Transcript Slide 1
SCHIP 101:
Learning from 10 years of
Experience
Liz Arjun
State Health Policy Analyst
Center for Children and Families
Georgetown University Health Policy Institute
www.ccfgeorgetown.org
[email protected]
Tennessee First Focus Training
June 14, 2007
Overview
• SCHIP History and Successes
• Lessons Learned
• What’s Next?
Key Policy Ingredients of
Original SCHIP Legislation
• Block grant / No entitlement to coverage
• No mandates / State option with
“enhanced matching funds”
• Funds dedicated to NEW coverage
• Medicaid treated as the base off of which
states would build
• State flexibility to use Medicaid and/or a
separate state program with fewer federal
standards
SCHIP Enrollment, 1997-2004
(in millions)
State fiscal crisis and
extensive SCHIP cutbacks
(2002 – 2004)
51st state implements
SCHIP; enrollment
efforts are strong;
states pursue family
coverage waivers
(2000)
3.8
3.4
2.7
HIFA initiative allows
SCHIP funds to be
used for coverage of
childless adults
(2001)
3.9
3.9
$1.3 billion in
unspent SCHIP
funds lost
(2004)
1.8
SCHIP adopted
(August 1997)
0.9
1997
1998
1999
2000
2001
2002
Source: CCF; and enrollment data from Kaiser Commission on Medicaid and the Uninsured.
2003
2004
Trends in the Uninsured Rate of
Low-Income Children, 1997- 2005
Uninsured rate of low-income children under 19
22.3%
21.5%
20.1%
20.0%
18.0%
15.8%
1997
1998
1999
2000
Source: CCF analysis of National Health Interview Survey.
2001
2002
15.9%
2003
15.2%
14.9%
2004
2005
Percent of Poor and Near-Poor Children
with a Usual Place of Care
94.4%
Public
Private
Uninsured
92.8%
96.2%
95.5%
67.9%
61.2%
Poor Children*
Near-Poor Children*
*Poverty status is based on family income and family size using the U.S. Census Bureau poverty thresholds for 2002 Federal Poverty
Level (FPL) in 2002 in the 48 contiguous states and the District of Columbia is $15,020 for a family of three.
Source: National Health Interview Survey, 2003.
ESI Coverage Rates Have Declined for
Children and Adults
65.40%
60.80%
58.90%
55.40%
Children under 18
1999-2000
Working Adults
2004-2005
Source: Percent with employer-sponsored insurance from E. Gould, “Health Insurance Eroding for Working Families,” Economic
Policy Institute (September 2006).
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
26.3
27.8
2003
2004
4.6
21.0
21.4
21.6
21.9
22.6
25.5
1997
1998
1999
2000
2001
2002
Medicaid
32.3
SCHIP
Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.
Lessons Learned
• States will use SCHIP to respond to the
needs of families
• Administrative practices and policies make
a difference in enrollment and retention
• States need more tools, incentives and/or
requirements to finish the job
• States need additional funding to cover
uninsured children
Children’s Eligibility for Medicaid/SCHIP by
Income, May 2007
NH
VT
WA
MT
ND
MN
OR
ID
WI
RI
MI
WY
PA
IA
NE
NV
IL
CA
CO
KS
MO
AZ
NM
WV
DE
VA
MD
NC
DC
KY
SC
AR
MS
TX
CT
NJ
OH
IN
TN
OK
MA
NY
SD
UT
ME
AL
GA
LA
AK
FL
HI
> 200% FPL (18 states)
< 200% FPL (9 states)
200% FPL (24 states including DC)
Note: The Federal Poverty Line (FPL) for a family of three in 2007 is $17,170.
Source: Based on a national survey conducted by the Center on Budget and Policy Priorities for Kaiser Commission of Medicaid and
the Uninsured (2006), as updated by CCF.
Tennessee
Medicaid and SCHIP Income Eligibility Thresholds
for Children and Parents
Income Threshold as a Percent of the Federal Poverty Line
250%
250%
250%
185%
SCHIP
133%
100%
Medicaid
70%
Infants
Children
1-5
Children
6-19
Parents
Note: As of June 2007; income thresholds for non-working parents as of July 2006.
Children's Enrollment in Washington's Public
Insurance Programs,
April 2002-October 2005
650
645
640
April 2003:
State begins
income
verification
July 2003:
12-month continuous eligibility
ends; 6-month renewal cycle
replaces 12-month cycle
Thousands
635
630
625
January 2005:
Administrative
order to return to
12-month renewal
cycle and
establishes
continuous
eligibility policy
620
615
610
605
A
pr
-0
2
Ju
l-0
2
O
ct
-0
2
Ja
n03
A
pr
-0
3
Ju
l-0
3
O
ct
-0
3
Ja
n04
A
pr
-0
4
Ju
l-0
4
O
ct
-0
4
Ja
n05
A
pr
-0
5
Ju
l-0
5
O
ct
-0
5
600
Source: Washington State Department of Social and Health Services, 2005, updated 2006.
