Pennsylvania s CHIP Expansion to Cover All Uninsured Kids

Transcription

1 Pennsylvania s CHIP Expansion to Cover All Uninsured Kids

2 National Conference of State Legislatures October 4, 2007 George L. Hoover Deputy Insurance Commissioner Pennsylvania Insurance Department

3 PA A Leader In Children s Health Care Coverage 1993: PA CHIP began providing free and subsidized health insurance coverage to children of low-income families prior to federal SCHIP legislation implementation. - A waiting list was implemented. 1997: Federal SCHIP legislation enacted

4 PA A Leader In Children s Health Care Coverage May 1998 Pennsylvania s State Plan approved by CMS. Federal financial participation received for individuals in households with income no greater than 200% of the FPL. Eligibility for families with income from 200% to 235% of FPL available (state funds/family paid only). - No more waiting list.

5 Statistics of the Uninsured in PA PA Insurance Department identified the number of people in need of insurance and who they are by completing a state-specific study of the uninsured (2004) 900,000 Pennsylvanians (8% of population) do not have any type of health insurance coverage (includes adults and children). About 133,000 (4% of children) under age 19 do not have health insurance coverage. Most of these children are between the ages of 11 and 18. Reasons that these children do not have coverage: o Increasing health care costs for families o Lack of health care coverage with parents employers o People in transition -- between or without jobs

6 PA A Leader in Children s Health Care Coverage October 2006: PA General Assembly enacted Cover All Kids legislation to assure that all uninsured PA children have access to affordable health insurance by expanding CHIP. February 2007 Pennsylvania s State Plan approved by CMS March 2007 New eligibility rules implemented

7 Expanded CHIP Income Guidelines Eligible families with income under 200% of the Federal Poverty Level (FPL) (ex. $41,300 for a family of 4) receive free CHIP no co-pays, no premiums. Eligible families with income up to 300% of the FPL (ex. $61,950 for a family of 4) receive lowcost subsidized CHIP low co-pays and premiums. Families above 300% of the FPL may purchase CHIP at full cost, if they meet the program s criteria.

8 PA CHIP and Medicaid In PA, a child with a level of disability equal to the SSA s disability determination automatically qualifies to have parental income disregarded for Medicaid eligibility purposes. Children in families with income below CHIP eligibility are referred to Medicaid. Outreach initiatives for CHIP also result in increased enrollment in Medicaid.

9 Criteria for Families Under 200% of FPL Eligible families under 200% of FPL receive free CHIP, with no copayments or premiums. Children must: o Be Pennsylvania residents. o Not be eligible for Medicaid or have any other health insurance. o Be under age 19 and meet citizenship requirements.

10 Criteria for Families 200% -300% of FPL Eligible families between 200% and 300% of FPL receive low-cost (subsidized) CHIP, with low copayments and premiums. Children must: Meet same requirements as listed under free CHIP Additionally, applicants must show that their child has been uninsured for six months, unless: o The child is under age 2; or o The child has lost health benefits because a parent lost their job; or o The child is moving from another public insurance program

11 Why Reduce the Period of Uninsurance for Children Under Age Two? Support from the Pennsylvania Chapter of the American Academy of Pediatrics Early intervention more cost effective, and serious problems can be mitigated by early doctors visits. Recommended that children receive 8-10 well-child visits with up to immunizations by age 2.

12 Criteria for Families Over 300% of FPL Eligible families above 300% of FPL receive fullcost CHIP and are required to pay copayments and full-cost CHIP premiums. Children must: o o Meet free and low-cost CHIP eligibility requirements. Additionally, families must show that private coverage: o Was denied due to a pre-existing condition; or o Was not affordable to the family, which happens when: Coverage cost is more than 10% of annual family income; or Premium cost is more than 150% of the CHIP premium.

13 What Products Are Affordable and Available? Data call to all insurers in Pennsylvania Asked to Identify CHIP-like products that are available for 150% of the CHIP premium ($150 x 150% = $225 per month) No comparable plans are currently available, so automated system reflects that current finding Instituted data match to show those already enrolled in other products

14 What Prompted Legislation to Expand CHIP to Cover All Kids? Strong commitment from Governor Rendell Children have access to healthcare and services needed Healthier communities preventive care promoted through health insurance Healthier kids - Better learners with higher school attendance rates Providers receive reimbursement for services (less uncompensated care)

15 What Prompted Legislation to Expand CHIP to Cover All Kids? Strong support from advocacy community Without health insurance, identification of health problems are often delayed until treatment is more costly. No state or federal dollars used for families over 300% of FPL. Provides access to a product not otherwise available or affordable to some families.

16 Final Sticking Points Limiting eligibility for subsidized CHIP to 300% of FLP Verification of go-bare period Premium Level Determination Administrative costs for contractors

17 Pennsylvania s Commitment to Cover ALL Uninsured Kids Governor Rendell is committed to reaching out to and enrolling all uninsured children. First half-year enrollment goal (2007): approximately 9,000 children Governor Rendell s 6-year enrollment goal: insure approximately73,000 more eligible children ( )

18 Financing the Expansion No new taxes PA continues to tax tobacco products Federal financial participation increased for enrolled individuals with household income no greater than 300% of FPL. Families with income over 300% pay entire monthly premium (no state dollars spent)

19 Cost of Expansion (first half-year) Total State Funds $ 1,853,000 Federal Funds 3,937,000 Family Premiums 2,838,000 Total $ 8,628, (sixth year) Total State Funds $ 34,882,000 Federal Funds 42,467,000 Family Premiums 47,702,000 Total $125,051,000

20 Challenges Making Process Easier for Families Adequate Federal Funding at Reauthorization Recent directive from CMS contained in SHO letter #

21 What is on PA s Horizon? Next Steps

22 Questions? For more information, call or George L. Hoover Deputy Insurance Commissioner Pennsylvania Insurance Department 333 Market Street, Lobby Level Harrisburg, PA