive treatment or behavioral health services, cap prescription drug coverage and impose a low cap on medical benefits. A report released in early November by the Division of Health Care Finance and Policy shows that a number of national, for-profit health insurance firms are gouging over 95,000 students in Massachusetts with very high premiums for very little benefits. We are particularly concerned that while the major non-profit private insurers based in Massachusetts do just fine spending about 10% on administrative costs, and earning a 2% profit margin, some students are being forced into plans where 25% of the premium goes to administration, and another 20% to profit. The average for all plans offered by insurers was just 67% of premiums going to medical costs. The average profit margin was 10%, compared to 2% for private employer plans. Health Care For All supports this bill and additional policy solutions that level the playing field for this population who often experience other barriers to their education – their health should not be one of them.
- Jessica Hamilton

Jessica Hamilton

On Friday, Dr. James Mandell, CEO of Children’s Hospital Boston, presented “Children are not Little Adults: A Pediatric View on Payment and Insurance Reform” at the Health Law and Policy Forum Brown Bag Lunch Series.

Through case studies, Dr. Mandell emphasized that the issues surrounding pediatric care are different than those surrounding adults. Yet, most of the thinking and analyses of health care is taken from the adult care system. The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is the child health component of Medicaid. While EPSDT is required in every state and is designed to improve the health of low-income children by financing appropriate and necessary pediatric services, those measures are not part of the analyses or discussion of health care reform. In many of the national health reform proposals, children are placed into so-called Exchange programs that are primarily designed for the health needs of adults. Inclusion of an EPSDT wrap is imperative in these cases.

Dr. Mandell also found that the cost drivers in pediatric care are different than those for adults. Pediatric health care spending in the United States is 13% of health care dollars. While the cost of health care for most children is relatively low, those who require hospitalization or specialty care experience a tremendous increase in total cost. While 95% of kids average barely $400 per year in health costs, there are a small number of children (1%) who need more than $30,000 in annual care.

The unique needs of children should be included in health care reform. Instead of treating children as little adults in terms of health care, children’s needs should be specifically addressed. Coverage for children should include coverage for hospitalization. Early screening and prevention should be part of the scope of benefits. Reimbursement rates should reflect the actual cost of medical procedures. Even though it is often more expensive than it would be to do the procedure on an adult, Medicaid/SCHIP currently pays 30% less for pediatric procedures. Inequity in provider payments makes it hard for kids to get the care needed for complex medical procedures. A shortage of persons who train for pediatric subspecialties limits access for children who need specialized care.

In closing, Dr. Mandell remarked that pediatric health is more of an investment rather than a cost, and one that has significant long term benefits.
-Jaspreet Chowdhary & Yelena Kuznetsov

Last week, the Legislature’s Joint Committee on Public Health held a hearing on health insurance and financing related bills. The hearing was chaired by Senator Fargo and Representative Sanchez and began with an executive session to favorably report out S. 810. This bill establishes a permanent Office of Health Equity in the Executive Office of Health and Human Services, and is priority of the Disparities Action Network.

Two HCFA priority bills were heard:

• S. 54, “An Act Ensuring Access to Basic Health Care for Children and Young Adults,” which expands MassHealth eligibility to cover youth through age 20; and
• H. 4258/S. 873, “An Act Strengthening Health Reform,” which improves health reform through a number of fixes, including prohibiting lifetime caps in all Massachusetts health insurance plans and codifying the Health Care Reform Outreach and Education Unit and the MassHealth Outreach Grant program.

Dr. Cathryn Samples of Children’s Hospital Boston testified on behalf of S. 54. Dr. Samples testified that expanding MassHealth services to all recipients through age 20, “is right and fiscally responsible.” As a physician in a clinic that provides 15,000 visits to 5,000 patients per year, she noted that most of her patients were MassHealth beneficiaries. She also explained that this bill could provide access to healthcare for the majority of uninsured youth who come from poor households and would qualify for MassHealth services. In her testimony, Dr. Samples gave three specific reasons for supporting the bill. The continuity of coverage would provide stability for youths and keep any of their chronic conditions under control. Keeping youths covered under MassHealth until age 21 would also simplify administration of the program which is often a daunting process to adults let alone youths. MassHealth in its implementation is a simpler and more straightforward way to ensure that young people have health insurance coverage. We blogged more details last week.

The ACT!! Coalition panel testified on behalf of H. 4258/S. 873. Neil Cronin from the Mass Law Reform Institute set the tone for the content of the panel. He explained that this bill seeks to make some “policy tweaks” to Chapter 58 including CommCare eligibility provisions, reimbursement of interim services, and the inclusion of a Fair Hearings officer in the appeal process. He explained how CommCare provisions often lead to gaps in coverage because eligibility only occurs a month after the month of enrollment in the plan. Mike Sroczynski of Mass. Hospital Association described how the bill would allow the Health Safety Net coverage to be retroactive to all eligible patients.