Enrollment in Louisiana's Medicaid Program
October 1998 - January 2005
700
June 2000:
Trained
workers
in new
philosophy
Thousands
650
600
June
2001:
Baseline
report re:
renewal
July 2001:
New renewal
procedures: calls
re: renewal forms
not returned, “ex-parte”
for LaChip
550
May 2000:
“Reasonable
certainty”
standard
500
July 2000:
“Ex-Parte”
renewal
for children
losing cash
benefits
450
October 2003:
Telephone
renewals, rolling
renewals
March 2003:
“Reasonable
certainty” for
renewal
400
350
5
4
-0
4
n0
Ja
O
ct
l-0
Ju
4
r-0
4
Ap
n0
Ja
3
-0
3
O
ct
l-0
Ju
r-0
3
3
Source: Louisiana Department of Health and Hospitals Monthly Enrollment Reports, 2005
Ap
2
-0
2
n0
Ja
O
ct
l-0
Ju
2
r-0
2
Ap
1
-0
1
n0
Ja
O
ct
l-0
Ju
1
r-0
1
Ap
n0
Ja
0
-0
0
O
ct
l-0
Ju
0
r-0
0
Ap
9
-9
9
n0
Ja
O
ct
l-9
Ju
9
r-9
9
Ap
n9
Ja
O
ct
-9
8
300
Medicaid & SCHIP are Reaching an
Increasing Share of Eligible Children
Participation Rate of Eligible Children in Medicaid & SCHIP
100%
82%
80%
74%
73%
68%
60%
48%
40%
20%
0%
1997
1999
2002
Medicaid
Source: L. Dubay analysis of 1997,1999,2002 National Survey of America’s Families.
1999
2002
SCHIP
Where Does Tennessee Stand?
Better Than the U.S. Average, But Worse Than Its Neighbors
Uninsured
Rate of All
Children
Participation in
Uninsured
Medicaid/SCHIP
Rate of LowAmong LowIncome
Income
Children
Children
U.S.
average
11.0%
17.9%
74.2%
Tennessee
9.4%
15.5%
77.6%
Alabama
5.5%
7.7%
88.8%
Arkansas
9.3%
11.2%
84.4%
Kentucky
7.8%
13.2%
80.9%
Missouri
7.9%
13.5%
81.4%
Source: CCF analysis of CPS 2005 and 2006 March Supplement (i.e., data from 04-05).
SCHIP Spending is Rapidly Outpacing
New Funds Being Made Available
(in billions)
$9.4
$8.8
$8.1
$7.6
$6.9
$6.4
$6.0
$5.1
$4.2
$4.2
$4.2
$4.3
$4.2
$4.1
$3.8
$3.1
$5.0
$5.0
$5.0
$5.0
$5.0
$5.0
$4.6
$3.2
$5.0
$3.2
$2.7
$1.9
$0.9
$0.1
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
SCHIP Spending
SCHIP Allotment
Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional
Research Service (October 2006); 2007-2012 spending data from CBO March 2007 SCHIP baseline (February 2007) includes
outlays plus additional SCHP spending required to maintain current programs.
With 9 Million Uninsured Children,
More Needs to Be Done
Children’s Health Care Coverage, 2005
• 88% have at least one
employed parent.
Medicaid/
SCHIP
25.9%
• Uninsured children are
disproportionately in the
South (43%) and West
(29%).
Uninsured
11.6%
Employerbased &
Other
62.5%
• A disproportionate share
(38%) of uninsured children
are Hispanic.
• 35% of uninsured children
live in families with incomes
below 100% FPL.
77.9 Million Children Under 19
Source: CCF analysis of CPS 2006 March Supplement; and Campaign for Children’s Health Care, No Shelter from the Storm:
America’s Uninsured Children (September 2006).
What Is Next for Children’s Health
Insurance?
• Most Uninsured Children are Eligible
• Recent Surge of Activity at the State-Level
Indicates States are Ready to Move
Forward
• Voters Strongly Support Efforts to Get
Children Covered
• SCHIP Reauthorization is Happening
7 out of 10 Uninsured Children are
Eligible But Unenrolled
49% are
Medicaid Eligible
19% are
SCHIP Eligible
Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules
States are Moving Forward
NH
VT
WA
MT
ME
ND
MN
OR
MA
NY
ID
SD
WI
RI
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
SC
AR
MS
TX
AK
DC
AL
GA
LA
FL
HI
Implemented or Recently Adopted
Legislation to Improve Children’s Coverage
(18 states and DC)
Considering Significant Proposal to
Improve Children’s Coverage (11 states)
Source: As of June 8, 2007 based on CCF review of state initiatives.
Key State Strategies
• Enrolling and retaining eligible children
• Increasing eligibility
• Integrating with private coverage
Americans Strongly Support
Covering Children
New York Times, March 2, 2007
Specific Policy Issues Emerging in
Reauthorization
• How much SCHIP funding will be available to
states?
– Overall Funding
– Formula: i.e. historical spending, number of uninsured
children, others
• Who will be covered?
–
–
–
–
Income range of children who can be covered
Treatment of adults covered with SCHIP funds
Refinancing of pre-SCHIP expansions
Special groups of children (legal immigrants, state
employees children)
Specific Policy Issues Emerging in
Reauthorization (continued)
• What kind of coverage or product will be provided?
– Pressure on benefit package (HSAs, vouchers)
– Efforts to strengthen benchmark standards
– Relationship to employer-based coverage (premium assistance)
• How do we reach eligible, but uninsured children?
–
–
–
–
Outreach funding and incentives
Helping states with the increased Medicaid costs
Express Lane and other tools
Administrative barriers such as citizenship documentation
requirement
• How do we pay for it?
Timeline for Congressional
Action??
Senate
Finance Senate
Committee Floor
Late
June
After
July 4
Note: These dates are all tentative
House
Energy
and
Commerce
Committee
July
House
Floor
Late
July
Conference
August
No
new funds
available
Sept
30