Transcript Slide 1

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Impact of Texas’ Eligibility System Changes
on CHIP and Medicaid
80th Texas Legislature
House Committee on Human Services
February 23, 2007
Anne Dunkelberg, Associate Director
([email protected] )
900 Lydia Street - Austin, Texas 78702
Phone (512) 320-0222 – fax (512) 320-0227 - www.cppp.org
Center for Public Policy Priorities
www.cppp.org
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CHIP and Medicaid: Helping Texas Kids
As of February 2007:
• 1.77 million Texas children (under age 19) were enrolled in Medicaid
•
•
•
•
about 100,700 of these children get Medicaid because of a serious disability
About 122,000 in TANF cash assistance families (7% of the kids)
About 12,700 pregnant teens (less than 1% of the children)
Other 1.53 MILLION predominantly in WORKING poor families
• 325,479 Texas children were enrolled in CHIP.
“CHIP stands on the broad shoulders of Medicaid”
That’s 2.09 million Texas children –
nearly one-third of all our kids.
Center for Public Policy Priorities
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Income Caps for Texas Medicaid and CHIP, 2006
250%
200%
$21,708
$30,710/yr $30,710/yr
$22,078/yr
150%
100%
$16,600
$33,200
222%
200%
Long
Term
Care
CHIP
$7,476
185% 185%
133%
50%
100%
$2,256
$3,696
13.6% 22.3%
74%
0%
Pregnant Newborns Age 1-6 Age 6-18 TANF Working SSI (aged
Women
parent of Parent of
or
2, no
2
disabled)
income
Mandatory
Optional
Income Limit as Percentage of Federal Poverty Income
Annual Income is for a family of 3,
except Individual Incomes shown for SSI and Long Term Care
Center for Public Policy Priorities
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Texas Kids’ Uninsured Rate Drops,
Thanks to CHIP and Medicaid
BEFORE CHIP and streamlined Children’s Medicaid
In 1997, When Congress created the CHIP Block Grant, U.S. Census
estimated that:
• 24%-25% of Texas children were uninsured (about 1.4 million children),
– and over three quarters (76%) of these were in families at or below 200% FPL.
•
There were about 5.95 million Texas children (under age 19).
SINCE CHIP and Streamlined Children’s Medicaid:
• 20.4% of Texas children under age 19 (1.37 million) are uninsured
– just over two-thirds (68%) are in families below 200% FPL.
•
There are about 6.6 million Texas children (under age 19).
Texas CHIP and streamlined children’s Medicaid have provided
health coverage for about 1 million more Texas children.
Uninsured Texas children below 200% FPL have dropped from 35%
to 29% (kids potentially served by children's Medicaid and CHIP) .
Center for Public Policy Priorities
www.cppp.org
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2006: Tough Year for Children’s Medicaid and CHIP
CHIP
• CHIP rolls had declined every month since September 2003, but in 2006 the
rate of monthly decline more than tripled, compared to 2005.
•
CHIP enrollment in February 2007 is just above December 2005, with no
growth trend established yet.
Children’s Medicaid
•
Children’s Medicaid had grown steadily since 1999, though recent growth
was slow & steady -- reflective of population growth.
•
Medicaid had not experienced more than 2 consecutive months of declining
child enrollment since the days of welfare reform, when parents leaving
welfare were not told that their children could still receive Medicaid coverage.
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In 2006, children’s Medicaid rolls have declined for 7 out of 12 months.
•
Drop of over 118,000 children statewide from December 2005 to October
2006 caused alarm.
•
Children in Medicaid as of February 2006 remains more than 68,995 below
the December 2005 caseload, a decline of 3.8%.