In her testimony, Suzanne Curry, the ACT!! Health Reform Coordinator explained that the bill makes permanent the EOHHS health outreach unit. It would also create an advisory committee to oversee the program. She also spoke about the importance of outreach and the way it helps people navigate the health care system by connecting people to coverage, as well as to care and providers. A major component of the bill is to employ culturally and linguistically competent outreach workers who will be able to strengthen the lines of communication surrounding healthcare reform. Allyson Perron from the American Heart/American Stroke Association demonstrated the need to prohibit lifetime caps in all health insurance by telling the story of Jake. Jake needed to have three heart surgeries within the first two years of his life and by age four, had used half of his $1 million lifetime cap. He is 14 years old now and doing well but has about $750,000 in medical bills each year and thankfully now has a plan without a lifetime cap.

Several other bills were heard. The single-payer bill, H. 2127 (“An Act to Establish the Massachusetts Health Care Trust”) received extensive testimony. Co-sponsors Rep. Matt Patrick and Senator Patricia Jehlen spoke passionately in support of the bill, while Jehlen acknowledged its lack of political feasibility.

Testimony was also heard for S. 848, “An Act Relative to MassHealth Enrollment for Persons Leaving Correctional Facilities,” from James Walsh of the Massachusetts Association of Sheriffs and Marilyn Morningside of the Health Services Administration at a western MA correctional facility. They explained that most prisoners were MassHealth eligible when entering the corrections system, but have no MassHealth card when released. They believe enrolling this population of approximately 15,000 people will not add significant costs to the state’s bottom line because this population was already part of the state healthcare system whether through MassHealth or the corrections system. Furthermore, they argue that without proper healthcare services, these inmates could wind up back in the corrections system, which would cost the state even more money.

The public hearing was a powerful display of ideas and Massachusetts ingenuity. Panelists provided very touching and informative testimony aimed at improving and streamlining health care processes in Massachusetts.
- Yelena Kuznetsov

Think back to when you were 19. Were you a freshman in college? Living in your first apartment? Working your first full-time job? Living at home with your parents?

There are certain age milestones in all of our lives. For many, their late teen / early 20s are ones of transition. With all the changes going on in their lives, making informed, well-reasoned decisions about health coverage is difficult, if not impossible.

When the Legislature passed Health Reform in 2006, they recognized the often tumultuous nature of these years and extended the age when children could be on their parents’ employer-sponsored health insurance to age 26.

Although this was an important step, there are many young people for who this is not an option.

Low income children (under 300% of the Federal Poverty Level) are eligible for coverage under MassHealth through age 18. However, the current statute ends their MassHealth eligibility once they turn 19.

For many reasons, it makes sense to extend the age of MassHealth eligibility.

First, there is the issue of continuity of care. With all the changes going on in young people’s lives during these years, allowing them to maintain their coverage and their doctors until a point when they are more settled just makes good sense.

Second, there is the issue of cost. Although Young Adult Plans (YAPs) were established through Health Reform, the out-of-pocket costs for young people are higher for subscribers. In some cases, premiums for YAPs are $78 per month higher than they would be under MassHealth.

In this time of economic and budgetary crisis, this is actually a low-cost fix for the Commonwealth. Because of federal matching funds available through Medicaid, much of the cost burden of this expansion would be borne by the federal government rather than the state. And Massachusetts wouldn’t be breaking new ground here – 16 other states make 19-21 year olds eligible for Medicaid.

Finally, expanding MassHealth takes on the issue of the uninsured head-on. While we have made remarkable progress in reducing the number of individuals without insurance, young people remain disproportionately uncovered. While young people from 18-24 represent 12% of Massachusetts’ population, they make up 24% of our uninsured.

This morning, the Joint Committee on Public Health heard testimony in support of SB 54, An Act Ensuring Basic Health Care For Children And Young Adults. This legislation would expand MassHealth eligibility up to age 21 from 19.

Testifying in support of the bill was Dr. Cathryn Samples, an Adolescent Medicine Specialist at Children’s Hospital Boston. She spoke powerfully about the challenges facing many of her patients and how allowing them to remain on MassHealth coverage would make a difference in their lives.

Huge thanks from the Children’s Health Access Coalition to Dr. Samples for her testimony.

Being in your early 20s can be an overwhelming time. Life is full of change and new experiences. When you are also low income, it can be even more difficult. Passing and enacting SB 54 would make things just a little easier.

Matt Noyes
Policy Manager

The Joint Committee on Public Health will hold a hearing tomorrow in State House Room B-1 at 10am. The topic for tomorrow’s session is Health Insurance and Financing; testimony on approximately 20 bills will be accepted. Two priority HCFA bills, An Act Strengthening Health Reform (S.873/H.4258)
and An Act Ensuring Access to Basic Health Care for Children and Young Adults (S.54) will be heard.

The ACT!! Coalition has a great panel lined up; Neil Cronin from Mass Law Reform Institute, Mike Sroczynski from the Massachusetts Hospital Association, Allyson Perron from the American Heart/American Stroke Association and Meg Kroeplin from Community Partners will all provide testimony in support of Act Strengthening Health Reform. The Children’s Health Access Coalition has asked Cathryn Samples, MD, an adolescent medicine physician who has worked at Children’s Hospital Boston over 20 years to testify in support of An Act Ensuring Access to Basic Health Care for Children and Young Adults.

Please check back tomorrow for highlights and details about the hearing.

