The Future of Children s Coverage: CHIP and Medicaid Joe Touschner. Overview

Transcription

1 The Future of Children s Coverage: CHIP and Medicaid Joe Touschner September 17, :30 pm Overview o Our Children s Coverage Success Story o How the ACA Impacted the Children s Coverage Landscape o How Does CHIP Stack Up as the ACA Is Implemented? o Looking Ahead 2 1

2 Unprecedented Progress Covering Children Thanks to Medicaid/CHIP Source: Table 124. No health insurance coverage among persons under age 65, by selected characteristics: United States, selected years NHIS Trend Tables. Available at Early Release of Selected Estimates Based on Data From the 2012 National Health Interview Survey. Available at 3 Unprecedented Progress Covering Children Thanks to Medicaid/CHIP 13.0% 12.0% 11.0% CPS Lowest uninsured rate since Census started collecting data in 1987! 10.0% 9.0% ACS 8.0% 7.0% 6.0% 5.0% Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic Supplement; American Community Survey (ACS) 4 2

3 Even as more children have slipped into poverty, coverage rates have improved. 25.0% 20.0% 15.0% Children's Uninsured Rate 18.2% 20.0% Children's Poverty Rate 21.6% 22.50% 22.60% 10.0% 9.3% 8.6% 8.0% 7.50% 7.20% 5.0% 0.0% Source: American Community Survey, Rate of Uninsured Children By State Source: Children s Health Coverage on the Eve of the Affordable Care Act, Georgetown Center for Children and Families (November 2013). No statistically significant difference from the national average (5 states) Uninsured rate lower than national rate (31 states, including DC) Uninsured rate higher than national rate (15 states) 3

4 Children are much less likely to be uninsured than adults. 25.0% 20.0% 21.4% 21.0% 20.6% 15.0% 10.0% 8.0% 7.5% 7.2% 5.0% 0.0% Children Adults Source: American Community Survey, Today s Children s Coverage Landscape 8 4

5 EWB6 How Children Were Covered, 2012 Of 72.6 million children Medicaid & CHIP, 37.4% Employer, 51.4% Individual Market, 7.1% Uninsured, 7.1% Medicaid & CHIP Employer Individual Market Uninsured Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau s 2012 American Community Survey. Note: Coverage sources are not mutually exclusive. Children may have more than one source of coverage. Medicare excluded. 9 EWB7 How Low-Income Children Were Covered, 2012 Of 32.8 million low-income children Medicaid & CHIP, 67.3% Employer, 21.7% Individual Market, 4.5% Uninsured, 10.0% Medicaid & CHIP Employer Individual Market Uninsured Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau s 2012 American Community Survey. Note: Coverage sources are not mutually exclusive. Children may have more than one source of coverage. Low-income defined as under 200% of the Federal Poverty Level (FPL). Medicare excluded. 10 5

6 EWB8 Medicaid and CHIP Enrollment, 2012 CHIP, 8,148,397 Medicaid, 36,305,242 Source: Medicaid.gov: Guidance/Downloads/FY-2012-Childrens-Enrollment-04_09_13.pdf 11 Children s Health Insurance Program (CHIP) Basics State-federal partnership Well-funded block grant capped allotments States can use CHIP funds to cover kids in Medicaid or create separate CHIP program - most use some combination Enhanced federal match (65% - 81%) 12 6

7 State s Maximum Eligibility Threshold for Children 138% of FPL Medicaid State CHIP Choices CHIP M caid Medicaid CHIP Medicaid Expansion Separate CHIP Combination Program 13 Medicaid and CHIP: Managed Care Managed Care Penetration, US Medicaid for children, % Separate CHIP, % (state range: %) Source: Medicaid and CHIP Payment and Access Commission, Report to the Congress on Medicaid and CHIP, March 2014 and June

8 Medicaid and CHIP: Benefits for Children Medicaid CHIP Children s Benefits Children receive medically necessary services through the Early and Periodic Screening, Diagnosis, and Treatment benefit standard (EPSDT) States select benefits by choosing a benchmark plan or Secretaryapproved coverage Dental benefits required 15 CHIP Dental Benefits Dental benefits required since CHIP Reauthorization (2009) All states had offered some benefits pre-chipra, though some used $ cap or excluded orthodontics No rules yet to define benefit, but medically necessary orthodontics must be covered States may select benchmark plan or design their own benefit [D]ental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions 16 8

9 Supplemental Dental in CHIP Option for states to offer supplemental dental benefits through CHIP to children with private medical coverage Iowa has adopted this option 17 Where Does CHIP Stand in the Context of the ACA? 18 9

10 Public Children s Coverage in the U.S., 2014 *Median income threshold **Federal minimum under Medicaid SOURCE: Based on the results of a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, Updated by KCMU (forthcoming). 19 Affordable Care Act (2010) Keeps children s coverage stable until 2019, assuming federal funding is in place ( Maintenance of Effort or MOE). Funds CHIP through September 2015 Increases each state s CHIP matching rate by 23 percentage points, starting in October 2015 New coverage options for parents through exchanges or Medicaid 20 10

