CHIPRA: Just the Facts, PLEASE

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Information about CHIPRA: Just the Facts, PLEASE

Published on October 19, 2007

Author: nashp



Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author:

CHIPRA Just the Facts, PLEASE National Academy for State Health Policy October 2007 Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families

Achievements • Sharp decline in uninsured rate among low-income children • Coverage has let children secure the care they need • Cost effective

Second Consecutive Year of Rising Number of Uninsured Children 710,000 300,000 2005 2006 Uninsured rate Uninsured rate of 11.2% of 12.1% Source: Kaiser Commission for Medicaid and the Uninsured

States are Moving Forward NH VT ME WA MT ND MN MA OR NY ID SD WI MI RI CT WY PA NJ IA OH NE IN NV DE IL IL WV VA UT MD CO CA MO KS KY NC DC TN SC OK AR NM AZ GA AL MS TX LA AK FL HI Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC) Considering Significant Proposal to Improve Children’s Coverage (3 states) Source: As of September 25, 2007 based on CCF review of state initiatives.

But A Showdown Nonetheless Co Ho hite ng re e eW ss us Th

Key Elements • Eligibility for children • Incentives/options to cover children already eligible but unenrolled • Adult coverage • Benefits • Public/private

CHIPRA Is Projected to Cover Nearly 4 Million Otherwise Uninsured Children 3.8 Million Otherwise Uninsured Children Children Newly Eligible 600,000 Through SCHIP Expansions Uninsured 84% Eligible 2,500,000 Children Already Under Eligible Current Program Rules Children Currently in SCHIP 700,000 Who Could Lose Coverage New Children's Enrollment in SCHIP & Medicaid Note: Average monthly enrollment for fiscal year 2012; SCHIP & Medicaid would cover 5.8 million children when reductions in other coverage are included; numbers may not sum due to rounding. Source: CBO estimate of changes in SCHIP and Medicaid enrollment of children under the House Amendments to the Senate Amendments to H.R. 976, the Children’s Health Insurance Program Reauthorization Act of 2007 (September 24, 2007).

CHIPRA: Children’s Eligibility Current flexibility constrained • Medicaid match for States covering Income children over 300% in the future • August 17th directive replaced by new rules that take effect in 2010 Immigration status No change State employees No change Age No change

CHIPRA Targets Children Currently Eligible but Unenrolled 9 Million Uninsured Children 4.4 Million are 1.7 Million Eligible for are Eligible Medicaid for SCHIP Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

How? Based on: • # of children covered (eligible as of 7/07) Performance • Medicaid v. SCHIP Bonus Payments • average per capita cost Must adopt 4 out of 7 designated policies Citizenship documentation New options “Express Lane” Grants Outreach Higher match for translation services

Coverage Gains Over the Past Decade Have Come Equally from Medicaid & SCHIP Enrollment of Children in Public Coverage (Millions) 34.0 32.3 30.8 27.2 6.2 25.2 6.0 5.3 23.5 22.3 21.0 4.6 1.9 3.3 0.9 27.8 26.3 25.5 22.6 21.9 21.6 21.4 21.0 1997 1998 1999 2000 2001 2002 2003 2004 Medicaid SCHIP Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.

CHIPRA: Other Populations No new waivers Financing moved to separate allotment in 2010 Parents Enhanced match through 2010 “Remap” beginning in 2011 if certain conditions met No new waivers (DRA) Funding moved to separate allotment in 2009 Regular (Medicaid) match in 2009 only for Childless Adults grandfathered individuals Possible Medicaid waiver (for grandfathered individuals) after 2009 Pregnant SCHIP option Women

CHIPRA: Benefits & Quality Dental Care Required Mental Health Not required, but “benchmark” parity Development of measures and Quality Initiatives reporting standards

CHIPRA: Public/Private Integration At least 40% Er contribution Premium Assistance Option Voluntary for state/family State may require ERs to provide info on benefits New Tools Child with CHIP/Medicaid must be allowed to enroll in ESI (if offered), regardless of open enrollment periods Employer buy-in option Other Child losing CHIP/Medicaid can enroll in ESI (if offered) regardless of open enrollment periods

Where Do We Go From Here?

White House Veto • WH proposed $4.8b in new federal funds • Favors “free competitive marketplace”/private coverage • Crowd out concern/income eligibility • Objection to offsets

Focus on Low-Income Uninsured Children Limits “Crowd Out” CHIPRA “I think (the Senate Finance 5.8 Million Children Committee) approach is pretty Children Who much as efficient as you can Otherwise 2 possibly get per new dollar Would Have Had Coverage spent to get a reduction of roughly 4 million uninsured children.” Otherwise 3.8 Peter Orszag, Uninsured Children CBO Director (July 19, 2007) Medicaid/SCHIP Enrollment Source: CBO Estimate of Changes in SCHIP and Medicaid in Enrollment of Children under CHIPRA 2007 (September 25,2007.

States Have Reasons for Moving Forward Growth in Family Insurance Premiums Compared to the Federal Poverty Level 120% 102.7% 100% 80% 60% 40% 24.0% 20% 0% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Family Premium Federal Poverty Level Note: This data represents the cumulative growth in employee premium contributions for employer-sponsored family health insurance and the cumulative growth in the federal poverty level for a family of three. Source: Agency for Healthcare Research and Quality estimates of 1996-2005 Medical Expenditure Panel Survey Insurance Component Tables, generated using MEPSnet/IC (August 21, 2007); and CCF analysis of 1996-2005 Federal Poverty Guidelines.

Distribution of the Increase in Uninsured Children, by Income, 2005-2006 21.2% 150,000 400%+ FPL 47.5% 340,000 200-399% FPL 31.3% 220,000 <200% FPL 710,000 Uninsured Children Source: Urban Institute for the Kaiser Commission on Medicaid and the Uninsured

Most Children Covered by SCHIP Have Family Incomes Below 200% FPL 6.7 million children enrolled in SCHIP, 2006 At or Below Above 8.7% 91.3% 200% FPL 200% FPL Note: The reporting classification of a child with family income above 200% FPL who Is determined to be eligible at or below 200% FPL due to deductions or disregards (I.e., a net income test) is up to the discretion of the state and constrained by their reporting systems. Source: CCF analysis using enrollment data from C. Peterson & E. Herz, Estimates of SCHIP Child Enrollees Up to 200% of Poverty, Above 200% of Poverty, and of SCHIP Adult Enrollees, Congressional Research Service (March 13, 2007).

A Wave of Support

Polling: America Wants a Strong Kids Coverage Bill 90%

Editorial Boards Nationwide 275+

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