Transcript Figure 0 Children’s Coverage: The Role of Medicaid & SCHIP Diane Rowland, Sc.D. Executive Vice President, Henry J.

Figure 0
Children’s Coverage: The Role of
Medicaid & SCHIP
Diane Rowland, Sc.D.
Executive Vice President,
Henry J. Kaiser Family Foundation
and
Executive Director,
Kaiser Commission on Medicaid and the Uninsured
for
Alliance for Health Reform
Washington, DC
February 2, 2009
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 1
Health Insurance Coverage of
Children, 2007
Private NonGroup
4%
EmployerSponsored
Coverage
55%
Medicaid/ Other
Public
29%
Uninsured
11%
78.6 Million Children
NOTES: Data may not total 100% due to rounding. Children includes all individuals
under age 19.
SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute
analysis of 2008 ASEC Supplement to the CPS.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 2
Growing Medicaid and SCHIP Enrollment of
Children, FY 1998 – FY 2005
Medicaid
SCHIP
Millions of Children
28.3
27.8
27.3
25.5
21.8
20.9
20.7
.7
1998
23.4
2.0
1999
3.4
2000
4.6
2001
5.4
2002
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute
analysis of HCFA-2082, MSIS, and SEDS data, 2007.
6.0
2003
6.1
2004
6.1
2005
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 3
Children’s Access to Care,
by Health Insurance Status, 2007
Employer/Other Private
Medicaid/Other Public
Uninsured
32%
28%
24%
18%
17%
13%
3% 4%
No Usual
Souce of
Care
2% 3%
1% 2%
Postponed Needed Care
Seeking Care but Did Not
Due to Cost* Get it Due to
Cost*
13%
3% 3%
Last MD
Contact >2
Years Ago
12%
4%
6%
Unmet Dental Last Dental
Need Due to Visit >2 Years
Cost*
Ago
* In the past 12 months
Questions about dental care were analyzed for children age 2-17. Respondents who said usual source of care was the emergency
room were included among those not having a usual source of care.
K A I S E R C O M M I S S I O N O N
SOURCE: KCMU analysis of 2007 NHIS data.
Medicaid and the Uninsured
Figure 4
Key Differences Between Medicaid and SCHIP
in Children’s Coverage
Medicaid
SCHIP
Enrolled
28.3 million
6.1 million
Coverage
Required for newborns to age 6 up to
133% FPL and 6-19 at 100% FPL with
state option to go above
Above Medicaid levels
(44 states ≥ 200% FPL)
Entitlement
To Beneficiaries and States
To States
Financing
Guaranteed Federal Match
Capped Financing
Enrollment
Caps
Not permitted
Permitted
Matching Rate
Regular Match Rate (average 57%)
Enhanced Match Rate
(average 70%)
Scope of
Coverage
Option to impose benchmark benefits,
EPSDT Wrap-Around Coverage
Benchmark Benefits, no
mandate for EPSDT
Cost-Sharing
and Premiums
Generally, not allowed for mandatory
Permitted but limited
children; premiums allowed >150% FPLK A I S E R C O M M I S S I O
N O N
Medicaid and the Uninsured
Figure 5
Median Medicaid/SCHIP Income Eligibility Thresholds
for Children, Pregnant Women and Parents,
January 2009
Percent of Poverty
200%
185%
Federal Poverty Line
for a family of three
($17,600 per year in 2008)
68%
41%
Children
Pregnant
Women
Working
Parents
Jobless Parents
K A I S E R C O M M I S S I O N O N
SOURCE: Based on a national survey conducted by the Center on Budget
and Policy Priorities for KCMU, 2009.
Medicaid and the Uninsured
Figure 6
Children’s Eligibility for Medicaid/SCHIP by Income,
January 2009
NH
VT
WA
MT
ND
MA
MN
OR
ID
NY
SD
WI
RI
MI
WY
PA
IA
NE
NV
ILIL
UT
CA
ME
CO
OH
IN
WV
DE
VA
KS
MO
KY
NC
TN
OK
AZ
NM
AK
MD
DC
SC
AR
MS
TX
CT
NJ
AL
GA
LA
FL
HI
< 200% FPL (7 states)
*The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year.
***IL uses state funds to cover children above 200% FPL.; MA uses state funds to
cover children above 300% FPL; NY uses state funds to cover children from 250%
to 400% FPL; WI uses state funds to cover children from 250% to 300% FPL.
SOURCE: Based on a national survey conducted by the Center on
Budget and Policy Priorities for KCMU, 2009.
200-250% FPL (33 states)
>250% FPL (11 states & DC)
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured
Figure 7
Simplifying Enrollment and Renewal:
Strategies States are Using in Children’s
Health Coverage Programs, Jan 09
Number of States:
49
No Interview at Renewal
48
No Interview at Application
46
No Asset Test
45
12-month Renewal Period
18
12-month Continuous Eligibility
Presumptive Eligibility in Medicaid
Administrative Verification
14
11
K A I S E R C O M M I S S I O N O N
SOURCE: Based on a national survey conducted by the Center
on Budget and Policy Priorities for KCMU, 2009.
Medicaid and the Uninsured
Figure 8
The Nonelderly Uninsured,
by Age and Income Groups, 2007
<200% FPL
Children
14%
Parents
17%
200% FPL +
Children
6%
Parents
8%
Adults without
Children
21%
Adults without
Children
35%
Total = 45.0 million uninsured
Low-income includes those with family incomes less than 200% of the federal
poverty level.
SOURCE: KCMU/Urban Institute analysis of March 2008 CPS.
K A I S E R C O M M I S S I O N O N
Medicaid and the Uninsured