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SCHIP in California SCHIP in California Covers Nearly 1.1 Million Covers Nearly 1.1 Million
ChildrenChildrenCalifornia’s SCHIP is the biggest in the
country: greater than the next 3 largest states combined!
What this means: California has done a fabulous job
enrolling uninsured children–over 1.3 million (HFP and MC)!!!!!!
California expenditures (and, to some degree, policy) drive the national budget.
SCHIP Reauthorization SCHIP Reauthorization HistoryHistory
Twice, bipartisan bills were sent to the President:– Vetoed H.R. 976 on October 3, 2007: CHIPRA 1– Vetoed H.R. 3963 on December 12, 2007:
CHIPRA 2 October 1, 2007 funds expired (Reauthorization
fails!) December 29, 2007 SCHIP funding extension bill
signed– Does not change policy– Flat-funds state allotments and adds supplemental funds for 21 shortfall states (including CA) thru March 31, 2009
February 4, 2009 President Obama signs CHIPRA 3, a 4 ½ year extension of SCHIP
Funding California’s Funding California’s CHIP Coverage:CHIP Coverage:
What Will it Cost?What Will it Cost?
Harbage ConsultingHarbage Consulting
February 17, 2009February 17, 2009
Draft ReleaseDraft Release
Prepared for the California HealthCare Foundation
2009
04/19/23Draft CopyBackground: California’s Title XXI Programs
ProgramProgramEnrollment Enrollment SFY 07-08SFY 07-08
(Average (Average Monthly)Monthly)
Total Total SpendingSpendingSFY 07-08SFY 07-08In MillionsIn Millions
State State Spending Spending FY 07-08FY 07-08In MillionsIn Millions
Healthy Healthy Families Families Program (HFP)Program (HFP)
851,000851,000ChildrenChildren $1,077$1,077 $398$398
Access for Access for Infants & Infants & Mothers (AIM)Mothers (AIM)
1,0351,035MothersMothers $131$131 $57$57
Medi-Cal Medi-Cal Associated Associated ProgramsPrograms
331,000331,000ChildrenChildren $726$726 $260$260
6
Note: HFP includes legal immigrant children and AIM-linked infants. AIM enrolled a total of 12,415 women in SFY 07-08, with an average of 1,035 new mothers enrolling every month.
California’s Overall Federal California’s Overall Federal NeedNeed
8
04/19/23Draft Copy
$667
$760
$1,259
$2,193
Access to Full PresentationAccess to Full Presentation
Full presentation available at Full presentation available at www.mrmib.ca.govwww.mrmib.ca.gov..
One first screen, look to HFP/Federal One first screen, look to HFP/Federal IssuesIssues
ConclusionConclusion
Ample federal funding for FFY 2009 and Ample federal funding for FFY 2009 and 20102010
Future federal allotments dependent on Future federal allotments dependent on what states’ have spent (“rebasing”)what states’ have spent (“rebasing”)
It still takes a state dollar to get 2 federal dollars. The state of California has invested significantly in SCHIP, particularly during these difficult fiscal times. It is an incredible challenge to come up with the state match.
CHIPRA 3: Policy IssuesCHIPRA 3: Policy Issues
In addition to providing sufficient In addition to providing sufficient federal funding for SCHIP, CHIPRA 3 federal funding for SCHIP, CHIPRA 3 enacted a number of policy and fiscal enacted a number of policy and fiscal changes.changes.
A number of these require policy A number of these require policy guidance from CMS. guidance from CMS.
The state will have to amend state law The state will have to amend state law to implement some of them.to implement some of them.
Several are in the jurisdiction of Medi-Several are in the jurisdiction of Medi-Cal rather than HFP.Cal rather than HFP.
Mandates Mandates RequirementRequirement Date ApplicableDate Applicable
Application of DRA Application of DRA citizenship citizenship documentation and documentation and identification identification requirements to requirements to SCHIP. SCHIP.
1/1/10 1/1/10
Mental health and Mental health and substance abuse substance abuse parity. parity.
10/1/09 unless state 10/1/09 unless state law change needed. If law change needed. If so, 1/ 1/11.so, 1/ 1/11.
Mandates (continued)Mandates (continued) RequirementRequirement Date Date
ApplicableApplicable
State cannot prevent FQHC from State cannot prevent FQHC from contracting with a private contracting with a private dentist. dentist.
Applies to Medicaid and SCHIP. Applies to Medicaid and SCHIP.
