11

SCHIP At A Crossroads: SCHIP At A Crossroads: - Funding Reauthorization- Funding Reauthorization

- SCHIP Impact on - SCHIP Impact on Universal Universal Children’s Children’s

CoverageCoverageAcademy Health Research MeetingAcademy Health Research Meeting

June 25, 2006June 25, 2006

Lesley Cummings, Executive DirectorLesley Cummings, Executive Director

California Managed Risk Medical Insurance Board California Managed Risk Medical Insurance Board 6/20066/2006

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Federal Funding Federal Funding ReauthorizationReauthorization

SCHIP Allocation IssuesSCHIP Allocation Issues

• Size of the potSize of the pot– Past funding Past funding notnot an indicator of an indicator of

future needfuture need

California Managed Risk Medical Insurance Board

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California's SCHIP Allotments, Carryover California's SCHIP Allotments, Carryover Funding and Expenditures AllotmentsFunding and Expenditures Allotments

California Managed Risk Medical Insurance Board

Carryover Funding and Expenditures are based on the Federal Fiscal Year - FFY- (October 1st through

September 30th)

$0

$400

$800

$1,200

$1,600

$2,000

Federal Fiscal Year

(In

th

ou

san

ds)

Title XXIAllotments

CarryoverFunding

Federal FundExpenditures

44

In 2005, 31 states spent more than their In 2005, 31 states spent more than their federal allotmentfederal allotment

Federal SCHIP Appropriations, Original Allotments, and Spending, FY 1998-FY 2007 (per CRS)

02468

Billions of

dollars

Original allotments to states and territories Total Spending/demandCalifornia Managed Risk Medical Insurance Board

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SCHIP Allocation Issues (cont)SCHIP Allocation Issues (cont)

•Who Is EligibleWho Is Eligible for FFP?for FFP?– Income Cap for Children ?Income Cap for Children ?

• 38 states set eligibility at or below 200%38 states set eligibility at or below 200%

– Pregnant Women aka “the unborn” (9 Pregnant Women aka “the unborn” (9 states)states)

– Parents (7 states)Parents (7 states)– Childless Adults (5 states)Childless Adults (5 states)

California Managed Risk Medical Insurance Board

66California Managed Risk Medical Insurance Board

• Present law says:Present law says:– Number of childrenNumber of children

– Number of low income children without health insurance Number of low income children without health insurance – Number of all low-income childrenNumber of all low-income children

Factors weighted equally (since 2001)Factors weighted equally (since 2001) Low income means 200% FPL or lowerLow income means 200% FPL or lower

– State costState cost•Based on wages of employees in the health Based on wages of employees in the health

services industryservices industry

Allocation Among Allocation Among StatesStates

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California Managed Risk Medical Insurance Board

• What data source should be used to estimate What data source should be used to estimate the number of low income/uninsured children the number of low income/uninsured children determined?determined?– CPS : CPS :

• 3 year average used now to reduce sampling error3 year average used now to reduce sampling error• BBRA provided funds to increase sample sizeBBRA provided funds to increase sample size• Still significant variation. Still significant variation. • Estimates differ substantially from other representative Estimates differ substantially from other representative

surveyssurveys• Poverty thresholds vs. poverty guidelinesPoverty thresholds vs. poverty guidelines

– State SurveysState Surveys

• State cost factorState cost factor– Data source used (NAICS) does not include data Data source used (NAICS) does not include data

on self-employedon self-employed

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California Managed Risk Medical Insurance Board

Other Allocation OptionsOther Allocation Options– Number of children Number of children enrolledenrolled in SCHIP in SCHIP

• States that expanded before SCHIPStates that expanded before SCHIP

– State spending State spending • Per CRS, would require 25% increase in appropriationPer CRS, would require 25% increase in appropriation

• Per CRS, Texas will spend $ 409 of its $ 560 million Per CRS, Texas will spend $ 409 of its $ 560 million allotment for 2007allotment for 2007

– Funding floorFunding floor

• RedistributionsRedistributions

• Future coverage expansions?Future coverage expansions?

