The State of Children s Health

Transcription

1 Figure 0 The State of Children s Health Robin Rudowitz Principal Policy Analyst Kaiser Commission on NCSL Annual Meeting Boston, MA August 8, 2007

2 Figure 1 SCHIP Builds on Medicaid for Children s Coverage SCHIP 6.1 million Medicaid 28 million 2005 Enrollment (Children)

3 Figure 2 SCHIP Builds on Medicaid for Children s Coverage Coverage Entitlement Enrollment Caps Financing Scope of Coverage Cost-Sharing and Premiums Required for newborns to age 6 up to 133% FPL and 6-19 at 100% FPL To Beneficiaries and States Not permitted Medicaid Guaranteed Federal Match Regular match rate Option to impose benchmark benefits, EPSDT Wrap-Around Coverage Generally, not allowed for mandatory children; premiums allowed >150% FPL Above Medicaid levels To States Permitted Capped Financing Enhanced match rate Benchmark Benefits, no mandate for EPSDT Permitted SCHIP

4 Figure 3 Coverage of Children Has Grown with Increasing Medicaid and SCHIP Enrollment Medicaid SCHIP Millions of Children SOURCE: Kaiser Commission on and Urban Institute analysis of HCFA-2082, MSIS, and SEDS data, 2007.

5 Figure 4 And, the Percentage of Low-Income Children Without Health Insurance Has Declined 25 23% 21% % Note: Low-income is defined as children in families with income below 200% of poverty. Source: L. Ku, Medicaid: Improving Health, Saving Lives, Center on Budget and Policy Priorities analysis of National Health Interview Survey data, August 2005.

6 Figure 5 Health Coverage Promotes Improved Access to Care for Children Private Medicaid/Public Uninsured 35% 28% 23% 17% 17% 12% 12% 9% 13% 2% 3% 2% 3% 1% 2% 2% 3% 4% No Usual Place of Care Delayed Care due to Cost Unmet Medical Need Last MD* Visit >2 Years Ago Unmet Dental Need Last Dental Visit >2 Years Ago * MD or any health care professional, including time spent in a hospital. All estimates are age-adjusted. SOURCE: National Center for Health Statistics, CDC Summary of Health Statistics for U.S. Children: National Health Interview Survey, 2005.

7 Figure 6 Yet, One in Ten Children under 19 are Uninsured WA MT ND VT NH ME OR CA NV ID UT WY CO SD NE NE KS MN WI IA MO IL MI IN OH KY NY PA WV VA CT NJ DE MD MA RI AZ NM OK AR MS TN AL GA NC SC DC TX LA AK FL HI US Average = 11% SOURCE: Urban Institute and KCMU analysis of the March 2006 Current Population Survey. Two-year pooled estimates for states and the US ( ). > 11% (14 states) 9-11% (17 states) < 9% (20 states including DC)

8 Figure 7 Low-Income Parents Value Health Coverage for their Children Health coverage for their children a top priority Without access to affordable job-based coverage for their children Misconceptions about who is eligible Need simple enrollment and renewal for Medicaid/SCHIP; burdensome procedures pose barriers to coverage Covering both parents and children helps ensure children s well-being SOURCE: Enrolling Children in Medicaid and SCHIP: Insights from Focus Groups with Low-Income Parents, Kaiser Commission on, May 2007.

9 Figure 8 Average Annual Premium Costs for Covered Workers, 2000 and 2006 Employer Contribution Worker Contribution $11,480 $6,438 $8,508 $2,471 $2,137 $334 $4,242 $3,615 $627 $4,819 $1,619 $2, Single Coverage Family Coverage Note: Family coverage is defined as health coverage for a family of four. SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.

10 Figure 9 Distribution of Uninsured Children, 2004 (in millions) Not Eligible >300% FPL, 1.1M (13%) Eligible for Medicaid, 3.7M (46%) Not eligible on the basis of immigration status, 0.6M (8%) Not Eligible <300% FPL, 1.0M, (12%) 8 Million Uninsured Eligible for SCHIP, 1.7M (21%) SOURCE: Urban Institute analysis of the 2005 Annual and Social Economic Supplements to the CPS for KCMU. Data has been adjusted for the Medicaid undercount.

