Worth Noting States Say Need for Citizenship Proof Denies Medicaid to Eligible Citizens A federal law enacted in 2005 that requires states to obtain documentary evidence of U.S. citizenship or nationality from Medicaid applicants and current beneficiaries is turning out to be a barrier to Medicaid for many eligible citizens, according to a review of state experiences by the U.S. Government Accountability Office (GAO). Two aspects of the law seem to be causing the most problems: the documents provided have to be originals, and the list of acceptable documents is complex and doesn't allow for any exceptions. Previous to enactment of the law, applicants for Medicaid could simply self-claim citizenship and nationality. The new requirements were expected to save money by preventing ineligible noncitizens from receiving Medicaid. Twenty-two of the 44 states that responded to a GAO questionnaire confirmed they have experienced declines in Medicaid enrollment as the result of the citizenship requirement, and a majority of those states said a lot of people "who appeared to be eligible citizens" lost Medicaid because they were unable to come up with the necessary documents. The federal National Institute of Child Health and Human Development (NICHD) is inviting comments and suggestions on the National Children's Study, a long-term study of child health in the United States that will follow 100,000 children from birth to age 21, to examine the effects of environmental exposure and gene-environment interactions. Since a focus of the study is to assess effects of exposures that occur early in pregnancy, enrollment in the first four years will include pregnant women and their partners, couples planning pregnancy, and women with some probability of becoming pregnant. The study will then look at the impacts of environmental exposures at specific stages in the children's development. Information about the study is available at www.nationalchildrensstudy.gov and procedures for commenting are at website www.nationalchildrensstudy.gov/research/research_plan/index.cfm. The highest rates of sports- and recreation-related traumatic brain injuries are incurred by children between the ages of 5 and 18, according to the Centers for Disease Prevention and Control (CDC). In a report in Morbidity and Mortality Weekly (MMWR), the CDC points out that an estimated 65 percent of emergency department visits for sports- and recreation-related traumatic brain injuries are by persons in that age group. The CDC also notes that persons in the age group are at increased risk of concussion and for long-term effects, delayed recovery, and cumulative consequences of multiple traumatic brain injuries, including depression and dementia. The report, "Nonfatal Traumatic Brain Injuries from Sports and Recreation Activities," appears in Morbidity and Mortality Report for July 27, 2007, at www.cdc.gov/mmwr. The following information appeared during the months of June and July 2007 in the News Alerts section of the website of the Center for Health and Health Care in Schools, at www.healthinschools.org. The Office of Population Affairs in the U.S. Department of Health and Human Services announced yesterday that it expects to make approximately $81.1 million available for Title X family planning grants to public or nonprofit agencies in 21 specified states or population areas in fiscal year 2008. As in previous years, the grants may not be used for programs in which abortion is a method of family planning, and grantees must provide counseling to minors on how to resist efforts to coerce them into sexual activities. Recipients of grants are also required to conform to state laws requiring them to report child abuse, child molestation, sexual abuse, rape, or incest. Program priorities for 2008 include services to individual from low-income families and require that grantees assure access to a broad range of "acceptable and effective" family planning methods and related preventive health services, including "natural family planning methods; infertility services and services for adolescents; highly effective contraceptive methods; breast and cervical cancer screening and preventive services; STD and HIV prevention education, counseling, testing, and referral; and adolescent abstinence counseling. The announcement of 2008 program priorities appears in the Federal Register for June 11, 2007, which can be accessed at wais.access.gpo.gov. June 14, 2007 The Kellogg Company said today it is changing "what and how" it markets to children between the ages of six and twelve, using "nutrient criteria"that set an upper threshold per serving of no more than 200 calories, 2 grams of saturated fat, zero grams of trans fat, 230 milligrams of sodium, and 12 grams of sugar. The new criteria will apply to advertising on TV, radio, and the Internet, as well as in print, and include in-school marketing, the company said. The change will require reformulation of some products to meet the nutrient criteria, and products that do not make the cut will not be marketed to children under 12 by the end of 2008, according to a press statement. The company also announced that beginning later this year, consumers will see Guideline Daily Amounts on the front of ready-to-eat cereal packages in the United States, Canada, and Mexico. In the U.S., new packaging will feature a label on the top, right-hand corner of cereal boxes, identifying percentages of calories, total fat, sodium, and grams of sugar per serving. The labels will also identify nutrients Americans need to consume more of, including fiber, calcium, potassium, magnesium, and vitamins A, C, and E. Kellogg brands include Kelloggs, Keebler, Pop-Tarts, Eggo, Cheez-It, Nutri-Grain, Special K, Rice Krispies, Murray, Austin, Morningstar Farms, Famous Amos, Carr's, Plantation, Ready Crust, and Kashi. June 14, 2007 The U.S. Department of Health and Human Services (HHS) said today it has awarded contracts to two U.S. manufacturers to retrofit their influenza vaccine