Congress has allowed the Children’s Health Insurance Program (CHIP), which insures 9 million children in the United States, to expire. The program provided coverage for children in families making under 200% Federal Poverty Level (FPL) as well as to pregnant women. CHIP played a huge part in decreasing the rate of uninsured children from 14% in 1997 to 4.5% in 2015. By taking no action to renew the program before September 30, 2017 the U.S. Congress allowed the program to lose future funding, putting millions of American children at risk of major health complications from ordinarily treatable conditions.

CHIP covers comprehensive coverage for children, including routine check-ups, immunizations, doctor visits, prescriptions, dental and vision care, inpatient and outpatient hospital care, laboratory and x-ray services, and emergency services. The out-of-pocket costs are different depending on which state a family is living in, but they will not exceed 5% of a family’s annual income. For the

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Here at NeedyMeds we regularly refer people to their state’s Medicaid program, and in today’s blog post we are going to explain exactly what Medicaid is and how it functions. Are you currently enrolled in Medicaid? Share your experience with us in the comments section.

How is it Financed?

Medicaid, sometimes called Medical Assistance, is a joint federal and state entitlement program for people with limited income that helps to pay for medical costs. It receives a combination of funding from both the state and federal government. The amount paid to each state by the federal government, also known as the Federal Medical Assistance Percentage or FMAP, varies depending on multiple criteria, notably per capita income. From Medicaid.gov,The regular average state FMAP is 57%, but ranges from 50% in wealthier states up to 75% in states with lower per capita incomes. FMAPs are

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We’ve been getting a lot of questions from our readers about how the resources we list on our website, especially the pharmaceutical patient assistance programs, will be affected by the Affordable Care Act. While we are still far away from having all the answers, we do have some additional information we can provide you after attending a recent PAP Conference. The overarching consensus is that PAPs will continue to exist to help those in need that fall into the gaps.  Here is an overview of what we learned at the CBI PAP 2014 Conference, held in Baltimore on March 6-7.

Background

→ There are currently no shared processes between programs.

→ Open Enrollment ends March 31st

  • Negative image of Affordable Care Act in the media.
  • For those working with the disabled – visit the National Disability Navigator Resource Collaborative for resources http://www.nationaldisabilitynavigator.org.
  • Many advocates are having trouble enrolling the population that has been uninsured for a long time, as they are not informed about how health insurance works at all.

→ Medicaid Donut Hole

  • In the states that have not expanded Medicaid, there are going to be folks too poor to be eligible for subsidies under the marketplace and not poor enough to qualify for Medicaid in their states.

→ Not everyone between 100% and 400% of Federal Poverty Level are eligible for subsidies. This, for example, can depend on age.

Pharma Priorities and Considerations

→ Priorities are to contain costs, increase quality, encourage innovation while enhancing patient access.

→ Legal Considerations.

  • Anti-kickback statute – always a legal issue for companies. Pharmaceutical companies cannot induce (or even appear to induce) patients to use a certain drug.
  • November 2013
    • HHS Secretary Kathleen Sebelius wrote a letter saying that plans purchased on a state or federally run market place are not counted as government sponsored programs.
    • Absent further guidance – these plans are going to be treated as private plans by Patient Assistance Programs (PAPs), foundations, etc.

    → Lingering question – what happens when someone doesn’t pay or defaults on their premium? There is currently a grace period to

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The Children’s Health Insurance Program (or CHIP) is a national program available in every state. Many families find themselves above the income limit to be eligible for Medicaid but still unable to afford health insurance. CHIP aims to assist these families in getting healthcare coverage by providing children under the age of 19 whose family income is too high to qualify for Medicaid with health insurance at low or no cost. The program is available throughout the nation but requirements vary by state, and the program goes by various names as well. The income limits vary by state and range from as low as 175% of the Federal Poverty Level (FPL) to as high as 300% of the FPL. States operate CHIP as either an expansion of Medicaid, a separate program entirely, or as some combination of the two.

Financing

  Signed into law in 1997, CHIP is funded jointly by the federal government and individual states. The federal government matches a percentage of the amount each state funds. This percentage is

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For today’s blog post we would like to share with our readers some fantastic online healthcare resources. There are many websites out there dedicated to healthcare, some great and some not-so-great. Here are four resources that the staff at NeedyMeds think you will find helpful.

Together Rx Access – Together Rx Access provides a number of different resources for patients and healthcare professionals alike. They have partnered with a number of the nation’s leading pharmaceutical companies to offer a free drug discount card program for those without prescription drug coverage. Furthermore, their website has extensive articles on the Affordable Care Act and healthcare reform as well as a “Better Health” section with articles and insights on how to maintain a healthy lifestyle. They also have an entire “Resources For Professionals” section with information for patient advocates and other healthcare professionals.

Consumer Reports Best Buy Drugs – Consumer Reports is a non-profit

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