- Jessica Hamilton

Thursday is an important day for oral health in the Commonwealth. On October 1, 2009 MassHealth dental benefits will be extended to cover children under the age of 19 who receive Family Assistance premium assistance, in order to comply with CHIPRA regulations. A copy of the announcement can be downloaded here (.pdf).

Regular readers know that oral health is an important part of overall health. Left untreated, dental disease can interfere with a child’s ability to eat, sleep, speak and learn. As we age, the implications of this disease become more severe. Decades of research have confirmed the associations between dental disease and serious lifelong ailments such as heart disease, stroke, and diabetes.

Under the newly expanded benefit, MassHealth will pay for dental services that are not already covered by the child’s private dental insurance. This includes essential services, such as comprehensive and periodic screenings and preventive care, as well as emergency care, oral surgery, and more. Access to these benefits will ensure better oral health and overall health for the children of Massachusetts.

If you have MassHealth coverage, you can find a list of services covered here (as well as a list of those that aren’t, here), courtesy of MassResources.org.

- Courtney Chelo
Oral Health Campaign Organizer

With all the noise surrounding the national health reform debate over the last several months, one group that was at risk of being lost in the shuffle was children. At one point, advocates were concerned that kids would be forgotten and that they would be lumped in with adults when it came time to design coverage plans. Thanks in large part to our friends at Community Catalyst and the New England Alliance For Children’s Health, it looks like this won’t happen.

Children are not little adults – they have unique health care needs that need to be accounted for. One thing that the Children’s Health Insurance Program (CHIP) did particularly well was to recognize these needs and to mandate standards of care that had to be met.

Early drafts of the health reform proposals seemed to indicate that CHIP was going to be eliminated and that kids were going to end up covered through the Exchange system by health plans designed for adults.

Fortunately, Senator Baucus heard the calls of advocates and has included a provision in the Finance Committee’s proposal that would require coverage of child-specific services that would otherwise not be part of Exchange plans. There are other amendments that are expected to be considered during the committee debate. For more on all the child-focused provisions and amendments in the legislation, click here.

Massachusetts has long recognized the unique needs of kids, though it’s Children’s Medical Security Plan and kids-focused MassHealth programs.

We have a long way to go before any of this becomes reality, but it’s good to know that at least from the kid perspective, things are moving in the right direction.
-Matt Noyes

The Health Care Financing Committee held its last scheduled hearing on primary jurisdiction bills today. Included were key HCFA priority bills on children’s health and oral health (see our photos here).

Kids: The success of Massachusetts in extending health coverage to virtually all children is laudable, but an insurance card alone is not enough to guarantee care. Nearly 16,000 children in the Commonwealth access care through the Children’s Medical Security Plan (CMSP), but the scope of services offered under this program are frequently insufficient to fully address their health needs.

CMSP is a program specifically designed to cover children who do not have access to private coverage and who are ineligible for other public programs. However, CMSP has caps on essential provisions of care that significantly limit the a family’s ability to make sure their child is healthy:

• CMSP limits prescription drug coverage to $200 per year. A single ear ache alone would easily exhaust this benefit;
• Durable medical equipment is likewise capped at $200 – a level insufficient to cover major equipment such as a wheelchair or a breathing machine;
• Paradoxically, although CMSP covers vision and hearing screening, it does not cover eyeglasses or hearing aids.

At today’s Health Care Financing Committee hearing (video hightlights above), Senator Sonia Chang-Diaz, Dr. Sean Palfrey, Toby Guevin, and Patty Glidden all testified in support of H. 1087 / S. 537, An Act Relative to Equitable Health Coverage for All Children.

Dr. Palfrey and Patty Glidden in particular cited specific cases from their experience as medical professionals of children who went over their caps and were put in difficult positions.

Patty spoke of a boy she works with at the Martha Elliot Health Center in Jamaica Plain who requires expensive medication to control his asthma. $200 covers only a few months of medication, forcing the family to seek out samples or make difficult family budget decisions.

Dr. Palfrey told the committee about a girl who receives care at Boston Medical Center. The girl has kidney disease, which requires her to self-catheterize several times a day. The $200 cap on durable medical equipment is insufficient for the year. The family tried to sterilize the equipment themselves to make it last longer, but the girl came down with a serious infection, resulting in an expensive hospitalization.

H. 1087 / S. 537 would eliminate the current two-tiered system of care that we now have for children and eliminates the unrealistic caps in CMSP.

Oral HealthTwo important oral health bills were heard. Both aim to improve overall health by increasing access to important preventive and restorative oral health services.

H. 1100 / S. 31, An Act Relative to Equitable Dental Reimbursement Rates for Services Provided to Publicly Aided Patients, sponsored Senator Harriette Chandler and Representative John Scibak, will increase access by bringing reimbursement rates for MassHealth dental services to an equitable level.

H. 1101 / S. 1038, An Act to Include Dental Benefits in All Commonwealth Care Plans, is also being co-sponsored by Senator Harriette Chandler and Representative John Scibak. This bill will include dental benefits in Commonwealth Care plans for adults between 100% and 300% of the federal poverty level. Dental benefits are not included in Commonwealth Care plans for individuals with incomes above 100% but below 300%. This bill would require that plans offered to adults with incomes below 300% include comprehensive dental benefits.