Center for Public Policy Priorities
www.cppp.org
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Texas Child Medicaid Enrollment
(February 2001-February 2007)
Simplified Enrollment
begins
High:
1,838,239
1,900,000
now:
1,769,244
1,600,000
1,300,000
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Source: Texas Health and Human Services Commission
Center for Public Policy Priorities
www.cppp.org
Average Monthly Enrollment Growth for Texas Children
in Medicaid, FY 2001 – FY 2007*
2.2%
Simplification
of application
and renewals
Rolled back some
simplification
measures
1.4%
0.8%
0.7%
0.2%
Change in
Enrollment:
FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007
-0.16% -0.13%
68,189
285,584
280,594
122,402
67,084
-35,679
-15,058
*FY 2007 YTD; Avg. annual TX child population growth rate 1.2% (2001-2004)
Source: CPPP analysis of Texas Health and Human Services Commission data
Center for Public Policy Priorities
www.cppp.org
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Texas CHIP Enrollment
(May 2000-February 2007)
Highest, 5/02:
529,271
600,000
9/03:
507,259
2/07:
325,479
400,000
200,000
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Source: All figures from Texas Health and Human Services Commission;
Compares most recent month with September 2003
Center for Public Policy Priorities
www.cppp.org
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Texas Child Medicaid and CHIP Enrollment
6.5
Enrollment (millions)
5.5
Estimated child population growth
of almost 70,000 per year
2.5
4.5
Sept. ’03:
2,150,543
3.5
2.0
2.5
Combined CHIP/Child
Medicaid Enrollment
Feb. ’07:
2,094,723
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1.5
1.5
Child population (millions)
3.0
Sources: Enrollment from Texas Health and Human Services Commission;
Texas State Demographer's 0-17 Population Estimates
Center for Public Policy Priorities
www.cppp.org
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Why Children’s Medicaid & CHIP Dropped in ‘06
•
Fall 2005: State staffing shortages in HHSC eligibility offices hit critical
levels, due to worker anticipation of Integrated Eligibility job losses and the
October 2005 announcement of positions to be eliminated (~100 workers
leave per month from 10/05 to 7/06);
•
November 2005: Transition from original private CHIP eligibility contractor
to the new contractor which was in charge of the entire Integrated Eligibility
project;
•
November 2005-January 2006: HHSC imposed a range of CHIP policy
and processing changes which
– complicated the contractor transition,
– materially changed the process for parents,
– were implemented without prior outreach or education for CHIP families,
and without advance consultation with CHIP health plans or contracted
CBOs; and………
Center for Public Policy Priorities
www.cppp.org
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Why Children’s Medicaid & CHIP Dropped in ‘06
• December 2005: Operations by the new CHIP/Integrated Eligibility
contractor marked by errors due to multiple problems & failures of
various contractor computer systems, and heavy reliance on
untrained entry-level private workers.
• January 2006: The same problems with the new contractor also
created problems for Medicaid clients of all ages in Travis and Hays
counties, where Integrated Eligibility is first piloted. These problems
were compounded by continued problems with TIERS, the computer
system the state has been developing for years to replace SAVERR
and support Integrated Eligibility.
• Multi-layered sources of these troubles naturally suggests that fixing
the current woes will also require a multi-faceted approach.
Center for Public Policy Priorities
www.cppp.org
Focus on Children’s Medicaid Decline
Medicaid drop caused by factors in both the Public and the Private
components of the eligibility system:
•
Inadequate state staffing levels resulted in long delays in processing new
applications as well as renewals,
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–
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Confusion: HHSC originally announced that all new children’s Medicaid
applications would be processed by the contractor.
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resulting in automated closures of cases up for renewal, despite parents having
returned all required information.
These problems persist, with state “timeliness” ratings well below the minimum
standards required under federal law.
Even though HHSC reversed that decision early in the year, for several months
workers in some parts of the state continued to instruct parents to send their
applications to the contractor, causing many to be delayed or even lost entirely.
Finally, even if Medicaid applications had not been misdirected to the
contractor, the CHIP (and Integrated Eligibility) contractor would still have
had a major impact on children’s Medicaid enrollment, because it:
1.
2.
processes a major stream of new Medicaid applications, and
is responsible for moving children from CHIP to Medicaid every month.
HHSC CHIP statistics show the average number of children on CHIP
moving directly to Medicaid every month was 6,800 in fiscal year 2003 and
7,800 in 2004.
