Children’s Health Coverage Observations from Louisiana

1. Children’s Health Coverage Observations from Louisiana Children’s Health Coverage—A Primer Luncheon Briefing Alliance for Health Reform Kaiser Commission on Medicaid & the Uninsured Washington, DC February 2, 2009 J. Ruth Kennedy La. Dept of Health & Hospitals

2. Lessons From Our Decade of Increasing Coverage for Children • Focus equally on Medicaidand SCHIP • Administrative simplification matters • Retaining eligiblechildren at renewal is essential • Needs differ in 2009 than in 1997 • Covering (virtually) all kids is achievable

3. High rate of poverty and poor health outcomes Absolute minimum levels of coverage for children Onerous application and verification requirements Nation’s third highest percentage of uninsured kids Almost 1 in 3 low income children had no health coverage Children’s Health Coverage in Louisiana a Decade Ago abysmal

4. “A Rising Tide Lifts All Boats” —John F. Kennedy Streamlining/Simplifying Medicaid Eligibility & Enrollment Policies for Children Streamlining/Simplifying SCHIPEligibility & Enrollment Policies

5. Most Louisiana Children in Public Coverage Are Enrolled in Medicaid

6. Many Still Uninsured Kids Live Below Poverty Level • Highest percentage of La uninsured low income children: 50 to 100% of FPL • Literacy issues • Parental priorities—Maslow’s hierarchy of needs • “Simplicity” of enrollment is relative • High mobility and lack of long term attachments

7. The Case for Administrative Simplification Essential to enroll and retain most vulnerable children Possible to achieve without compromising program integrity Accelerates enrollment—access to care for eligible children Positive administrative impact for cash strapped states Advances in technology present new opportunities

8. What Difference Does “Fixing” Renewals Make? August 2008 • 10,425 SCHIP Kids—Couldn’t renew 90 • 34,214 Medicaid Kids—Couldn’t renew 303 • 44,639 Total Kids—Couldn’t renew 393 • 393 • <1% • (2008 Rate) 9,822 22% (2001 Rate)

9. Unexpected Roadblock in La on the Road to 300% • SCHIP reauthorization philosophical debate • CMS “August 17th” letter set new conditions for expansion • 95% of kids <200% already covered • Five year ESI trend for kids in state • La expansion currently at 250%

10. The New “Hole in the Bucket” • Modest raises are putting families >200% FPL • Children moving from SCHIP or Medicaid coverage to uninsured • 85% of enrollees in new LaCHIP Affordable Plan • Received Medicaid or LaCHIP in last 36 months • Did not voluntarily drop ESI in last 12 months • Increasing income limits will be essential to maintain gains

11. We Can See Light at the End of the Tunnel • Children with public coverage in La have more than doubled since 1999 • State survey by LSU indicates uninsured rate for kids is 5.4% • “Culture” of eligibility has radically changed • Public and legislative support for children’s coverage • SCHIP reauthorization contains additional resources

12. Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has!— Dr. Margaret Mead Ruth Kennedy LaCHIP/Medicaid Eligibility Division Director La Department of Health & Hospitals 427 N 4th St Baton Rouge, LA 70802 Telephone: 225 342 3032 Fax: 225 342 9508 Blackberry: 225 241-1437 E-Mail: rkennedy @ dhh.la.gov www.lachip.org