Many speakers stood up to remind legislators that dental insurance is health insurance! Senator Harriette Chandler, Representative John Scibak, and Representative Ellen Story all testified in support of the bills. HCFA also helped organize a diverse panel to emphasize several important aspects of this legislation. Dr. Lynda Young, a pediatrician in Worcester, MA, spoke about the importance of oral health to overall health, and the huge impact that dental disease can have on all aspects of life. Former Massachusetts Representative Kathy Teahan discussed the negative impact that poor oral health can have on businesses and the economy, and the importance of access to sustaining a robust workforce in the Commonwealth. Lastly, Dr. Cynthia Stevens, the VP of Dental Services for Community Health Connections Health Centers in Fitchburg and Gardener talked about how increasing reimbursement rates is essential to keeping the doors of health safety net and health centers open. The speakers all did fantastic jobs of highlighting how these two bills will help improve the overall health of the Commonwealth by making sure that we are providing whole-body coverage to our residents.
- Matt Noyes and Christine Keeves

The Joint Committee on Health Care Financing held a public hearing on Wednesday May 27th. Several bills were heard relating to insurance, the Insurance Partnership program, medical malpractice and the health care workforce.

Georgia Maheras testified on behalf of the Affordable Care Today (ACT!!) Coalition in strong support of Senator Montigny’s bill, An Act relative to coverage for chronic illness (S. 551). This bill would eliminate co-payments for all prescriptions and devices used for the treatment of chronic illness, a bold step forward in Massachusetts’s attempt to make quality health care affordable for everyone. Research has shown that increased cost sharing, especially in the course of treatment of chronic illness, serves as a barrier to patients who are seeking care. Even relatively small co-payments have been associated with lower rates of seeking preventive services and co-payments for treatment of chronic illness would only hinder the treatment’s rate of success. It makes economic and medical sense to eliminate chronic illness cost-sharing. Prevention will increase and costs will decrease. Estimates have shown savings of nearly $2,000 per patient annually, along with a decrease in mortality rates. Twelve states across the country have already eliminated it from their Medicaid programs, with successful results.

Mary Lou Buyse from the Mass. Association of Health Plans spoke in opposition to S. 551. Buyse argued that eliminating copays for chronic care would violate health reform’s mantra of shared responsibility and lead to increased costs and utilization. Buyse fervently stated that health care should not be free.

Representatives from the small business, artist and insurance communities testified on the Insurance Partnership bills: S. 530/H.1083 An Act Improving the Insurance Partnership Program, H. 1071 An Act Relative to the Insurance Partnership and H. 1078 An Act Relative to Massachusetts Artists. Health Care For All is supportive of S.530/H. 1083, which would increase eligibility for the IP to 400% fpl from the current 300% fpl level. These bills also increase by 50% the payment to employers who participate in the plan by providing coverage to eligible employees. H. 1078 goes further than S.530/H. 1083 and raises the eligibility level to 400% fpl. It also makes more extensive changes to the program, including eliminating the 6-month look-back. This bill also would allow self-employed people to receive Commonwealth Care, expand the Section 125 requirement to firms with 5 or more employees, and direct the Department of Revenue to review how Adjusted Gross Income (AGI) is calculated for individuals with a combination of self-employment and wage income. HCFA opposes H. 1071, which appears to cut back on eligibility for the IP in 2009. We support an in-depth appraisal of the strengths and weaknesses of the IP and the other health assistance programs. A comprehensive, rational framework should be devised that equitably provides help to everyone who qualifies for assistance. To read our full testimony click here (.pdf). Kathy Bitetti, Executive Director of our ACT!! Coalition partner The Artists Foundation, also spoke in support of H. 1078 and H. 1083 and urged the Committee to not let self-employed people and people with combination incomes fall through the cracks.

Two sets of bills generated much discussion: childhood vaccines and medical malpractice reform. DPH Commissioner John Auerbach and several other experts from the fields of pediatrics and public health spoke in strong support of Rep. Wolf’s bill, H.3453 An Act establishing the Massachusetts childhood vaccine program and the Massachusetts immunization registry. The experts emphasized the need to ensure that all kids receive necessary and cost-effective vaccinations. Senator O’Leary as well as Mass. Medical Society President Mario E. Motta spoke in support of his medical malpractice reform bills – S. 573 An Act providing for a fair judgment interest rate for medical malpractice actions and S. 574 An Act relative to malpractice reform; representatives from the Mass. Academy of Trial Lawyers argued in opposition to these bills.

Catherine Hammons
Health Reform Associate

When the omnibus Act Relative To Children’s Mental Health (Chapter 321 of the Acts of 2008) was signed into law last year, there was one provision that was not included: reimbursement for collateral contacts by commercial insurance.

Collateral contacts can be more accurately referred to as coordination of care. When an adult is working with a mental health professional, the adult can typically express what is going on in his or her life directly to the clinician in such a way as to make treatment effective. When it is a seven year old, it’s not so simple.

Children are not little adults. To have treatment of mental health needs be effective, it is vital that the treating clinician speak to other people in the child’s life – parents, teachers, pediatrician, etc. Only through this coordination will the child have the best chance to have his or her mental health needs addressed properly.

Of course, to protect the privacy of the young people involved, this type of coordination would only be done with parental consent.

