Medicaid and Health Reform: How Will They Work Together?

1. Medicaid and Health Reform: How Will They Work Together? Jocelyn Guyer Center for Children and Families http://ccf.georgetown.edu

2. Medicaid’s Coverage Role Today Children = 78.6 million Uninsured 11% Employer-Sponsored Insurance 55% Medicaid/Other Public 29% Individual Coverage 4% Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

3. Medicaid Provides Coverage for Half of Low-Income Children Percent with Medicaid Coverage Source: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, and Urban Institute estimates; Birth data: NGA, MCH Update. Note that “poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008.

4. Decline in the Rate of Uninsured Low-Income Children is Attributable to Enrollment in Medicaid and CHIP Source: Data reflects low-income (<200% FPL) children. Johns Hopkins University Bloomberg School of Public Health analysis of the National Health Interview Survey for the Center for Children and Families (March 1, 2008).

5. 70% of Uninsured Children are Below 200% FPL Children = 8.9 million 300% + 200-299% 100-199% 70% below 200% FPL Under 100% Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

6. Children Currently Eligible but Unenrolled 9 Million Uninsured Children 4.4 Million are Eligible for Medicaid 1.7 Million are Eligible for SCHIP Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

7. Medicaid Income Eligibility Levels 51 states cover children above the minimum eligibility level Source: D. Cohen Ross and C. Marks, “Challenges of Providing Health Coverage for Children and Parents in a Recession,” Kaiser Commission on Medicaid and the Uninsured (January 2009).

8. Medicaid and SCHIP Eligibility Levels for Children, January 2009 WA* NH VT MT* ME ND OR MN MA ID WI SD NY WY MI RI CT IA* PA NV NE NJ OH* IL UT IN* DE CO* CA WV* KS* VA MD MO KY NC* DC TN AZ OK* NM AR SC MS AL GA TX LA* AK FL HI < 200% FPL (4 states) 200% FPL (16 states) 201%-250% FPL (9 states) > 250% FPL (21 states) Source: D. Cohen Ross, A. Horn, & C. Marks, “Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,” Kaiser Commission on Medicaid and the Uninsured (January 2008);updated by the Center for Children and Families. Note: States with asterisks (*) have enacted, but not yet implemented to the levels shown.

9. Medicaid/CHIP Coverage Improves Access to Care Source: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007. Summary of Health Statistics for U.S. Children: NHIS, 2007. Note: 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. An asterisk (*) means in the past 12 months.

10. Medicaid’s BIG Role in Covering Foster Children • All IV-E foster care children are eligible for Medicaid • States have the option to cover non-IV-E foster care children - All do • All children receiving federal adoption subsidies are eligible for Mediciad • Most states (50) provide Medicaid coverage to adopted children receiving state subsidies

11. Foster Children Covered by Medicaid In 2001: • 869,087 foster care children were covered under Medicaid • Estimates suggest, this reflects only 853% of those eligible for care • Foster children represent 3.7% of the non-disabled children on Medicaid Source: R. Geen, A. Sommers, M. Cohen, “Medicaid Spending on Foster Children,” Urban Institute (August 2005)

12. Medicaid Spending on Foster Children In 2001: • $3.8 billion was spent by states to provide coverage for foster children • On average, states spent more on foster children ($4,336 per child) than on all non-disabled children ($1,315) • Foster children accounted for 12.3% of expenditures Source: R. Geen, A. Sommers, M. Cohen, “Medicaid Spending on Foster Children,” Urban Institute (August 2005)

13. The Importance of Medicaid for Foster Children Foster children tend to have significant health problems - Medicaid is there to help.

14. What About Health Reform?

15. But First . . . CHIP Reauthorization New funding levels and formula New incentives to enroll Medicaid children Eligibility changes Benefit changes Significant new emphasis on quality, access

16. Health Care Reform Proposals Obama plan maintains Medicaid and SCHIP, but no details yet. Baucus plan extends Medicaid to all below 100% FPL and requires states to cover children in CHIP up to 250% of FPL; higher levels required/permitted.

17. Broader Health Reform – What Do Children Need? Access to affordable coverage for all children Stronger financing structure A benefit package designed for children and their unique developmental needs High quality care with access to needed providers Family-based coverage

18. Broader Health Reform – Risk Points for Children Failure to acknowledge and address the unique needs of children Politicians using mandates to claim victory on enrollment issues Poor coordination between existing programs and new initiatives Fracturing of coverage within families Criticism of Medicaid/CHIP as “failed” programs