11 Figure 10 Higher Eligibility Levels for Medicaid/SCHIP Help to Reach More Uninsured Children WA VT NH ME MT ND OR CA NV ID AZ UT WY CO NM SD NE KS OK MN WI IA IL IL MO AR MS NY MI PA OH IN WV VA KY NC TN SC AL GA CT NJ DE MD DC MA RI TX LA AK FL HI < 200% FPL (7 states) National Median Eligibility = 200% FPL *The Federal Poverty Line (FPL) for a family of three in 2006 is $16,600 per year. **IL uses state only funds to cover children above 200% FPL ***PA and WV expanded coverage to >200% FPL in 2007 SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, % FPL (20 states) > 200% FPL (24 states including DC)

12 Figure 11 Streamlining the Enrollment Process for Medicaid and SCHIP is Also Critical Number of States in No Asset Test No Interview at Enrollment * * 12-Month Continuous Eligibility State Agency Verification of Income Presumptive Eligibility * In 2006 an additional 11 states apply Continuous Eligibility only in their SCHIP program. 2 additional states apply Presumptive Eligibility only in their Medicaid program and 1 state applies Presumptive Eligibility only in their SCHIP program. SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2006.

13 Figure 12 State Actions are Broadening Coverage for Children Several states have passed and are implementing plans that provide universal coverage for children (IL, ME, MA, PA, VT, WA); Many additional states are looking to improve coverage by expanding eligibility and/or improving outreach and enrollment States use a combination of: Medicaid/SCHIP eligibility increases Public program buy-in allowing children at higher incomes to purchase coverage Premium assistance for employer-sponsored insurance Increased funding for outreach, administrative simplification, and coordination

14 Figure 13 State Coverage Expansions for Children, OR WA MT ND MN WI VT NY ME MA CA CO IL IN OH PA WV CT NM OK TN NC SC AK LA HI last updated 7/24/07 Enacted Universal Coverage (7 states) Enacted Expanded Coverage (14 states plus DC) Proposed Universal or Expanded Coverage (5 states)

15 Figure 14 SCHIP Enrollment Projections for Children if Federal Financing is Held Constant at $5 Billion Annually Millions of Children SOURCE: CBO March 2001 Baseline: SCHIP Fact Sheet, February 23, 2007

16 Figure 15 Reduction in Uninsured Children in the Senate and House SCHIP Reauthorization Proposals Expansions of SCHIP to New Populations 4.0 Million 0.6 Million 5.0 Million 0.6 Million Additional Enrollment Within Existing Eligibility Groups 2.7 Million 3.5 Million Currently Eligible Who Would Lose Coverage Under Baseline 0.8 Million 0.8 Million Reduction in Uninsured Children in 2012 SOURCE: CBO s Estimate of Changes in SCHIP and Medicaid Enrollment of Children Under the Children s Health Insurance Program Reauthorization Act of 2007 and Under the Children s Health and Medicare Protection Act (HR 3162) July 26, 2007 and August 1, 2007

17 Figure 16 SCHIP Reauthorization Bills in the House & Senate Enrollment Changes Coverage for Children Pregnant Women Parents and Other Adults Immigrants Senate 6.2 million (4.0 million otherwise uninsured) Option to cover kids up to 300% FPL (Medicaid match >300% FPL) Limits coverage to kids <19 New state Option No new waivers for parents Transitions coverage for childless adults to Medicaid No option to cover immigrants House 7.3 million (5 million otherwise uninsured) No upper FPL for kids Option to cover children up to age 24 New state Option Can apply for parent waivers conditional on kids outreach and enrollment efforts New option to cover legal immigrant children and pregnant women

18 Figure 17 SCHIP Reauthorization Bills in the House & Senate Allotments Enrollment / Outreach Incentives Financing Senate $35 Billion over 5 years Based primarily on actual and projected spending Inflation for population and health care costs Contingency Fund 2 years to spend allotments Incentive Bonus Pool 10 State Express Lane Demonstration Grants $100 million > 5 years outreach grants 61 cent increase in cigarette tax House $47 billion over 5 years Based primarily on state spending projections Inflation for growth and health care costs Funds available to states with shortfalls 2 years to spend allotments Performance Bonus Express Lane Option Enhanced match for translation / interpretation services 45 cent increase in tobacco tax; reductions to Medicare advantage plans

19 Figure 18 SCHIP Reauthorization Bills in the House & Senate Citizenship Documentation Benefits Quality Premium Assistance Senate Applied to SCHIP New option to use SSN Grants for dental Mental Health Parity Development of measures and reporting standards Allows states to offer subsidies to qualified ESI Demonstration to allow employers to buy-in to a pool that offers SCHIP benchmark coverage House Not applied to SCHIP New state options to comply Dental required Mental health parity Development of measures and reporting standards Demonstration for 10 states to purchase family coverage through an employer buy-in

20 Figure 19 Outlook Administration has threatened to veto the House or Senate bills Deadline for reauthorization is Sept. 30, 2007 Without additional federal funds, states cannot support current programs putting children at risk of becoming uninsured SCHIP reauthorization has implications for health reform at the state level Ideological debate is a pre-cursor of things to come for national health reform