In Massachusetts, the state already reimburses mental health clinicians for collateral contacts when children are covered under MassHealth. Commercial insurance, on the other hand, does not provide this benefit. Mandating reimbursement for collateral contacts will ensure that care coordination is the standard practice rather than an exception to the rule.

The collateral contacts piece of Chapter 321 was not included in the final version of the law because a cost analysis had not been completed by the Division of Health Care Financing and Policy. The cost review was completed late last year and it found that collateral contacts are extremely inexpensive – 5.5 cents per member per month or 0.01% of total premium costs.

This piece of the original omnibus bill was refiled for the current legislative session as H. 3586 / S. 757, An Act Relative To Coordination of Children’s Mental Health Care, and was heard yesterday by the Joint Committee on Mental Health and Substance Abuse.

Testimony was given in support of the legislation by two panels.

On the first panel, Dr. David DeMaso, Psychiatrist in Chief at Children’s Hospital Boston and Professor of Psychiatry and Pediatrics at Harvard Medical School, illustrated the importance of coordination of care by asking Senate Chair Jen Flanagan to imagine herself as a third grade teacher with a student displaying mood swings and classroom outbursts. In an effort to more effectively attend to the behaviors while also teaching the other students, isn’t it a good idea to talk with the child’s psychiatrist, Dr. DeMaso asked.

Similarly, Dr. DeMaso asked House Chair Liz Malia to put herself in the shoes of a pediatrician treating a young woman with severe asthma. Before changing her patient’s medication to address her asthma, wouldn’t it be responsible for her to speak to her patient’s mental health clinician to avoid a potentially dangerous interaction with her antidepressant medication?

The second panel featured testimony from Central Massachusetts: Cathy Apostolaris from the Winchendon Project, Tony Poti from the Choices Program, and Dr. David Keller, a pediatrician from Webster. For all three of these individuals, care coordination has been vital to the success of their work.

Passage and enactment of An Act Relative To Coordination of Children’s Mental Health Care is the top legislative priority of the Children’s Mental Health Care. More effective coordination of care is an important step in addressing the mental health needs of Massachusetts’ children.

Matt Noyes
Children’s Health Coordinator

The House started the week with a budget with appropriations at $27.44 billion, with $19.53 billion from taxes. On Monday, the House voted to increase the sales tax from 5% to 6.25%, bringing in an additional $900 million. They voted to allocate $205 million of those additional funds towards local aid. The left over amount has been used throughout the week for consolidated line item amendments. HCFA’s coalitions continued to advocate for vital state funded programs. The week had both good and bad news.

On Tuesday, the House recognized the importance of children’s mental health by restoring funding to several key line items. $3.4 million was put back in the Child and Adolescent Mental Health Services line item, (5042-5000), $25 million was allocated to the Children’s Behavioral Health Initiative (Rosie D.), and the line item for Early Education Mental Health Services (3000-6075) was restored with $1 million.

Of the Children’s Health Access Coalition (CHAC) priorities, $4 million was added to the Healthy Start account, which will allow thousands of pregnant women to receive health services that reduce infant mortality and low birth weights. In addition, the House restored more than $6 million for Early Intervention, a program that provides services to more than 30,000 infants and toddlers with developmental delays each year. However, even with this additional funding, the amount appropriated will likely force the State to make programmatic cuts or restrict eligibility.

The Disparities Action Network (DAN) is pleased with the inclusion of language restoring the EOHHS Office of Health Equity in the Medicaid line item. The language continues the work of the office created in last year’s budget, focused on implementation of a comprehensive health disparities reduction strategy for the state. The EOHHS Office of Health Equity is actively working across state secretariats to create interagency health equity strategies and developing an annual state health disparities report card. With continued support through the budget process, the Office will be able to continue advancing its efforts to eliminate health inequalities.

The DAN thanks Rep. Rushing for championing this amendment and his sustained dedication to health equity.

Unfortunately, the ACT!! Coalition’s two budget priorities – FMAP transparency and funding for the MassHealth Outreach Grant program were not included in the final House budget. Likewise, increase funding for the quality bureau and for the Betsy Lehman Center at DPH, were also not included. Both ACT!! and the Health Quality Consumer Council will continue to advocate for these items in the Senate.

An additional $10 million dollars was appropriated to the Prescription Advantage Program. This program provides prescription drug coverage for low-income senior citizens who cannot otherwise afford the cost of their medication. Special thanks to Representative Wolf for introducing this amendment.

Late Thursday night the House voted to increase appropriations for public health programs. The Massachusetts Prescription Reform Coalition (MPRC) had a victory with the Academic Detailing program funded at $100,000 within the Public Health Consolidated budget amendment. This program was not funded in the Governor’s budget or in the original House budget. The goal of academic detailing is to close the gap between the best available science and actual prescribing practice, so that each prescription is based on the most current and accurate evidence about efficacy, safety, and cost-effectiveness and to deliver this information to doctors in an efficient, user-friendly way.