11 Medicaid and CHIP: Too integrated to be separated! State history and design decisions impact the roles Medicaid and CHIP play (Medicaid expansion, Separate CHIP, Combination) CHIP often a funding source rather than a program In 2013, 66% of CHIP-funded children in separate programs (MACPAC) Due to recent federal and state policy changes, we estimate less than half of CHIP kids will remain in separate programs for What changes are on the horizon for CHIP? 11

12 CHIP Timeline 1997 CHIP Enacted 2007 CHIP Reauthorization Vetoed; Temporary Funding Extended 2009 CHIPRA Enacted: Funding through 2013, Dental Benefits Required 2010 ACA Enacted: Establishes MOE, Extends CHIP Funding through CHIP Funding Expires 2016 Federal Match Increases 23 Percentage Points 23 What Happens to CHIP Kids if Funding Runs Out? Enrolled children will fall under one of three scenarios: o Continuing coverage in Medicaid state receives lower match/less federal funding o Move to marketplace coverage with premium and cost sharing subsidies for families o Fall into family glitch Lose access to subsidized coverage altogether 24 12

13 Visualizing What Happens to CHIP Kids if Funding Runs Out Public/Medicaid: EPSDT Private: Essential Health Benefits Uninsured 25 What Happens to CHIP Kids if Funding Runs Out? o CCF analysis with Center on Budget and Policy Priorities: o Roughly 4 million children remain in Medicaid, states lose enhanced CHIP match o Roughly 4 million kids would lose CHIP o Some eligible for Marketplace subsidies o Many could become uninsured o Over a year, 900,000 children in Texas alone would forgo CHIP coverage 26 13

14 Key Questions for the Future of CHIP o Why do we need CHIP if we have the exchanges? o Why don t we cover children with their parents in the exchange? o Or at a minimum why don t we let parents choose? o Is kids coverage better in CHIP or the exchange? 27 CHIP Affordability o For most kids in most scenarios, CHIP is significantly more affordable than marketplace plans o CCF analysis of Arizona plans found that families paid more in QHPs than CHIP in 17 out of 18 scenarios o 20 states limit cost-sharing in CHIP below required 5% of income cap Sources: Benefits and Cost Sharing in Separate CHIP Programs, National Academy for State Health Policy & Center for Children and Families (May 2014). T. Brooks, EWB9 M. Heberlein, & J. Fu, Dismantling CHIP in Arizona: How Losing KidsCare Impacts a Child s Health Care Costs, Center for Children and Families (May 2014) 28 14

15 CHIP Affordability Source: Comparison of Benefits and Cost Sharing in Children s Health Insurance Programs to Qualified Health Plans, Wakely Consulting Group (July 2014) 29 How Do CHIP Benefits Compare? States designed CHIP benefits with children s needs in mind Most states use Medicaid benefits as a starting place for CHIP Most programs provide dental without significant limitations, vision/corrective lenses, mental health parity Source: Benefits and Cost Sharing in Separate CHIP Programs, National Academy for State Health Policy & Center for Children and Families (May 2014) 30 15

16 Dental Benefits in Marketplaces Unclear how well Marketplaces are meeting children s oral health needs Benefits often defined by state s CHIP benefit or federal employees plan Can children access the benefit? Fewer than 1 in 6 child enrollees took up standalone dental plans in FFMs and California State range: 2.6% - 36% 1 in 3 medical plans in FFMs offer embedded dental benefits State range: 0% - 100% Sources: Update: Take-up of Pediatric Dental Benefits in Health Insurance Marketplaces Still Limited, American Dental Association (May 2014); Children s Dental Health Project, Teeth Matter Blog (March 2014) 31 CHIP Coverage vs. Marketplaces for Kids Evidence suggests: CHIP is more affordable for families (in many cases, much more so) Pediatric Essential Health Benefits (EHBs) have gaps Dental plan choice challenges families 32 16

17 Keeping Our Commitment to Kids Keeping CHIP and Medicaid strong and stable will be vital to continued success covering kids in the coming years Simpson Family of Benton, AR 33 CHIP Resources Dismantling CHIP in Arizona: How Losing KidsCare Impacts a Child s Health Care Costs (CCF, May 2014) Benefits and Cost Sharing in Separate CHIP Programs (CCF and NASHP, May 2014) Comparison of Benefits and Cost Sharing in Children s Health Insurance Programs to Qualified Health Plans (Wakely Consulting Group, July 2014) 34 17

18 For More Information o Joe Touschner, Georgetown University Center for Children and Families o Joe.Touschner@georgetown.edu o CCF website: ccf.georgetown.edu o o Say Ahhh! Our child health policy blog: ccf.georgetown.edu/blog/