1. Children’s Coverage: On the Move

2. Children’s Coverage: On the Move Cindy Mann, Executive Director Center for Children and Families Georgetown University Health Policy Institute www.ccfgeorgetown.edu crm32@georgetown.edu Grantmakers for Health and Grantmakers for Children Youth & Families April 24, 2007

3. The Value of Health Coverage

4. Children need proper physical and mental health to grow and develop to their full potential. Studies show that compared to uninsured children, insured children: –Have better access to a usual source of care; –Are more likely to receive needed care; and –Have fewer unmet health care needs. Insurance coverage can prevent unnecessary hospitalizations and emergency room use by providing timely and appropriate care. Health coverage can affect many aspects of a child’s life. The Importance of Health Coverage for Children

5. Medicaid Supports Working Families Kevin Hall has severe allergic asthma 13 medications a day Visiting nurse New (expensive) treatment Kevin’s mother had coverage from her job, but unaffordable cost sharing and uncovered treatments. Medicaid coverage has “given Kevin back his life” and let his mother hold on to her job.

6. Medicaid’s Role For Children with Special Health Care Needs Brandie Haughey was adopted from foster care Multiple medical and developmental problems Weighs 55 pounds Requires medications for epilepsy, intensive speech and physical therapy, and ongoing monitoring for lesions. Brandie won’t be “cured” but now her seizures are under control. She can use scissors, ride a bike, color within lines, and her gait, speech, and physical strength are improving.

7. “Why Medicaid Matters to Rhode Island” Source: The Poverty Institute at the RI College School of Social Work, Why Medicaid Matters to Rhode Island, 2006. http://www.povertyinstitute.org/matriarch/documents/PI_medicaid_finalweb%281%29.pdf

8. Progress to Date

9. Children’s Eligibility for Medicaid/SCHIP, as Implemented April 2007 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA Note: The Federal Poverty Line (FPL) for a family of three in 2007 is $34,340. Source: Based on a national survey conducted by the Center on Budget and Policy Priorities for Kaiser Commission of Medicaid and the Uninsured, 2006, updated by CCF. TX IL 200% FPL (22 states including DC) FL AL > 200% FPL (18 states) < 200% FPL (10 states)

10. Medicaid & SCHIP are Reaching an Increasing Share of Eligible Children Source: 1999 & 2002 National Survey of America’s Families. 10 SCHIPMedicaid 1997 1999 2002 1999 2002

11. Trends in the Uninsured Rate of Low- Income Children, 1997- 2005 Source: CCF analysis of National Health Interview Survey.

12. What Are the Key Issues in SCHIP Reauthorization?

13. (in billions) Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006); 2007-2012 spending data from CBO March 2007 SCHIP baseline (February 2007) includes outlays plus additional SCHP spending required to maintain current programs. SCHIP Spending is Rapidly Outpacing New Funds Being Made Available

14. Key Issues in Reauthorization Financing: How much funds will be available, how they be distributed, and how will new SCHIP funding be “paid for”? Who can be covered? What kind of coverage will be provided and how can quality care for all children be assured? Is there more the federal government can do to help states reach and retain eligible, uninsured children?

15. States are Moving Forward

16. AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MO KS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA Source: Review of state initiatives by the Center for Children and Families, between January 2006 and April 15, 2007. TX IL FL AL Implemented or Recently Adopted Legislation to Improve Children’s Coverage (11 states and DC) Considering Significant Proposal to Improve Children’s Coverage (18 states) States Are Improving Children’s Coverage

17. States are Looking to Enroll More Children Who are Already Eligible but Still Uninsured Arizona – proposal to increase state funding for outreach and to change state law to facilitate school-based outreach and enrollment. Colorado – proposal to cover more uninsured children by 2010 through a SCHIP eligibility expansion and by implementing presumptive eligibility and 12-month continuous eligibility for children. New Hampshire – proposal to add funding to enroll an additional 10,000 children who are eligible for coverage.

18. States are Looking to Raise SCHIP Income Eligibility CurrentProposed AK 154% 175% CA 250% 300% CO 200% 300% DC 200% 300% FL 200% 225% MN 275% 300% MT 150% 175% NY* 250% 400% * = New York recently approved a budget reflecting the expanded eligibility levels and Washington has already signed legislation expanding eligibility. Note: Alaska’s current eligibility level is frozen at 175% of the 2003 FPL, which approximates 154% of the 2007 FPL, and Minnesota covers infants up to 280% FPL. Source: CCF, Children’s Health Coverage: States Moving Forward (May 2007). CurrentProposed ND140%150% OH200%300% OK185%300% OR185%200% RI250%300% SC150%200% WA*250%300% WI185%300%

19. Key Questions Going Forward How will SCHIP reauthorization affect state activity? How can the current momentum be supported and strengthened? What are the implications of broader coverage proposals and initiatives? In light of the progress achieved and current interest in covering children, is this the time to “get to the finish line”?