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America’s Youngest Outcasts

November 19, 2014 Comments off

America’s Youngest Outcasts
Source: National Center on Family Homelessness

America’s Youngest Outcasts documents the number of homeless children in every state, their well-being, their risk for child homelessness, and state level planning and policy efforts. Using findings from numerous sources that include well-established national data sets as well as our own research, we rank the states in four domains, and then develop a composite of these domains to rank the states from 1 (best) to 50 (worst). A page about the District of Columbia is also available.

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HHS OIG — CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services

November 18, 2014 Comments off

CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services
Source: U.S. Department of Health and Human Services, Office of Inspector General

Summary

WHY WE DID THIS STUDY
In a 2010 report entitled Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services, OEI-05-08-00520, OIG found that children enrolled in Medicaid were not receiving all required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings. In addition, OIG also found that children who received medical screenings were not receiving complete medical screenings. The 2010 OIG report recommended improvements in both areas. CMS concurred, or partially concurred, with the recommendations. This memorandum report describes the steps that CMS has taken since the OIG’s 2010 report to encourage children’s participation in EPSDT screenings and to ensure that providers deliver complete medical screenings.

HOW WE DID THIS STUDY
We conducted structured interviews with the CMS staff responsible for EPSDT and four representatives from a national workgroup that CMS created to address EPSDT issues. We also reviewed documents provided by CMS or workgroup representatives, including informational bulletins, strategy guides, Web seminars, and workgroup reports. In addition, we reviewed States’ reports on EPSDT participation from 2006-2013, as well as the national aggregate reports for those same years.

WHAT WE FOUND
We found that CMS has taken actions toward encouraging participation in EPSDT screenings and toward encouraging the delivery of all components of medical screenings, but that it has not fully addressed OIG’s recommendations. Further, we found that children’s participation in EPSDT medical screenings remained lower than established goals. Although the national participation ratio improved from 56 percent in 2006 to 63 percent in 2013, both ratios are below the Secretary’s goal of 80 percent participation.

Given the results of our review, OIG considers all four of the recommendations from the 2010 report to remain open. This report contains no new recommendations, but we reiterate the following recommendations from 2010: CMS should (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

ACA — The Family Glitch

November 14, 2014 Comments off

The Family Glitch
Source: Health Affairs

The Affordable Care Act’s (ACA’s) “family glitch” bears no relationship to the early technology deficiencies that dominated the news and plagued the rollout of healthcare.gov and the state-based Marketplaces. Instead, it refers to how some low-to-moderate-income families may be locked out of receiving financial assistance to purchase health coverage through the new health insurance Marketplaces.

Eligibility is not solely determined by income. It is also subject to whether a family has access to affordable employer-sponsored insurance. The problem is that the definition of “affordable”–for both an individual employee and a family–is based only on the cost of individual-only coverage and does not take into consideration the often significantly higher cost of a family plan.

This shortcoming is a trouble spot in how the ACA is being implemented. As its name clearly conveys, the law was intended to make coverage more affordable, and for millions of Americans, it has. Families caught up in this glitch, however, cannot qualify for premium tax credits to reduce the cost of a Marketplace plan or for cost-sharing reductions to lower their out-of-pocket payments for health services, even if the family cannot afford coverage otherwise.

While a large number of children in these families are eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP), spouses and some children will remain uninsured without a path to affordable insurance if the family glitch is not fixed. However, many more children could be affected if Congress does not act to extend funding for CHIP after the current appropriation ends in September 2015.

Health Outcomes in Young Adults From Foster Care and Economically Diverse Backgrounds

November 14, 2014 Comments off

Health Outcomes in Young Adults From Foster Care and Economically Diverse Backgrounds
Source: Pediatrics

BACKGROUND AND OBJECTIVES:
Foster youth have high rates of health problems in childhood. Little work has been done to determine whether they are similarly vulnerable to increased health problems once they transition to adulthood. We sought to prospectively evaluate the risk of cardiovascular risk factors and other chronic conditions among young adults formerly in foster care (FC) and young adults from economically insecure (EI) and economically secure (ES) backgrounds in the general population.