The Office of Oral Health line item was restored by $256,000, including earmarks for oral health programs funded through the Department of Public Health. The current economic climate is a challenging one and our advocates did a great job of educating our legislators, bringing on new cosponsors to support oral health, and ultimately improving funding for the oral health in the House budget! The consolidated amendment, which includes funding for oral health programs, can be found here. A special thank you goes out to Representatives Scibak, Atsalis, Coakley-Rivera, Fagan, and Fennel for their hard work last night to provide more equitable funding for the Office of Oral Health.

Thank you to all our House budget leads, including Reps. Rushing, Scibak, Hecht, Stanley, Malia, Clark, Pedone, Malika, Kafka, O’Day, Garballey, D’Amico and Provost. Also congratulations to Chairman Murphy, and Vice-Chairs Kulik and L’Italien.

The Senate Ways and Means Committee plans to release its budget on May 14-15. Because of decreased revenues thus far in 2009, Senators have hinted at their projected revenues being over $1 billion below the Governor’s projections.

The New England Alliance for Children’s Health (NEACH) will be hosting their 3rd annual Children’s Health Care Summit on Friday, April 24th from 9:30-4:30PM. The FREE event will take place at the Doubletree Hotel in Lowell, Massachusetts. For an updated list of the day’s events and speakers, please see the Children’s Health Summit Agenda (.pdf). The last day to register is Tuesday, April 21st. Click here to register for the Summit.

This afternoon, the Mental Health and Substance Abuse Committee held a long, and sometimes intense, oversight hearing into the impact of budget cuts on mental health services.

Committee members closely questioned EOHHS Secretary JudyAnn Bigby about how choices of what programs to cut were made. In particular, Rep. Angelo Scaccia (D-Boston) raised concern about the disproportionate burden of the 9c and House 1 cuts on individuals and families served by the Department of Mental Health.

Scaccia said that he was troubled by the danger of cuts to such a vulnerable population. “We never want cuts for the poorest of the poor,” he said, “As a Democrat, these cuts really stick in my craw.”

Following Secretary Bigby to the witness table were Dr. David deMaso of Children’s Hospital Boston, Marylou Sudders of MSPCC, and Lisa Lambert of PAL.

Dr. deMaso spoke about the tremendous cost associated with untreated mental health needs. However, he said, we have an opportunity to prevent mental illness from spiraling to a crisis point through early identification and treatment. The mental health system, he testified, should change its emphasis to one of long-term intervention rather than short term fixes at crisis points.

Lisa Lambert followed up on this testimony by sharing some of the most frequent concerns of parents: the barrier to treatment of high out of pocket expenses such as co-pays, a desire to be assured of the effectiveness of treatment types, and the diverging policies of returning children with mental health needs to their homes versus zero tolerance policies of many schools, which serve to make transition back to the community more difficult for these kids.

Finally, Marylou Sudders spoke of her mixed outlook for kids with mental health needs. On one hand, she said, there is reason to be optimistic because of the very real policy changes that have been enacted recently in the form of Rosie D, mental health parity, and the passage of Chapter 321, An Act Relative To Children’s Mental Health. At the same time, however, she is concerned that the new systems being created through these policies are being built on a crumbling reimbursement infrastructure that does not pay clinicians sufficient rates to allow them to treat those in need.

Throughout the children’s mental health panel, there were many nodding heads among the Mental Health Committee members. House Chair Liz Malia (D-Jamaica Plain) thanked the group for their testimony and asked them to continue to hold the legislature’s feet to the fire on this issue.

During a difficult economic and budgetary time with very little good news on the human services front, today’s hearing was a sorely-needed bright spot.

Matt Noyes
Children’s Health Coordinator

Last Thursday, the Children’s League of Massachusetts hosted a State House briefing on the effects of the state’s recent budget cuts on vulnerable children. The Children’s League is a non-profit statewide network of over 60 organizations, advocates, and consumers whose mission is to promote the well-being of children and their families through the effective use of the public policy system.

The purpose of the event was to educate state leaders and consumers about the effect recent budget cuts to the health and human services have on vulnerable children and at-risk youth and young adults. A new report,”Public Secrets: Silent Suffering – The State of Our Most Vulnerable Children,” highlights details of what the cuts have done. The report came on the heels of a survey that the group disseminated to its member organizations, advocates and families who depend on the services offered by the state through DCF, DYS, DMH, DEEC and DPH aimed at get a clearer picture of what the cuts are doing to children across the Commonwealth. The biggest concern: approximately 3,000 kids are no longer getting the services and care they need because the fiscal cuts have meant a cut in eligibility levels.

The speaking program was moving. Senator Bruce Tarr was acknowledged for this commitment to children of the Commonwealth. Representative Kay Khan, Chair of the Committee on Children, Families and Persons with Disabilities spoke about the possibility of moving money around in order to save children. As the grandmother of 7 young grandchildren, she also mentioned that this is a very important issue to her that she hopes advocates will often engage her in. Larry Fisher, a 21 year old street worker for the city of Boston and former foster care child, spoke about the impact cuts have had on his ability to do his job. As someone who works to place homeless teenagers in overnight shelters, he shared his hope that the state will prioritize children and work to find funding for programs that house homeless children so that he won’t be forced to call the police when shelters are closed. He emphasized the need for state to provide residential, financial and emotional stability to children and asked, “Don’t you think these kids have had enough cuts [to deal with]?”