Center for Public Policy Priorities
www.cppp.org
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Focus on CHIP Process Problems
CHIP Contractor had multiple Computer & Training Woes:
Contractor staff did not understand CHIP or Medicaid program rules, thus:
– Did not understand when they had a complete application; and
– Asked thousands of parents for “missing information” that was irrelevant to their
child’s case;
– Delayed or closed renewal cases, and “timed out” applications, over information
that never should have been requested.
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Parents submitted the same “missing information” multiple times, yet the
data never got linked to their child’s record.
•
Parents submitted enrollment fees, checks cleared, but their child’s case
was not credited and their coverage was dropped.
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CHIP HMOs received inaccurate and incomplete electronic enrollment files
from contractor.
Results: Renewal rates plummeted.
•
– Renewal rates 9/03 to 11/05 averaged 78%, but for 5 months from 1/06 to5/06
averaged just 54%
– Rates understate the decline somewhat: the actual NUMBER of CHILDREN
renewing successfully every month in calendar 2005 was over 33,000 per month;
from January 2006 to present dropped to under 25,000 per month
– Last 5 months have seen improved renewal rates and numbers, but upward
trend not yet established.
Center for Public Policy Priorities
www.cppp.org
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Focus on CHIP Process
• Parents received nonsensical letters demanding payments and
documents by deadlines months in the past.
• Contractor staff were (are still?) unable to locate missing information
that families have provided – even though received and scanned
into their system -- causing delays and case closures for “failure” to
submit info.
• Applications are not transferred from Medicaid to CHIP (and vice
versa) in a timely manner, causing serious delays in renewals and
applications, even though children’s Medicaid and CHIP have used
a joint application since 2001;
• Children with serious and chronic health care conditions – whose
parents are extraordinarily conscientious and attentive to details –
have been being wrongfully cut from CHIP and Medicaid coverage
through no fault of their own.
Center for Public Policy Priorities
www.cppp.org
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Devante Johnson, age 13
Diagnosis: Advanced Cancer of the Kidneys
•Mother submitted renewal 2
months before Medicaid expiration.
•Medicaid renewal sat for 6 weeks
without processing.
•Devante determined eligible for
CHIP - application transferred to
CHIP Contractor.
•Paperwork was lost in the system
and despite numerous calls and
faxes, Devante’s mother was
unable to track the application.
•State Representative intervened
to restore coverage.
Center for Public Policy Priorities
www.cppp.org
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• Devante is now being
•
•
treated at MD Anderson in
Houston.
When he lost coverage, he
could not receive regular
treatment and relied on
clinical trials for care.
Eligible child was uninsured
for 4 months while tumors
grew.
Center for Public Policy Priorities
www.cppp.org
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Rohrer Family
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•
Tried for 5 months to apply for CHIP without success.
CDF intervened to get the children covered in September 2006.
Matt suffers from manic depression and ADHD and his sister
Tasha suffers repeated fractures due to a brittle bone condition.
Paid $50 premium in September, more than the $35 required.
On October 25th, received a letter requesting they pay their
premium by July 17th or the children would lose coverage.
Center for Public Policy Priorities
www.cppp.org
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The Insure Texas Kids Campaign and the Texas CHIP Coalition
urge the following plan of action for the 80th Texas Legislature:
Cut the number of uninsured Texas kids in half by enrolling every eligible child
in CHIP and Medicaid
• Implement 12 months continuous eligibility for CHIP and
Children’s Medicaid
• Eliminate bureaucratic roadblocks to encourage personal
responsibility and help low income families achieve selfsufficiency:
– Fix problems with the Integrated Eligibility System to prevent
eligible kids from losing CHIP and Medicaid coverage
– Eliminate the CHIP asset test
– Eliminate the CHIP 90 day delay of coverage for uninsured children
– Deduct childcare and child support expenses when calculating income
for CHIP
• Provide adequate reimbursement for Medicaid and CHIP
providers
• Invest in outreach and education to ensure that all eligible
children get the care that they need
Center for Public Policy Priorities
www.cppp.org
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We CAN fix problems with the Integrated
Eligibility System to prevent eligible kids
from losing CHIP and Medicaid coverage
•
Adequate numbers of state eligibility workers to process applications, renewals
within federal law timeframes –and preferably faster than that!
