Covering All Kids Workshop

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Information about Covering All Kids Workshop

Published on October 19, 2007

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

National Academy for State Health Policy 20 th Annual State Health Policy Conference Covering All Kids Workshop October 16, 2007 Washington State Department of Social & Health Services Roger Gantz, Director Legislative & Policy Health and Recovery Services Administration Department of Social and Health Services State of Washington 623 8 th Avenue S.E. P.O. Box 45502 Olympia, Washington 98505-5502 (360) 725-1880 Email: [email_address]

Washington State Department of Social & Health Services Topics Washington’s Subsidized Coverage for Children Health Care Services for All Children (SSB 5093) Employer-Sponsored Insurance Program

Washington’s Subsidized Coverage for Children

Health Care Services for All Children (SSB 5093)

Employer-Sponsored Insurance Program

Washington State Department of Social & Health Services Washington State’s Subsidized Coverage for Children Washington has been a national leader in providing health coverage for children. August 1989 – Coverage for pregnant women and infants in families up to 185% FPL. January 1991 – Coverage for all children in families up to 100% FPL. January 1992 – Coverage for citizens converted to Medicaid and age increased to 19. January 1992 – Target fee increases for maternity services and children’s office visits. 1993 – Statewide implementation of Healthy Options (HO) managed care program – Coverage for non-SSI children, families and pregnant women. July 1994 – Coverage for citizen children increased to 200% FPL. February 2000 – SCHIP implemented with coverage to 250% FPL.

Washington has been a national leader in providing health coverage for children.

August 1989 – Coverage for pregnant women and infants in families up to 185% FPL.

January 1991 – Coverage for all children in families up to 100% FPL.

January 1992 – Coverage for citizens converted to Medicaid and age increased to 19.

January 1992 – Target fee increases for maternity services and children’s office visits.

1993 – Statewide implementation of Healthy Options (HO) managed care program – Coverage for non-SSI children, families and pregnant women.

July 1994 – Coverage for citizen children increased to 200% FPL.

February 2000 – SCHIP implemented with coverage to 250% FPL.

Washington State Department of Social & Health Services Washington State’s Subsidized Coverage for Children 100.0% 574,033 Total       2.3% 13,012 Basic Health Program       2.4% 14,037 Children's Health Program       1.8% 10,414 SCHIP       93.5% 536,569   0.4% 2,461 - Pregnant Women 3.1% 17,592 - Disabled Children 28.6% 164,079 - Family (TANF) Medical Program 61.4% 352,437 - Children's Medical Program     Medicaid %Total Number   State Subsidized Health Coverage (June 2007)

Washington State Department of Social & Health Services 2SSB 5093 (Health Care Services for Children) New consolidated health program for children - merges Medicaid, SCHIP and Children’s Health Program (CHP). Benefit design is full-scope Medicaid. Premiums for families with incomes above 200% of FPL ($41,300 for family of four). 12-month continuous eligibility coverage. July 22, 2007, state subsidized coverage available to all children in families up to 250% of FPL ($51,635 for family of four). Entitlement status. January 2009, state subsidized coverage expanded to 300% of FPL ($61,950 for family of four). Non-entitlement status. Families with higher incomes can buy coverage on a full-cost basis. Simplification of applications and renewal process, implementation of new on-line application process. Develop performance measures. Beginning in calendar year 2009, targeted provider rate increases to be linked to quality improvement measures. $63 million for SFY 2008-09 to cover 38,500 new children, including $4.4 million for new targeted outreach and health education. Pediatric services increased 48% (approx 90% of commercial) to support medical home.

New consolidated health program for children - merges Medicaid, SCHIP and Children’s Health Program (CHP).

Benefit design is full-scope Medicaid. Premiums for families with incomes above 200% of FPL ($41,300 for family of four). 12-month continuous eligibility coverage.

July 22, 2007, state subsidized coverage available to all children in families up to 250% of FPL ($51,635 for family of four). Entitlement status.

January 2009, state subsidized coverage expanded to 300% of FPL ($61,950 for family of four). Non-entitlement status. Families with higher incomes can buy coverage on a full-cost basis.