manufacturing facilities and set up "warm-base" operations in which the factories will be active year-round. The grants to sanofi pasteur, who makes an inactivated egg-based vaccine, and MedImmune, who makes a live, attenuated vaccine also based on eggs, will expand U.S. pandemic vaccine manufacturing capacity by 16 percent and will afford year-round production of pre-pandemic influenza vaccines for the national stockpile, the HHS said. A pandemic preparedness plan issued in 2005 calls for stockpiling enough vaccine to vaccinate 20 million persons in critical workforce positions at the onset of a pandemic, with "surge"manufacturing capacity capable of providing vaccine for another 300 million persons within six months of the beginning of a pandemic. New York State Governor Eliot Spitzer announced today that the state is awarding $13.2 million in grants to health care institutions that have agreed to sponsor health centers in schools. "School-based clinics are an innovative way of ensuring that children receive quality health care," Spitzer said. "These clinics provide easy access to health care professionals for checkups and treatment without missing classes and without parents needing time off from work. This is especially important for children who need routine treatment for asthma, diabetes, and other chronic conditions." The New York school-based health center program was established in 1981 and is now the largest program of its kind in the nation, with approximately 190,000 children accessing centers at 197 schools each year. The grants announced today range in size from more than $1 million to Lutheran Health Center in New York City to the smallest grant--$9,942—to a sponsor in the western part of the state. As they do every year, advocates for more federal spending to research and cure both forms of diabetes—type 1, formerly known as "juvenile diabetes" and type 2, formerly known as "adult onset diabetes"—brought a Children's Congress made up of young diabetes patients to Capitol Hill this week, for a conference and congressional testimony sponsored largely by Novo Nordisk, manufacturer of insulin products and delivery devices such as the insulin pen. In a fact sheet on diabetes mellitus. Novo Nordisk pointed out that diabetes is a chronic disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy. People who have diabetes have high levels of sugar in their blood, and untreated diabetes can lead to health complications, including heart disease and stroke, kidney disease, high blood pressure, blindness, nerve problems, and amputations. Currently, an estimated 20.8 million people, or 7 percent of the population, have diabetes in the United States, according to the fact sheet, and 6.2 million of them remain undiagnosed and are not being treated. Nearly two-thirds of people diagnosed with type 2 diabetes are not successfully managing the condition, exceeding the recommended sugar levels and putting themselves at risk for complications. "The incidence of diabetes is growing rapidly among children: more than 13,000 young people are diagnosed with type 1 each year,"the fact sheet points out, "and health care providers are finding more and more children with type 2 diabetes—a disease usually diagnosed in adults aged 40 years or older." Treatments for type 1 diabetes, in which the pancreas does not make insulin and insulin shots are required to use glucose from meals, include rapid-acting or "bolus"insulin taken after eating and long-acting or "basal"insulin that provides a steady amount of insulin for up to 24 hours. Persons with type 2 diabetes are usually treated with medication and urged to adopt a healthful eating and exercise program, but most will eventually require insulin. More information about both types of diabetes is available at the American Diabetes Association website, www.diabetes.org. June 22, 2007 Legislation introduced in the U.S. Senate June 20 would allow states to make school-based health centers (SBHCs) eligible for reimbursement under Medicaid and the State Children's Health Insurance Program (SCHIP) for comprehensive health and mental health services provided to children and adolescents who are enrolled in Medicaid and SCHIP. The bill, S. 1669, introduced by Senator Debbie Stabenow (D-MI) and five co-sponsors, would amend the Social Security Act to make SBHCs eligible entities under the two federal programs that insure children and adolescents whose families are unable to afford private health insurance. Under the proposed legislation, states would be able to pay under Medicaid and SCHIP for "covered items and services" furnished by school-based health centers that deliver primary pediatric and mental health services. The bill, Healthy Schools Act of 2007, can be read and tracked at http://thomas.loc.gov. July 5, 2007 It was the last of the common childhood diseases to be prevented by vaccination, and since a varicella vaccine was introduced in 1995, there has been a marked reduction from the estimated 4 million cases of chicken pox that occurred annually in the United States. Initially recommended by the Advisory Committee on Immunization Practices (ACIP) for administration to healthy children aged up to 12 months, and to previously unvaccinated adolescents and adults, the vaccine seemed to be highly effective, but increasing reports of outbreaks of chicken pox among highly vaccinated populations have caused the ACIP to upgrade its recommendations. The most recent suggestions, published June 22 in the CDC publication Morbidity and Mortality Weekly Report (MMWR), note that in the 10-year observation period, comparisons of one-dose and two-dose regimens showed onset of chicken pox after vaccination was more likely when children and adolescents were given just one dose of the vaccine. That is leading the ACIP to recommend that infants and young children be given two doses, one at 12 to 15 months of age and another at 4 to 6 years. For adults and adolescents, two doses 4 to 8 weeks apart are now recommended for all adolescents