•
Zero tolerance for gaps in coverage when kids move from Medicaid to CHIP, or
CHIP to Medicaid.
More improvement needed in CHIP contractor performance: prompt processing,
eliminate staff policy errors, fix ongoing computer problems.
Set high performance standards in both the public and private systems to try to
minimize “missing info” requests, eliminate “procedural” denials, and raise renewal
rates.
•
•
In Louisiana:
– children’s Medicaid/CHIP cases closed for failure to return renewal forms
dropped from 17% to 2%,
– renewal rates increased to 92%, and
– children with gaps in Medicaid-CHIP coverage reduced from 18% to 6% over
2 years.
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www.cppp.org
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Additonal Texas Medicaid & CHIP
Background Information
Center for Public Policy Priorities
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22
Adult Medicaid Trends - Statewide
Dec-05
Feb-07
Dec 05 to
Feb. 07
Change
Aged and
Disabled
687,177
721,062
33,885
4.9%
Cash
Assistance
31,876
24,288
-7,588
-23.8%
Maternity
93,617
93,063
-554
-0.6%
Other
Parents
64,656
55,901
-8,755
-13.5%
893,470
895,371
1,901
+0.2%
Total
•CAVEAT: Travis and Hays Medicaid enrollment DECLINED for adults,
including aged and disabled (-2.2% Travis; -6.9% Hays) from December 2005
to February 2007. (Numbers may be flawed.)
•Points to problems with the IE&E pilot and TIERS
Center for Public Policy Priorities
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Most Kids who lose Medicaid or CHIP are
Uninsured Afterwards
The 12/2004 independent ICHP disenrollment report found:
– 52% of kids leaving CHIP remained uninsured.
– of the 47% who got coverage later, 31% went to Medicaid and only
11% got employer-sponsored insurance (ESI)
New ICHP studies of children losing CHIP or children’s
Medicaid in 2006 found:
– only 28% of kids who lost CHIP (and 24% of kids losing Medicaid)
had any kind of health coverage afterwards, and
– only 19% (i.e., about two-thirds of the 28%) moved to Medicaid.
Center for Public Policy Priorities
www.cppp.org
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HHSC Eligibility Division is responsible for
Contracts with Community Based Organizations to
do outreach and education
• Responsible parents need help understanding the complexity
of the health care system--what care is available for children,
and what the parents’ responsibilities are in enrolling and
accessing that care.
• Ongoing outreach and assistance programs are vital to
connecting children with a medical home and keeping them
healthy.
• The Coalition applauds HHSC’s recent marketing and public
education efforts to inform families about the availability of
children’s Medicaid and CHIP. These initiatives also educate
families about the importance of keeping their children
enrolled, and inform them about how to effectively and
appropriately use health care services.
Center for Public Policy Priorities
www.cppp.org
Invest in outreach and education to ensure that
all eligible children get the care that they need
• Texas should leverage this marketing spending by preserving and
expanding the role of Community-Based Organizations in outreach and
education, proven effective in the CHIP-building years.
• In 2002-2003, community-based organization (CBOs) outreach was
funded at $6.1 million, and direct marketing at $3.8 million.
• April 2006 HHSC announced $3 million in marketing of
CHIP/children’s Medicaid.
• HHSC has announced $3.5 million contract, but this will expand
CBOs’ responsibilities for outreach to approximately 2 million
adults, in addition to the 2 million+ children already targeted.
• We must ensure that funding for children’s insurance programs
continues at or above 2002 levels, and provide additional funding to
support the new CBO responsibilities.
• Special resources are needed to remedy the higher lost CHIP
enrollment among preschool children, and rural Texas children.
Center for Public Policy Priorities
www.cppp.org
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