Simplification of applications and renewal process, implementation of new on-line application process.

Develop performance measures. Beginning in calendar year 2009, targeted provider rate increases to be linked to quality improvement measures.

$63 million for SFY 2008-09 to cover 38,500 new children, including $4.4 million for new targeted outreach and health education.

Pediatric services increased 48% (approx 90% of commercial) to support medical home.

Washington State Department of Social & Health Services 2SSB 5093 (Health Care Services for Children) Drop headline: Text text Text text

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Washington State Department of Social & Health Services Medicaid Employer-Sponsored Insurance Program Washington’s Medicaid employer-sponsored insurance (ESI) program is a voluntary program. 1 ESI eligibility – Medicaid-eligible, no other premium assistance, and not eligible for Medicare or state’s Basic Health Program. Person enrolled in ESI if they have access to employer-sponsored insurance and it is cost effective. Cost effectiveness guideline: employee’s premium contribution compared to age/gender adjusted Medicaid per-capita cost. ESI program directly reimburses family for employee’s premium contribution for family member covered through ESI, and not the employer. Medicaid covers wraparound services not covered by employer coverage. Point-of-service cost-sharing also covered. Pilot Medicaid employer-sponsored insurance (ESI) program implemented September 2004. Full program began July 2005. June 07 enrollment – 2,000, approx. 95% of ESI clients are children. 1 Pilot implemented under authority of Section 1906 of the Social Security Act.

Washington’s Medicaid employer-sponsored insurance (ESI) program is a voluntary program. 1

ESI eligibility – Medicaid-eligible, no other premium assistance, and not eligible for Medicare or state’s Basic Health Program.

Person enrolled in ESI if they have access to employer-sponsored insurance and it is cost effective.

Cost effectiveness guideline: employee’s premium contribution compared to age/gender adjusted Medicaid per-capita cost.

ESI program directly reimburses family for employee’s premium contribution for family member covered through ESI, and not the employer.

Medicaid covers wraparound services not covered by employer coverage. Point-of-service cost-sharing also covered.

Pilot Medicaid employer-sponsored insurance (ESI) program implemented September 2004. Full program began July 2005.

June 07 enrollment – 2,000, approx. 95% of ESI clients are children.

Washington State Department of Social & Health Services Medicaid Employer-Sponsored Insurance Program

Washington State Department of Social & Health Services Medicaid Employer-Sponsored Insurance Program Revisions to support ESI Enrollment 2007 state legislation requiring state regulated health insurance coverage to allow for Medicaid clients to enroll in employer-sponsored health plan without regard to any open enrollment restrictions (2SSB 5093, Sec. 7 and E2SSB 5930, Sec. 24) (Note: Neither ESSB 5930 or existing Medicaid law preempts ERISA) 2007 legislation requiring families, to extent permitted under federal law, to enroll in available employer-sponsored insurance as a condition of eligibility for Medicaid (2SSB 5093, Sec.2(4)). ESI has begun sending information to new Medicaid clients upon enrollment. Marketing to employers about ESI program.

Revisions to support ESI Enrollment

2007 state legislation requiring state regulated health insurance coverage to allow for Medicaid clients to enroll in employer-sponsored health plan without regard to any open enrollment restrictions (2SSB 5093, Sec. 7 and E2SSB 5930, Sec. 24)

(Note: Neither ESSB 5930 or existing Medicaid law preempts ERISA)

2007 legislation requiring families, to extent permitted under federal law, to enroll in available employer-sponsored insurance as a condition of eligibility for Medicaid (2SSB 5093, Sec.2(4)).

ESI has begun sending information to new Medicaid clients upon enrollment.

Marketing to employers about ESI program.

Washington State Department of Social & Health Services Medicaid Employer-Sponsored Insurance Program ESI Program Contact Norma Leavitt, Program Manager Employer Sponsored Insurance Program Department of Social and Health Services Health and Recovery Services Administration P.O. Box 45518 Olympia, Washington 98504-5518 Telephone: 1-800-794-4360, ext. 51355 FAX: 1-877-893-3810 E-Mail: [email_address]

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