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California’s Efforts to California’s Efforts to Cover ALL ChildrenCover ALL Children

1010

Insurance Status of Insurance Status of California ChildrenCalifornia Children

90 Percent90 Percent of California Children Were of California Children Were Insured in 2003*Insured in 2003*– 52 .1 % by employer coverage52 .1 % by employer coverage– 29.4 % in Medi-Cal or Healthy 29.4 % in Medi-Cal or Healthy

FamiliesFamilies– 8.3 % in “other” coverage (privately 8.3 % in “other” coverage (privately

purchased or other government purchased or other government sponsored programs)sponsored programs)

California Managed Risk Medical Insurance Board

* Data Sources: 2003 California Health Interview Survey (CHIS) and UCLA Center for Policy Research (“The State of Health Insurance in California”) for 0-17 year olds.

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Insurance Status of Insurance Status of California ChildrenCalifornia Children (continued)(continued)

The remaining 10%The remaining 10% are Uninsured are Uninsured:: 779,000 779,000

Eligible for Healthy Families/ Medi-Cal: Eligible for Healthy Families/ Medi-Cal: 429,000 429,000 eligible but unenrolledeligible but unenrolled children (204,000 for MC and children (204,000 for MC and 225,000 for HFP). 225,000 for HFP). Since the 2003 CHIS, HFP has enrolled an additional Since the 2003 CHIS, HFP has enrolled an additional

60,000 children 60,000 children

Children Ineligible for Federal/State Public Programs Children Ineligible for Federal/State Public Programs (potentially eligible for HK): (potentially eligible for HK): 350,000350,000:: Children Over- Income (over 250%): 157,000Children Over- Income (over 250%): 157,000 Undocumented Children: 193,000Undocumented Children: 193,000

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Children’s Health Initiatives: Children’s Health Initiatives: What are they?What are they?

• Children’s health initiatives (CHI’s) are Children’s health initiatives (CHI’s) are locally-operated children’s health programs locally-operated children’s health programs that provide services for children not that provide services for children not eligible for full-scope no-cost Medi-Caleligible for full-scope no-cost Medi-Cal11 or or the Healthy Families Programthe Healthy Families Program22 (HFP). (HFP).

• CHI’s are modeled after the HFP which CHI’s are modeled after the HFP which offers comprehensive insurance coverage offers comprehensive insurance coverage (health, dental and vision) -except only one (health, dental and vision) -except only one plan provides coverage.plan provides coverage.1California’s Medicaid program

2California’s S-CHIP program

California Managed Risk Medical Insurance Board

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• Santa Clara County launched the first Santa Clara County launched the first Healthy Kids program in 2001.Healthy Kids program in 2001.

• The Santa Clara approach was to The Santa Clara approach was to provide “one door” to families for provide “one door” to families for SCHIP, Medi-Cal or the HK programs.SCHIP, Medi-Cal or the HK programs.

• Numerous other localities established Numerous other localities established HK programsHK programs

California Managed Risk Medical Insurance Board

Children’s Health Children’s Health Initiatives: The BeginningInitiatives: The Beginning

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California Managed Risk Medical Insurance Board

Program Start Program Start DateDate

California CountyCalifornia County

20012001 Santa ClaraSanta Clara

20022002 San Francisco and RiversideSan Francisco and Riverside

20032003 San Mateo, Los Angeles, San San Mateo, Los Angeles, San Bernardino, and San JoaquinBernardino, and San Joaquin

20042004 Santa CruzSanta Cruz

20052005 Kern, Alameda, San Luis Kern, Alameda, San Luis Obispo, Santa Barbara, Obispo, Santa Barbara, Napa, SolanoNapa, Solano

20062006 Fresno, Sonoma, Tulare and Fresno, Sonoma, Tulare and YoloYolo

Data from the Institute for Health Policy Solutions “Overview of Local Children's Data from the Institute for Health Policy Solutions “Overview of Local Children's Coverage Expansions”, Revised 05/09/06Coverage Expansions”, Revised 05/09/06

Healthy Kids Current Program StatusHealthy Kids Current Program Status

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Healthy Kids Future Healthy Kids Future Coverage StatusCoverage Status

Planned Program Planned Program Start DateStart Date

California CountyCalifornia County

July, 2006July, 2006 Sacramento, Colusa, El Sacramento, Colusa, El Dorado, and Yuba Dorado, and Yuba CountiesCounties

To be determinedTo be determined Del Norte, Kings, Marin, Del Norte, Kings, Marin, Mendocino, Merced, Mendocino, Merced, Orange, San Diego, Orange, San Diego, VenturaVentura

88,000 children enrolled in HK 88,000 children enrolled in HK Programs. 12,000 children waitlistedPrograms. 12,000 children waitlisted**

* Institute for Health Policy Solutions* Institute for Health Policy Solutions California Managed Risk Medical Insurance Board

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Healthy Kids Program Healthy Kids Program Funding SourcesFunding Sources

For 0-5 Year Olds:For 0-5 Year Olds:

• Funding is generally available because this Funding is generally available because this population is the focus of the California First 5 population is the focus of the California First 5 Commission which has tobacco tax funding via a Commission which has tobacco tax funding via a proposition*.proposition*.

