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On Sept. 23, many changes to the nation’s healthcare system go into effect that will expand and improve access to health care for children.  As healthcare providers dedicated to the unique needs of children and sensitive to the impact these new guidelines will have on the quality and availability of care, St. Louis Children’s Hospital, SSM Cardinal Glennon Children’s Medical Center and Ranken Jordan – A Pediatric Specialty Hospital have teamed up to help families take advantage of this next phase of the Affordable Care Act.

“Caring for a sick child is already a tremendous responsibility that can take a physical and emotional toll on a family,” says Peggy Gordin, vice president of Patient Care Services at St. Louis Children’s Hospital. “If new provisions will provide families some relief by alleviating the financial toll, we are committed to helping our community take advantage of those opportunities.”

SSM Cardinal Glennon Children’s Medical Center, St. Louis Children’s Hospital and Ranken Jordan Pediatric Specialty Hospital all treat children regardless of the family’s ability to pay.             

“The elimination of lifetime caps will make a tremendous difference for children,” says Dr. Heidi Sallee, an SSM Cardinal Glennon pediatrician and professor at Saint Louis University School of Medicine. “Doctors now are able to do so much for children to save their lives and enhance their quality of life. Children with serious problems are living longer, and they need their insurance benefits to last longer. Lifetime caps on care create unnecessary stress and anxiety for families.”

The Humphreys family of Elkville, Ill., has experienced the stress over lifetime caps first-hand. Cardinal Glennon patient Jaxon, 3, has hemophilia, a bleeding disorder that requires frequent infusions. The family had not yet hit Jaxon’s lifetime limit, but mom Danelle had a nagging fear of the day coverage would run out.

“These changes will bring so much relief," Danelle says. "With the lifetime caps and pre-existing conditions going away, we won’t have to worry about it any longer.”

The Affordable Care Act was signed into law exactly six months ago, and will roll out in phases over the next four years. To help educate local families on how today’s changes will affect them, a consortium of St. Louis-area faith leaders, organizations, families and children’s hospitals decided to team up to share important information and perspective.

The benefits that take effect today include the following:

  • Insurance companies will not be allowed to deny a child coverage due to a pre-existing condition.
  • Insurance companies must allow young adults to remain on their parents’ policies until they are 26 years old.
  • Insurance companies may not cancel policies after an individual gets sick (except in cases where fraud is committed).
  • New group health plans cannot charge co-pays or deductibles for preventive care.
  • Lifetime limits are banned; new plans may not include annual limits.

In addition to the changes that take place on Sept. 23, other groups have already begun implementing new guidelines. For example, small businesses are now receiving tax credits to help pay for health insurance for their employees.  Senior citizens who fall into the coverage gap for prescriptions have begun receiving checks to help them pay for their medications.  And adults with pre-existing conditions have the option of enrolling in a new federally funded temporary high risk pool.

Cardinal Glennon has state benefits counselors on site to help eligible families enroll in Medicaid.

There are more than 100,000 children in Missouri who are eligible for this insurance, but not yet enrolled. 

For more information on the Affordable Care Act, visit HealthCare.gov.

 


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