Transcript SCHIP: Coming of Age or Stuck in Adolescence?

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
www.ccfgeorgetown.edu
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
WA
MT
ME
ND
MN
OR
MA
NY
ID
SD
WI
MI
WY
CT
PA
NJ
IA
OH
NE
NV
IL IL
UT
CA
CO
MO
KS
IN
DE
WV
VA
MD
KY
NC
TN
OK
NM
AZ
TX
DC
SC
AR
MS
AK
RI
AL
GA
LA
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
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
600,000
84% Eligible
Under
Current
Program
Rules
2,500,000
700,000
Children Newly Eligible
Through SCHIP
Expansions
Uninsured
Children Already
Eligible
Children Currently in SCHIP
Who Could Lose Coverage
Ne w Children's Enrollment in SCHIP & M edicaid
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
Income
Current flexibility constrained
• Medicaid match for States covering
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
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
How?
Performance
Bonus Payments
Based on:
• # of children covered (eligible as of 7/07)
• Medicaid v. SCHIP
• average per capita cost
Must adopt 4 out of 7 designated policies
New options
Citizenship documentation
“Express Lane”
Outreach
Grants
Higher match for translation services
Coverage Gains Over the Past Decade
Have Come Equally from
Medicaid & SCHIP
Enrollment of Children in Public Coverage (Millions)
30.8
21.0
23.5
22.3
25.2
1.9 3.3
0.9
27.2
34.0
6.2
5.3
6.0
25.5
26.3
27.8
2002
2003
2004
4.6
21.0
21.4
21.6
21.9
22.6
1997
1998
1999
2000
2001
Medicaid
32.3
SCHIP
Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.
CHIPRA: Other Populations
No new waivers
Parents
Financing moved to separate allotment in 2010
Enhanced match through 2010
“Remap” beginning in 2011 if certain conditions met
Childless Adults
No new waivers (DRA)
Funding moved to separate allotment in 2009
Regular (Medicaid) match in 2009 only for
grandfathered individuals
Possible Medicaid waiver (for grandfathered
individuals) after 2009
Pregnant
Women
SCHIP option
CHIPRA: Benefits & Quality
Dental Care
Required
Mental Health
Not required, but “benchmark”
parity
Quality Initiatives
Development of measures and
reporting standards
CHIPRA: Public/Private Integration
Premium
Assistance Option
At least 40% Er contribution
Voluntary for state/family
New Tools
State may require ERs to provide info on
benefits
Child with CHIP/Medicaid must be allowed to
enroll in ESI (if offered), regardless of open
enrollment periods
Other
Employer buy-in option
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
5.8 Million Children
Children Who
Otherwise
Would Have
Had Coverage
2
Otherwise
Uninsured
Children
3.8
“I think (the Senate Finance
Committee) approach is pretty
much as efficient as you can
possibly get per new dollar
spent to get a reduction of
roughly 4 million uninsured
children.”
Peter Orszag,
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
Family Pre mium
2001
2002
2003
2004
2005
Federal Poverty Le vel
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
150,000
400%+ FPL
21.2%
340,000
200-399% FPL
47.5%
220,000
<200% FPL
31.3%
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
200% FPL
91.3%
8.7%
Above
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+