Mary Ann Tufts, mother of Yolanda, the young lady for whom Chapter 321, last summer’s children’s mental health statute, is named for, also spoke. She shared her experience in dealing with state agencies to get appropriate care for her three adopted daughters who all suffered from mental illness and urged advocates to work together to “put a face on the cuts.” Representative Ann-Margaret Ferrante closed the speaking portion by explaining that the House expects make about $3.5-$4 billion of cuts to the budget. She urged advocates and parents not to every think that they are bothering a legislator but to instead call and write to legislators about the issues that matter the most

The Children’s League requests that we all get involved in efforts to support children in need by asking for a restoration of funding for DCF to the original FY09 levels. For more information about the report or The Children’s League Campaign for Our Most Vulnerable Kids, please contact them at 617-695-1991.
Jessica Hamilton

A recent report on data from the California Office of Statewide Health Planning and Development (OSHPD) found that people without dental coverage were significantly more likely to use the emergency department (ED) for preventable dental conditions such as untreated cavities, dental abscesses, and periodontal disease. Click here for the full report (.pdf).

Among the findings:

The report highlights what we already know about dental disease: that lack of access to oral health services has a significant impact on overall health. Poor oral health can lead to dental decay and has been associated with increased risk for heart disease and diabetes, all of which lead to costly visits to the ER. Dental decay can also affect individuals’ ability to speak, eat, and succeed in work and school. Fortunately, dental decay is almost entirely preventable when people have access to simple services such as screenings, dental sealants and fluoride treatment.

In California, these effects are demonstrated by the 80,000 visits a year for preventable dental conditions. Left untreated, cavities and other routine dental problems can develop into serious infections that require immediate treatment, exacting a high cost both on patients and the health care system.

Advocates in Massachusetts are working hard to make people aware of these issues and to increase access to care in order to eliminate the health risks. To learn more about our statewide public awareness campaign, please visit www.WatchYourMouth.org or contact Czarina Biton at biton@hcfama.org or 617.275.2838.

For more information about current legislation and advocacy, please visit the Oral Health Advocacy Taskforce online at www.hcfama.org/oralhealth/taskforce or contact Jaime Corliss at jcorliss@hcfama.org or 617.275.2801.

- Christine Keeves

This past Sunday and Monday, the Center on Budget and Policy Priorities and the Georgetown Center for Children and Families gathered advocates from around the country to discuss the recently-passed Children’s Health Insurance Program Reauthorization Act (CHIPRA). The new law will be a major step forward in providing health coverage to millions of children who are currently uninsured.

The conference itself was jam-packed with information, but here are some significant take-aways:

• Although everyone would like to see CHIPRA implemented as soon as possible, there have been delays as the new HHS secretary and CMS director have yet to be confirmed by the Senate. As soon as those posts are filled, expect RFRs and regulatory guidances to be issued quickly.
• States have an opportunity to get an enhanced federal matching rate if they enroll more eligible kids into CHIP. However, to even be eligible for this higher rate, each state must adopt a series of administrative streamlining regulations, including establishing 12 month continuous eligibility under both Medicaid and CHIP. HCFA and the Children’s Health Access Coalition are supporting legislation that would make exactly this change.
• Massachusetts stands to see significant cost savings due to the removal of the 5 year waiting period for legal immigrant children. Massachusetts already covers these children using state funds through the Children’s Medical Security Plan (CMSP), but according to EOHHS, there will be an estimated 500 children who will now be CHIP-eligible when the state takes up this option. In these difficult fiscal times, every dollar saved is important.
• CHIPRA doesn’t just provide health coverage – it also attempts to improve child health quality. According to a 2007 New England Journal of Medicine article, only 53% of children received appropriate care for chronic medical conditions, 41% received adequate preventive care, and 68% got treatment for acute medical problems. CHIPRA contains $225 million in funding specifically targeted toward child health quality initiatives. We have a real chance to make significant improvements not only in health access, but also on health outcomes.

The conference was too full to allow for sight-seeing, but I am pleased to report that the Cherry Blossoms on Haines Point appear to be on schedule to bloom just in time for next weekend’s Cherry Blossom Festival – at least that’s how they looked out the window of the Metro …
Matt Noyes

“As far as health condition and medical care are concerned, [homeless] children are prisoners of their socioeconomic and insurance status.”- America’s Youngest Outcasts: State Report Card on Child Homelessness, The National Center on Family Homelessness

A recent report (www.homelesschildrenamerica.org) by the Newton-based National Center on Family Homelessness (NCFH) begins with a call to action: “It is unacceptable for one child in the United States to be homeless for even one day.”

Still, in the richest country in the world, 1.5 million children go to bed with out a home each year. Just as alarming, NCFH found that 1 in 50 American children experience homelessness at some point in their life.

Dr. Ellen L. Bassuk, NCFH president, states that we need to provide “equal opportunities for all American children to grow and thrive in the safety and security of their own homes.”

For Massachusetts, there is some good news: according to the report, the Commonwealth ranks 8th in the nation for well-being of homeless children. This ranking is based on the number of homeless children and how these children fare in various domains (food security, health, and education), the risk of children becoming homeless, and the state’s planning and policy efforts.