and adults that have no evidence of immunity, with a catch-up of two doses for persons who received the previously recommended one catch-up dose. Varicella vaccination is now recommended for children attending child care centers, students in all grade levels, and persons attending college or other postsecondary education institutions. The report, "Prevention of Varicella," dated June 22, 2007, is available online at www.cdc.gov/mmwr. July 9, 2007 As the U.S. Congress returns from a Fourth of July break and settles down for the July/August session, major debate is expected on whether to continue and expand the State Children's Health Insurance Program (SCHIP), which provides health insurance to children in families too poor to buy private insurance but too well off to be on Medicaid. The Bush administration in its 2008 budget proposed to continue SCHIP but to increase funding for the program by $5 billion over the next five years, which is the amount expected to be needed to keep the current number of children enrolled in SCHIP. Congressional Democrats have vowed, however, to authorize an increase of $50 billion more for the program over the next five years, which would allow for a major expansion of the number of children with health insurance. The administration and some Republicans in Congress oppose any major increase in SCHIP as an opening wedge for universal health coverage and have pledged to oppose the Democratic increase. For further information about SCHIP, see April 2007 E-Journal. July 19, 2007 President Bush said yesterday that he will veto an extension of the State Children's Health Insurance Program (SCHIP) if Congress sends him legislation increasing spending for SCHIP by $35 billion over the next five years. A Senate committee is recommending the $35 billion figure after scaling down a proposal for a $50 billion increase. The added funds would allow the program to expand SCHIP to more children, a move the Bush administration opposes on what the President described yesterday as "philosophical" grounds. The administration has said it regards expansion of SCHIP as a first step toward government-provided health insurance for all Americans. The SCHIP program, which was enacted 10 years ago, is due to expire this year unless Congress acts and the President agrees to reauthorize it. The program is intended to provide affordable health insurance to families too well off to qualify for Medicaid but not earning enough to buy private insurance. July 20, 2007 Four reports in the August 2007 issue of the Journal of the American Academy of Child and Adolescent Psychiatry discuss outcomes of various types of treatment for children with Attention Deficit Hyperactivity Disorder (ADHD). In an analysis of the studies released today, the National Institute of Mental Health in the National Institutes of Health reported improvement following ADHD treatment in most children. "We were struck by the remarkable improvement in symptoms and functioning across all treatment groups," said Dr. Peter Jensen of Columbia University, who led one of the studies. The studies found, however, that children treated in a variety of ways for ADHD were at higher than normal risk for behavioral problems such as delinquency and substance abuse. And although half to two-thirds of children in the treatment groups were taking medication for more than three years, the studies found continuing medication was no longer associated with better outcomes by the third year. One of the studies found that taking medication slowed growth in children, and although growth became normal in the third year of medication, children never made up for the earlier slowing. The studies, funded by the National Institute of Mental Health, expect to continue as the participating children go through adolescence and enter adulthood. States and school districts differ on whether all children should be tested for tuberculosis infection before they enter kindergarten, and an article in the July issue of the journal Pediatrics asks whether such universal testing is cost-effective. Using California as an example, researchers noted that public officials have made decisions about whether to require testing "based on the available evidence and local preferences. "A universal TST (tuberculosis skin test) is mandated as part of the screening component of the Early and Periodic Screening Diagnosis and Treatment (EPSDT) program, and the researchers note that routine skin testing of all children is still practiced in many parts of the United States. That's despite a recommendation by the Pediatric Tuberculosis Collaborative Group, which recommended in 2004 that universal TST should be replaced by "risk factor screening" based on responses to questions such as country of birth, travel history, exposure to TB, and close contact with someone with positive TST results. When they looked at the cost-effectiveness of universal versus targeted screening (in terms of the costs of full-blown tuberculosis to the health system), the researchers concluded that they "strongly support" the recommendations of the Pediatric Tuberculosis Group for discontinuing universal TST of children. The article, "Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry" appears in the July 2007 issue of the journal Pediatrics. July 27, 2007 The state of Texas is offering public and charter schools opportunity to apply for grants that will total $20 million overtwo years, to support physical education, nutrition, and fitness programs for middle school students attending schools where enrollment is at least 75 percent economically disadvantaged. The new Texas Fitness Now grant program will be administered by the Texas Education Agency, which will evaluate grant applications and award funds to schools. An estimated 700 schools are expected to qualify for grants of no less than $1,500 each. Described as part of the state's "continued fight against childhood obesity," the grant program is expected to benefit more than 270,000 students. |