• The State California First 5 Commission has made The State California First 5 Commission has made funding of coverage for 0-5 year olds a priority and funding of coverage for 0-5 year olds a priority and has provided incentive grants to thehas provided incentive grants to the 58 County First 5 58 County First 5 Commissions so that coverage is also a local priorityCommissions so that coverage is also a local priority

For children ages 6-18:For children ages 6-18:

• Funding is challenging. Virtually all children on Funding is challenging. Virtually all children on waitlists are between 6-18.waitlists are between 6-18.

* California Children and Families Commission created by the California Children and Families First Act (Proposition 10, 1998)* California Children and Families Commission created by the California Children and Families First Act (Proposition 10, 1998)

California Managed Risk Medical Insurance Board

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Healthy Kids Program Healthy Kids Program Funding Sources (cont’d)Funding Sources (cont’d)

Funding sources have included: Funding sources have included:

• Governmental Health PlansGovernmental Health Plans

• Foundations including: The California Foundations including: The California Endowment, The California HealthCare Endowment, The California HealthCare Foundation and The David and Lucile Packard Foundation and The David and Lucile Packard FoundationFoundation

• Local Tobacco Settlement FundsLocal Tobacco Settlement Funds

• Cities and CountiesCities and Counties

• HospitalsHospitalsCalifornia Managed Risk Medical Insurance Board

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Evaluation of Healthy Kids Evaluation of Healthy Kids ImpactImpact

• Several evaluations on the grandmother CHI (Santa Several evaluations on the grandmother CHI (Santa Clara) were conducted by Mathematica, the Urban Clara) were conducted by Mathematica, the Urban Institute and UCSF (Institute and UCSF (funded by the David and Lucile Packard funded by the David and Lucile Packard

FoundationFoundation). ).

• Evaluations found:Evaluations found:– The program’s outreach efforts increased enrollment The program’s outreach efforts increased enrollment

in Medi-Cal and HFP by 28% above expected levels.in Medi-Cal and HFP by 28% above expected levels.– SC says a critical message is “We have coverage for SC says a critical message is “We have coverage for

ALL your children”ALL your children”

1919California Managed Risk Medical Insurance Board

.

- - Enrollment increased the percent of Enrollment increased the percent of children with a usual source of children with a usual source of medical care (medical care (from 49% to 89%)from 49% to 89%) and and preventive dental care preventive dental care (from 22% to (from 22% to 61%).61%).

-The percentage of children who did not

get medical care was reduced by more

than 50% (from 24% to 10%)

-The program doubled the percentage

of children whose parents were

confident they could obtain needed

care for their child (from 41% to 71%) .

Healthy Kids Impact (cont’d)Healthy Kids Impact (cont’d)

2020

On the Horizon: On the Horizon: Initiatives and LegislationInitiatives and Legislation

• The Governor’s May Revise – $23 million The Governor’s May Revise – $23 million proposal to fund children on CHI waiting lists.proposal to fund children on CHI waiting lists.

• Tobacco Tax Initiative of 2006, headed for the Tobacco Tax Initiative of 2006, headed for the November 2006 ballot, replaces CHI’s with a November 2006 ballot, replaces CHI’s with a state program. Children would be enrolled in state program. Children would be enrolled in HFP.HFP.

• The Budget Conference Committee approved The Budget Conference Committee approved the Assembly’s proposal to implement a the Assembly’s proposal to implement a coverage expansion even if the Initiative fails.coverage expansion even if the Initiative fails.

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For More Information, please For More Information, please contact:contact:

The California Managed Risk The California Managed Risk Medical Insurance Board Medical Insurance Board

Ms. Lesley CummingsMs. Lesley Cummings

Executive DirectorExecutive Director

1000 G Street, Suite 4501000 G Street, Suite 450

Sacramento, California 95814Sacramento, California 95814

(916) 324-4695(916) 324-4695