Transcript Slide 1

CHIPRA
Performance
Bonuses
for Medicaid
National Covering Kids & Families Network
Webinar – February 22, 2010
Tricia Brooks
The Performance Bonus
• To reward states
for (and help
offset the cost
of ) enrolling
low-income
children in
Medicaid
FFY 09 Bonus Awards
Performance Bonus - The Basics
• Enrollment Targets
• Cumulative over time
• Medicaid only
• Eligibility as of July 1, 2008
• Enrollment & Retention
Measures
• At least 5 of 8
• Apply to both Medicaid and CHIP
• Exception - premium assistance
The Bonus
• The Bonus
• 15% state share of cost for
enrollment > target
• 62.5% state share of cost for
enrollment > 110% target
• How can it be used?
• Cannot be used to draw down
federal match
• Otherwise, not restricted
What Have We Learned
from Guidance?
Enrollment Targets
Adjusted by increase or decrease in child population!
2007
• Base Year
• Mo. Ave
Enrollment
2010 2012
• +/- %
Change in
Child Pop
• + 3.5% per
year
2008
2013 2015
• +/- %
Change in
Child Pop
• + 4%
• +/- %
Change in
Child Pop
• + 3% per
year
2009
• +/- %
Change in
Child Pop
• + 4%
2016+
• +/- %
Change in
Child Pop
• + 2% per
year
12-Month Continuous Eligibility
• Guarantees 12-months of coverage regardless
of changes except these:
• Child moves out of state, ages out or passes away
• Voluntary request for disenrollment
• Is determined eligible and enrolled in Medicaid
with no gap in coverage
• Nonpayment of premium (temporarily allowed
pending further guidance)
• 22 states have continuous eligibility in both
programs; 8 more in CHIP alone
• 8 of the P/B states got credit
The Straight Forward Measures
• No asset test or administrative verification
of assets
• 48 states have eliminated the asset test
• All 9 P/B states got credit
• No in-person interview required at
enrollment or renewal
• 48 states require no face-to-face interview for
both programs at enrollment, 50 at renewal
• All 9 P/B states got credit
Same Application and
Renewal Forms and Procedures
• Interchangeable forms are OK (“no wrong
door” forms)
• Form generates referral to other program
• Supplemental forms to request information for
one program is only allowed if there is a difference
in Federal program rules
• Information verification process
• Procedure for verifying all eligibility criteria must
be the same
• Timeline for verifying information must be the
same
How Do States Fare on Joint Forms
and Same Verification Process?
• States that implemented CHIP as a Medicaid
expansion would qualify automatically (12)
• No specific source of information available to
determine precisely which states could qualify
•
•
•
•
48 states have a joint application
31 states have a joint renewal form
Same verification process is harder to assess
All 9 P/B states got credit
Administrative Renewals
or Ex Parte Renewals
• Administrative verification of income is central
to this measure
• 16 States do so in both programs, 3 in CHIP alone
• 8 P/B states got credit
• Administrative renewals
• Send preprinted form with eligibility information
• Include notice that coverage will be renewed
unless state receives other information
• Signature and return of form to confirm desire to
maintain coverage is allowed
• State verifies eligibility using electronic/other
means
Administrative Renewals
or Ex Parte Renewals
• Ex Parte renewals
• State makes a redetermination to the maximum
extent possible using information available to it
• References SMD Letter 4/22/97
• Can’t close Medicaid due to loss of eligibility for cash
assistance; must review other eligibility categories, use
information in SDX or BENDEX
• Further guidance coming with regulations
Presumptive Eligibility
• Allows states to use trained, qualified entities
to make preliminary determination pending
the formal eligibility process
• Ensures that kids get services while completing
the process
• May include hospitals, community health centers,
WIC, HeadStart and other programs receiving
federal funds
• 11 states currently meet this requirement; 3 have
PE in Medicaid only
• 4 P/B states received credit
Express Lane Eligibility
• Guidance issued separate from P/B
• Requires State Plan Amendment (SPA) that:
• Details the ELE agency
• Identifies if it applies to new applications,
renewals or both
• Describes which screen and enroll process is used
• 6 states have submitted ELE SPA’s
• Not clear if it applies to both programs
• No state got credit this year due to timing
Premium Assistance Programs
• Only measure that requires implementation in
either Medicaid or CHIP
• Must be one of the new premium assistance
programs enacted through CHIPRA
• Medicaid 1906A
• CHIPRA 2105(c)(10)
• 1 State has picked up new premium assistance
option
• No P/B state received credit
FFY 10 Performance Bonus
• If legislation is required for
1 of the 8 measures, it
must be enacted by
October 1, 2009
• Measure would need to be
in place for at least 6
months or on April 1, 2010 and remain in
place through September 30, 2010
Next Steps
• Regulations will provide more
detail
• Opportunity to comment on
proposed regulations before
final adoption
• President’s budget anticipates increase to
$240 million in FFY 11
Inquiring Minds Want to Know
• Are there ways to
make the performance
bonuses more
accessible?
• Phased in
implementation?
• Targets that recognize
states with low uninsured rates?
• Year-to-year targets not based on cumulative gains?
• How can advocates best engage to encourage
states to qualify?
Contact Information
Tricia Brooks
Senior Fellow
Georgetown University Center for
Children and Families
[email protected]
http://ccf.georgetown.edu/
http://www.theccfblog.org/
202-365-9148