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State Child Buy-In Programs: A Snapshot. Dawn Horner Georgetown Center for Children and Families http://ccf.georgetown.edu Families USA January 30, 2009. What is a State Child Buy-In Program?. State program for children with family income above Medicaid/ SCHIP.

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state child buy in programs a snapshot

State Child Buy-In Programs: A Snapshot

Dawn Horner

Georgetown Center for Children and Families

http://ccf.georgetown.edu

Families USA

January 30, 2009

what is a state child buy in program
What is a State Child Buy-In Program?
  • State program for children with family income above Medicaid/ SCHIP.
  • Family purchases insurance through the public plan, typically at full cost of coverage to state.
  • Do not operate under federal Medicaid/SCHIP rules.

health

GIVE

Care

US

where states stand
Where States Stand
  • At least 8 states have operated a program for ten years or more.
  • New wave of states; and others are planning or interested.
  • At least 3 states have launched as part of universal coverage strategy.
general characteristics
General Characteristics
  • Cost
    • Vary by state
    • Typically full cost; no state subsidy
    • Few subsidize premium or administrative costs
    • Some lower costs by broadening risk pool
  • Income Eligibility
    • Above Medicaid/SCHIP levels
    • Some with an upper limit
  • Administration
    • Same as the SCHIP
    • Marketing
general characteristics1
General Characteristics
  • Eligibility Rules
    • No limits on enrollees
    • Few limit enrollment length
    • Some require children to be uninsured prior
  • Others, less common:
    • No longer eligible for SCHIP
    • Medically uninsurable
apples to oranges how differ from other programs
Apples to Oranges? How Differ From Other Programs?
  • High Risk Pools
  • Family Opportunity Act: Medicaid Buy-In
high risk pools
High-Risk Pools
  • For "medically uninsurable", not necessarily low-income persons.
  • Not child-only.
  • Generally contract with insurance company to administer program with state subsidies.
  • Typically:
    • premiums more expensive than sold by private insurers
    • benefits similar to basic individual plan
    • can have high deductibles and co-payments
family opportunity act medicaid buy in
Family Opportunity Act: Medicaid Buy-In
  • New state option part of 2005 DRA.
  • Families with income below 300% FPL can buy into Medicaid.
  • Child must have SSI-defined disability.
  • Premiums on a sliding scale.
  • State receives regular Medicaid FMAP.
  • Employer coverage requirement.
child buy ins benefits
Child Buy-Ins: Benefits
  • Option for moderate-income uninsured children.
  • Lower cost/higher benefits than non-group market.
  • Universal outreach message.
  • “No or little cost” to state (although also challenge).
child buy ins challenges
Low enrollment

Affordability

Adverse selection

Funding

Child Buy-Ins: Challenges
key policy questions
Key Policy Questions
  • What is the Goal of the Program?
    • Universal or targeted population
    • At what income level/linkage with MC/CHIP
  • How to Structure Premiums/Financing?
    • What is affordable for families, at what income levels
    • How to set premiums: Pooling, subsidies
    • How to finance

3. How to Address Adverse Selection?

    • What risk is acceptable
    • Setting cost sharing levels/combining with other programs/other eligibility rules
    • Buy-in as option for children with disabilities