But while we can take some comfort in our overall ranking, the news on the health front is troubling – Massachusetts ranks 43 out of 50 for the percentage of homeless children reporting moderate to severe health conditions. Compared to middle-income families, homeless families in Massachusetts suffer proportionately more moderate to severe health problems, as well as more asthma, traumatic stress, and emotional disturbances.

Health insurance alone isn’t enough to guarantee good health. If that were the case, children in our state would be by far the healthiest in the nation (only 1.2% of our children do not have health coverage).

Good health depends on more than an insurance card.

If the NCFH report is a call to action for us to protect the health of our most vulnerable children, we should closely examine the impact that budget cuts will have on low income and homeless kids.

While no one can deny that these are unprecedented economic times and that difficult funding decisions need to be made, there are specific child health programs that must be held harmless.

The Healthy Start Program provides prenatal and limited post-partum coverage for low-income women not eligible for MassHealth. The program serves close to 4,500 pregnant women each year.

Healthy Start covers prenatal visits (including labs and radiology), outpatient mental health services, prescription drugs, medical nutrition therapy, durable medical equipment, amniocentesis, and postpartum care up to 60 days after delivery. Timely prenatal care is important to a healthy pregnancy and has been shown to produce better birth outcomes.

Early Intervention (EI) is the most comprehensive, family-centered program in the Commonwealth dedicated to serving children birth to three with developmental delays. The program serves more than 30,000 children and families in Massachusetts each year. EI is a range of services available to families of children up to three years old who have developmental delays or whose development is at risk because of particular birth or environmental factors. Services are based on the needs of the child and family, and can include home visits, child groups, parent groups, and services of specialty providers.

Current economic factors indicate that it would be irresponsible and short-sighted to cut Healthy Start and EI at a time when the demand for their services is likely to only increase.

The idea that children are our most valuable resource cannot be disregarded as simply another cliché – we must live this value by working to ensure that, in the words of Dr. Bassuk, there exists “equal opportunities for all American children to grow and thrive.”
Matt Noyes and Christine Keeves

A key issue affecting oral health for kids is homelessness. Last week, The National Center on Family Homelessness released a report called “America’s Youngest Outcasts: State Report Card on Child Homelessness” to provide a comprehensive snapshot of child homelessness in America today. Homelessness puts children at risk for many things- including poor health outcomes. Because oral health is a crucial part of overall health and a successful future, the report contained some new information about homeless children and oral disease.

Dental disease is the most common chronic childhood disease. It is five times more common than asthma in children all across the nation. Dental decay can affect some of life’s most basic activities, including speaking and eating, and can hinder kids’ ability to learn and advance in school. In adults, dental disease is associated with other health problems, such as heart disease, diabetes, and low birth weights. Measures such as dental sealants, fluoride treatments, and early childhood screenings can almost entirely prevent dental disease.

According to the report, the number of children who lack dental insurance is more than two and one-half times the number of children who lack medical insurance. Being uninsured significantly decreases the likelihood that children will visit a dentist, which means that they do not have access to these simple and effective preventive services.

The rates and impact of dental disease is even greater for low-income and homeless children. Homeless children are more likely to have tooth decay and cavities, and low-income children are burdened with more than twelve times as many restricted activity days due to dental disease as compared to their higher income counterparts.

When communities work together to make oral health a priority, dental disease is entirely preventable. This report is a reminder that we have a way to go before we can declare victory on dental disease. We have solutions to prevent this disease; yet more than one in four Massachusetts children enters school with a history of dental decay. By approaching this issue with community and state-wide solutions – providing access to screenings, fluoride, sealants and other preventive measures - we can eliminate dental disease and give our children the healthy childhood that they deserve.

The full report details the status of homeless children in four areas: extent of child homelessness, child well-being, structural risk factors, and state-by-state policy and planning efforts.

“And dropping out of high school is no longer an option. It’s not just quitting on yourself, it’s quitting on your country – and this country needs and values the talents of every American.”
- President Barak Obama: February 24, 2009

President Barak Obama’s first address to Congress last night featured calls to action on a range of issues: energy, health care, government spending, economic responsibility, and education.

Particularly striking was his direct charge to young people, placing the responsibility for remaining in school and graduating directly on their shoulders.

Addressing the epidemic of high school dropouts is a laudable goal, one that echoes Governor Patrick’s call to cut the Massachusetts dropout rate in half by the end of his first term. But telling students that dropping out is no longer an option is not enough – for many students contemplating leaving school, there are daily struggles with mental health needs that make going to class incredibly difficult.

Some 8% (21,000) of Massachusetts teens are high school dropouts – of these young people, 50% failed to complete school because of mental health issues.

To effectively reduce the dropout rates, we must do better in providing resources to schools and assistance to students with mental health concerns.

As part of Chapter 321 of the Acts of 2008, the Children’s Mental Health bill, the Department of Elementary and Secondary Education has convened an interagency Task Force on Behavioral Health in the Schools, which is in the process of developing a plan to help schools and students with these needs. The Task Force has met twice so far, with plans to meet again in April.

Health Care For All and the Children’s Mental Health Campaign applauds the Patrick Administration for its diligence in this issue.

If the goals of Chapter 321 are realized only in respect to mental health resources for schools, Massachusetts will again be leading the way nationally in an important health arena.
Matt Noyes