Transcript Document

CHIP Reauthorization:
New Opportunities for Moving Forward
Cindy Mann
Center for Children and Families
Georgetown University Health Policy Institute
http://ccf.georgetown.edu
Commonwealth Fund Leadership Forum on
Early Childhood Development
February 6, 2009
Public Programs’ Coverage Role Today
(Non-elderly, 2007)
Children = 78.6 million
Adults = 182.8 million
11%
20%
11%
29%
55%
63%
6%
4%
EmployerSponsored
Insurance
Uninsured
Medicaid/
Other Public
Individual
Coverage
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Income Levels of Uninsured, 2007
Children = 8.9 million
Adults = 36.1 million
15%
300% +
11%
15%
200-299%
25%
100-199%
29%
28%
70% below
200% FPL
42%
84% below
200% FPL
Under 100%
35%
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Impact of Unemployment Growth
on Medicaid and SCHIP
$3.4
1.0
1%
1.1
$1.4 State
=
Increase in National
Unemployment Rate
&
$2.0 Federal
Increase in
Medicaid &
SCHIP
Enrollment
(million)
Increase in
Uninsured
(million)
Increase in Medicaid &
SCHIP Spending
(billion)
Source: S.Dorn, et al.,”Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses,“ Kaiser Commission
on Medicaid and the Uninsured, April 2008. Note: a 1% increase in unemployment also equals a 3-4% decline in state revenues.
CHIPRA: Key Features
•
•
•
•
•
New funding levels and formula
New incentives to enroll Medicaid children
Eligibility changes
Benefit changes
Significant new emphasis on quality, access
Allotments Over Time
Source: Congressional Budget Office, “CBO’s Preliminary Estimate of the Effects on Direct Spending and Revenues of the Children’s Health
Insurance Program Reauthorization Act of 2009” (January 13, 2009; Congressional Budget Office, “Fact Sheet for CBO’s March 2008 Baseline:
State Children’s Health Insurance Program” (March 12, 2008); and Center for Children and Families analysis of historic allotments as reported in
the Federal Register.
New Formula Addresses “Mismatch” Under
Old Formula
Source: C. Peterson, “What Happens to SCHIP After March 31, 2009?,” Congressional Research Service (December 19, 2008)
CHIPRA: Key Features
•
•
•
•
•
New funding levels and formula
New incentives to enroll Medicaid children
Eligibility changes
Benefit changes
Significant new emphasis on quality, access
Coverage Gains Over the Past Decade
Have Come Equally from
Medicaid & SCHIP
Enrollment of Children in Public Coverage (Millions)
30.8
32.3
34.0
27.2
21.0
22.3
23.5
25.2
Source: Center for Children and Families analysis of preliminary data. Based on children ever-enrolled over the course of a year.
Children Currently Eligible but Unenrolled
9 Million Uninsured Children
4.4 Million are
Eligible for
Medicaid
1.7 Million
are Eligible
for SCHIP
Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules
Reaching the Eligible but Unenrolled
Children
Procedural closings in Louisiana:
< 1%
Source: LaCHIP/Medicaid Eligibility Division, La. Department of Health & Hospitals, September 2008
Performance Bonuses
Approximate Effective Medicaid Match
Rate for Additional Enrollment
Current Match Rate
Caseload Between
100-110% of Target
Caseload Above
110% of Target
50%
57.5%
81.25%
60%
66%
85%
70%
74.5%
88.75%
80%
83%
92.5%
CHIPRA: Key Features
•
•
•
•
•
New funding levels and formula
New incentives to enroll Medicaid children
Eligibility changes
Benefit changes
Significant new emphasis on quality, access
The Affordability Gap is Widening
Source: Center for Children and Families analysis of Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2008; and
the Federal Poverty Level for a family of three, 1999-2008, available: http://aspe.hhs.gov/poverty/figures-fed-reg.shtml.
Medicaid and SCHIP Eligibility
Levels for Children, January 2009
WA*
MT*
VT
ND
OR
MN
ID
WY
NV
UT
AZ
CO*
IL
OK*
TX
IN*
MO
PA
OH*
KY
WV*
TN
AR
MS
AL
VA
NJ
DE
MD
NC*
DC
RI
CT
SC
GA
LA*
FL
HI
< 200% FPL
(5 states)
MA
NY
IA*
KS*
NM
AK
ME
MI
NE
CA
WI
SD
NH
200% FPL
(16 states)
201%-250% FPL
(9 states)
> 250% FPL
(21 states)
Source: D. Cohen Ross, A. Horn, & C. Marks, “Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,”
Kaiser Commission on Medicaid and the Uninsured (January 2008);updated by the Center for Children and Families.
