The Future of CHIP and Children s Coverage under the Affordable Care Act

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1 The Future of CHIP and Children s Coverage under the Affordable Care Act National Health Policy Forum November 1, 2013 Catherine Hess Managing Director for Coverage and Access

2 Children s coverage is a success story! 2 5 P e r c e n t o f C h i l d r e n u n d e r % F P L w i t h o u t H e a l t h I n s u r a n c e U n d e r a g e 1 9 f r o m P e r c e n t o f U n i n s u r e d C h i l d r e n Y e a r Source: U.S. Census Bureau, Current Population Survey Annual Social and Economic Supplement, Income, Poverty, and Health Insurance Coverage,

3 ACA could further reduce children s uninsurance Source: Kenney, Genevieve, et al. Improving Coverage for Children Under Health Reform will Require Maintaining Current Eligibility Standards for Medicaid and CHIP. Health Affairs. (December 2011) 3

4 But there also are challenges for children s coverage under the ACA, in Outreach and Consumer Assistance Eligibility and Enrollment Affordability Provider Access Appropriate Benefits 4

5 OUTREACH & CONSUMER ASSISTANCE Key Policy Issues and Potential Strategies for States 5

6 Key Policy Issues for States Coordinating new consumer assistance such as navigators with existing assisters for Medicaid and CHIP Families with complex coverage scenarios Immigration status Varying family structure Differing program eligibility requirements 6

7 Potential State Options and Strategies Leverage assets and lessons learned from CHIP and Medicaid Targeted outreach efforts Relationships with community-based organizations Coordinate efforts to target whole families Allay concerns related to immigration status 7

8 ELIGIBILITY & ENROLLMENT Key Policy Issues and Potential Strategies for States 8

9 Key Policy Issues for States ACA raises Medicaid eligibility for youth ages 6-19 from 100% to 133% FPL 18 states must transition over 500k children ACA limits S-CHIP waiting periods to 90 days and requires exceptions Individuals near 133% FPL are especially prone to changes in eligibility 9

10 Potential State Options and Strategies Move 6-19 year olds into Medicaid before 2014 or explore options to delay or phase this transition Shorten or eliminate waiting periods, or allow for additional exclusions Strategies to minimize the harm of churn Continuous eligibility Administrative renewals Ex-parte renewals Express Lane Eligibility Maintain a robust consumer assistance program 10

11 AFFORDABILITY Key Policy Issues and Potential Strategies for States 11

12 Key Policy Issues for States Family Affordability Glitch Premium Stacking Affordability of stand-alone dental plans Tax credits may not be sufficient Separate annual out-of-pocket limit on costsharing Cost-sharing reductions do not apply 12

13 Potential State Options and Strategies Address premium stacking Waive or eliminate CHIP or Medicaid premiums for families facing premium stacking Provide families with a combined statement, incorporating all costs and minus any tax credits Ensure affordable dental options Consider options for embedding dental in future coverage years 13

14 PROVIDER ACCESS Key Policy Issues and Potential Strategies for States 14

15 Key Policy Issues for States Low reimbursement rates and limited access to providers in Medicaid Ensuring appropriate provider networks for children in the marketplace Maintaining plan/provider continuity between CHIP, Medicaid, and QHPs for children churning between programs 15

16 Potential State Options and Strategies Align QHP provider networks and/or health plans with Medicaid and CHIP Consider a bridge plan a Medicaid managed care plan certified as a QHP Allow children transitioning to QHPs to temporarily see non-network providers to ease transitions 16

17 APPROPRIATE BENEFITS Key Policy Issues and Potential Strategies for States 17

18 Key Policy Issues for States Defining benefits to meet children s unique needs Pediatric services, including dental and vision Habilitative services Ensuring consistent benefits as children and families transition across programs 18

19 Potential State Options and Strategies Use CHIP or Medicaid benefits to guide QHP benefit design Align QHP benefit packages with CHIP and Medicaid Encourage the purchase of dental benefits For example, design virtual prompt in enrollment portal when family attempts to purchase coverage without dental 19

20 CHIP Benefits: Preliminary Findings from a Forthcoming Study by NASHP & the Center for Children and Families Almost a third of 38 separate CHIP programs benefits look like Medicaid s Over two-thirds of separate programs, or about half of all states, have different packages All separate programs with packages different from Medicaid cover these optional benefits: Physical, occupational and speech therapy Durable medical equipment Mental health services 20

21 CHIP Benefits: Preliminary Findings from a Forthcoming Study by NASHP & the Center for Children and Families Most separate programs with different packages from Medicaid also cover with limits Corrective lenses and hearing aids Chiropractic and podiatry services Almost all 38 separate CHIP programs require cost sharing (not exceeding 5% family income) Most but not all require premiums or co-pays 21

22 Keeping Children s Coverage Strong: Four Key Considerations 1. We need to maintain the gains, 2. And resolve the uncertainties. 3. State flexibility remains key, 4. As does continued support for Medicaid and CHIP. Themes from NASHP 2012 publication Keeping Children s Coverage Strong in the Context of the Affordable Care Act: Perspectives from State Children s Health Insurance Leaders 22

23 Conclusion Children s coverage is a success story we want to build on and learn from There are many complexities to be worked through in implementing new coverage options and how they will work for children and families We need to keep children s coverage strong while we work out new systems 23

24 For more information Catherine Hess: Follow us on 24