METHODS:
We used data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth (FC group; N = 596) and an age-matched sample from the National Longitudinal Study of Adolescent Health (EI and ES groups; N = 456 and 1461, respectively). After controlling for covariates, we performed multivariate regressions to evaluate health outcomes and care access by group at 2 time points (baseline at late adolescence, follow-up at 25–26 years).

RESULTS:
Data revealed a consistent pattern of graduated increase in odds of most health outcomes, progressing from ES to EI to FC groups. Health care access indicators were more variable; the FC group was most likely to report having Medicaid or no insurance but was least likely to report not getting needed care in the past year.

CONCLUSIONS:
Former foster youth appear to have a higher risk of multiple chronic health conditions, beyond that which is associated with economic insecurity. Findings may be relevant to policymakers and practitioners considering the implementation of extended insurance and foster care programs and interventions to reduce health disparities in young adulthood.

U.S. Preterm Birth Rate Hits Healthy People 2020 Goal Seven Years Early

November 14, 2014 Comments off

U.S. Preterm Birth Rate Hits Healthy People 2020 Goal Seven Years Early
Source: March of Dimes

The national preterm birth rate fell to 11.4 percent in 2013 – the lowest in 17 years — meeting the federal Healthy People 2020 goal seven years early. Despite this progress, the U.S. still received a “C” on the 7th annual March of Dimes Premature Birth Report Card because it fell short of the more-challenging 9.6 percent target set by the March of Dimes, the group said today.

Returning to the Nest: Debt and Parental Co-residence Among Young Adults

November 13, 2014 Comments off

Returning to the Nest: Debt and Parental Co-residence Among Young Adults (PDF)
Source: Federal Reserve Board

This paper examines the relationship between a young adults’ debt burden and the decision to co-reside with a parent. Using a quarterly panel of young adults’ credit histories, and controlling for age, county, and quarter fixed effects, and local demographic characteristics, unemployment rates, and house prices, we estimate the relationship between current period debt and subsequent decisions to co-reside with a parent. Our results indicate that indebtedness–as measured by average loan balances, declining credit scores and delinquency on accounts–increases flows into parental co-residence. Moreover, after moving in, delinquency and low credit scores increase time spent in co-residence. We find that the changing debt portfolios of young adults over this period–characterized by rising student loan debt and small declines in credit card, auto and mortgage debt–can predict 30 percent of the observed increase in flows into co-residence, and 26 percent of the observed increase in time spent in co-residence.

Measuring National Well-being – Exploring the Well-being of Children in the UK, 2014

November 13, 2014 Comments off

Measuring National Well-being – Exploring the Well-being of Children in the UK, 2014
Source: Office for National Statistics

Children’s well-being is an important part of the nation’s well-being. In 2013, there were an estimated 12 million children aged 0 to 15, nearly a fifth of the UK population. Research from The Children’s Society has shown that a significant minority of UK children suffer from low well-being, which impacts on their childhood and life chances, and their families and communities (The Children’s Society, 2014).

Children’s well-being needs to be measured in a different way to adults. The framework for measuring national well-being puts indicators into 10 domains. Three domains (Governance, Natural Environment and Economy) are contextual and do not specifically relate to children’s well-being. The remaining 7 domains are consistent at all ages. To measure children’s well-being, the 7 domains have been adopted as a framework but have been populated with measures that reflect the aspects of children’s lives that are important to them, and have the greatest effect on their well-being.

ONS has developed a provisional set of 31 headline measures of children’s well-being across the 7 domains. These include both objective and subjective measures in the domains of:

  • Personal well-being
  • Our relationships
  • Health
  • What we do
  • Where we live
  • Personal finance
  • Education and skills

In March 2014, ONS published a consultation on the first version of these measures. The consultation response was published in July 2014 and an updated set of measures will be published in 2015. This report presents estimates for 22 of the 31 measures of children’s well-being1. These estimates can be thought of as a baseline for children’s well-being. The report also considers how selected measures have changed over time or differ by gender, where this information is available.

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