Note: States with asterisks (*) have enacted, but not yet implemented to the levels shown.
The “Welcome Mat” Effect
STATE
Total New
Enrollment
Previously
Eligible
Illinois
244,700
165,600 (68%)
Data from November 2005 - June 2008
Massachusetts
51,000
32,750
(64%)
11,000
(59%)
40,881
(83%)
Data from June 2006 - June 2008
Pennsylvania
19,000
Data from February 2007 - June 2008
Wisconsin
49,108
Data from February 2008 - May 2008
Source: Center for Children and Families, "Putting Out the Welcome Mat: Implications of Coverage Expansions for Already-Eligible
Children” (September 9, 2008).
CHIPRA Would Cover 4 Million Otherwise
Uninsured Children
4.1 Million Otherwise Uninsured Children
Children Newly Eligible
Through CHIP
Expansions
83% Eligible
Under
Current
Program
Rules
Uninsured Children
Already Eligible
Children Slated to Lose
Coverage at Current
Funding Levels
Source: CBO, January 16,2009. Note: Average monthly enrollment for fiscal year 2013.
CHIPRA: Key Features
•
•
•
•
•
New funding levels and formula
New incentives to enroll Medicaid children
Eligibility changes
Benefit changes
Significant new emphasis on quality, access
Benefits
•
•
•
•
Mental health parity
Dental coverage required
Supplemental dental coverage permitted
Clarification of “DRA” EPSDT provision
CHIPRA: Key Features
•
•
•
•
•
New funding levels and formula
New incentives to enroll Medicaid children
Eligibility changes
Benefit changes
Significant new emphasis on quality,
access
Quality Initiative
• Not limited to public program coverage
• Development of child health measures
addressing quality and stability; monitoring
and reports to Congress.
• New reporting from State Medicaid and CHIP
programs
• HHS to publish best practices; new
demonstration grants; funding for data
system upgrades
What’s Next?
State Budget Woes Worsening
WA
MT
VT
ND
OR
MN
ID
WY
NV
UT
AZ
MA
NY
IA
CO
IL
KS
OK
NM
TX
IN
MO
PA
OH
KY
WV
AR
AL
VA
NC
TN
MS
AK
ME
MI
NE
CA
WI
SD
NH
NJ
DE
MD
RI
CT
DC
SC
GA
LA
FL
HI
States with Shortfalls (47 states, including DC)
Source: E. McNichol and I. Lav, “State Budget Troubles Worsen,” Center on Budget and Policy Priorities (January 29, 2009). Note: includes states
with shortfalls in FY 2009 or projected shortfalls for FY 2010.
State Action on Children’s Health Coverage
2007-2008
WA
MT
VT
ND
OR
MN
ID
WY
NV
UT
AZ
MA
NY
IA
CO
IL
KS
OK
NM
IN
MO
TX
HI
PA
OH
KY
WV
AR
AL
VA
NC
TN
MS
AK
ME
MI
NE
CA
WI
SD
NH
NJ
DE
MD
RI
CT
DC
SC
GA
LA
FL
Enacted New Legislation/Took
Administrative Action to Improve
Children’s Coverage (10 states)
Implemented 2007 Legislation to
Improve Children’s Coverage
(15 states)
Source: As of September 17, 2008 based on a review by the Center for Children and Families of state initiatives in 2007 and
2008.
Take Aways
• FMAP increase could change the landscape
• Significantly increased allotments; shortfalls
should be averted.
Take Aways
• Incentive effect of new allotment formula
• Incentive effect of performance bonus
payments
• New opportunity for federal match for
covering legal immigrant children/pregnant
women
State Covering Legal Immigrant Children
WA
MT
VT
ND
OR
MN
ID
WY
NV
UT
AZ
MA
NY
IA
CO
IL
KS
OK
NM
TX
PA
OH
IN
MO
KY
WV
AR
AL
VA
NC
TN
MS
AK
ME
MI
NE
CA
WI
SD
NH
NJ
DE
MD
RI
CT
DC
SC
GA
LA
FL
HI
States Covering Legal Immigrant Children Not
Eligible for Federal Funds (23 states, including DC)
Source: National Immigration Law Center, “Guide to Immigrant Eligibility for Federal Programs” (December 2007); updated by the Center for
Children and Families.
Take Aways
• New data and reporting on enrollment and
quality
• Quality measures and demos