4/1/09 4/1/09
Dental coverage required. Dental coverage required. StateState must select one of several must select one of several specified benchmarks, one of which is specified benchmarks, one of which is state employee coverage. state employee coverage. Believe HFP will need to develop Believe HFP will need to develop encounter/claims based system to encounter/claims based system to meet reporting requirements.meet reporting requirements.
4/1/09 unless 4/1/09 unless state law state law change change needed. If needed. If so, 1/ 1/11.so, 1/ 1/11.
Mandates (continued)Mandates (continued) RequirementRequirement Date ApplicableDate Applicable
FQHC’s and RHC’s must be FQHC’s and RHC’s must be paid as they are in Medicaid paid as they are in Medicaid (prospective payments). (prospective payments).
10/1/09 unless 10/1/09 unless state law change state law change needed. If so, needed. If so,
1/ 1/11.1/ 1/11.
Medicaid Managed Care Medicaid Managed Care Standards applied to Standards applied to SCHIP.SCHIP.
(enrollee protections, anti-(enrollee protections, anti-discrimination, conflict of discrimination, conflict of interest, sanctions, etc.)interest, sanctions, etc.)
7/1/09 unless 7/1/09 unless state law change state law change needed. If so, needed. If so,
1/ 1/11.1/ 1/11.
Mandates (continuedMandates (continued)) RequirementRequirement Date ApplicableDate Applicable
Quality RequirementsQuality Requirements. CMS . CMS to establish mandatory to establish mandatory indicators. indicators. IOM and GAO to assess IOM and GAO to assess indicators for future indicators for future modification.modification. Promise of enhanced Promise of enhanced administrative funding for administrative funding for collecting and reporting collecting and reporting child health measures. child health measures.
HHS will HHS will establish Quality establish Quality Measurement Measurement Program by 1/10.Program by 1/10.
CA must submit CA must submit it’s Child Health it’s Child Health Quality Report Quality Report by 2/11. by 2/11.
Other ProvisionsOther Provisions RequirementRequirement Date ApplicableDate Applicable
Performance bonus for Performance bonus for increased Medicaid enrollment increased Medicaid enrollment of uninsured children. of uninsured children. (Contingent on satisfying 5 (Contingent on satisfying 5 “simplified” enrollment rules)“simplified” enrollment rules)
4/1/094/1/09
Outreach funding geared to Outreach funding geared to rural areas and racial and rural areas and racial and ethnic populations. CMS to ethnic populations. CMS to allocate funds.allocate funds.
4/1/094/1/09
Enhanced FMAP for translation Enhanced FMAP for translation and interpretation services for and interpretation services for both Medicaid and SCHIP.both Medicaid and SCHIP.
4/1/094/1/09
Other Provisions (cont.)Other Provisions (cont.)
RequirementRequirement Date ApplicableDate Applicable
GAO Report on Medicaid GAO Report on Medicaid Managed Care Rates. Managed Care Rates.
8/108/10
New commission on New commission on payment and access payment and access Medicaid and CHIP. Medicaid and CHIP. Reports due March 2010 Reports due March 2010 and June 2010. and June 2010.
2/ 4/092/ 4/09
Other Provisions (cont.)Other Provisions (cont.)
RequirementRequirement Date ApplicableDate Applicable
Small Employer Education Small Employer Education and Outreach Task Force and Outreach Task Force
4/1/094/1/09
PERM: CMS to issue final PERM: CMS to issue final rule on PERM within 6 rule on PERM within 6 months. months.
8/1/098/1/09
State OptionsState OptionsOptionOption Date ApplicableDate Applicable
Expand coverage up to Expand coverage up to 300% at SCHIP funding 300% at SCHIP funding ratios. Above 300% at ratios. Above 300% at Medicaid funding ratios. Medicaid funding ratios.
As of 4/09. If state expands As of 4/09. If state expands coverage and needs coverage and needs additional funding (above additional funding (above allotment), SPA needs to allotment), SPA needs to be submitted by 8/31/09 for be submitted by 8/31/09 for FFY 2010 FFY 2010
Cover pregnant women Cover pregnant women with SCHIP funds. Unborn with SCHIP funds. Unborn option left undisturbed option left undisturbed with statement that no with statement that no congressional intent congressional intent expressed on legality or expressed on legality or illegality of unborn option. illegality of unborn option.
As of 4/1/2009As of 4/1/2009
State OptionsState OptionsOptionOption Date Date
ApplicableApplicable
Draw down FFP for “recent legal Draw down FFP for “recent legal immigrant” children and pregnant immigrant” children and pregnant women in both Medicaid and SCHIP. In women in both Medicaid and SCHIP. In some cases, must obtain verification some cases, must obtain verification during eligibility re-determination that during eligibility re-determination that person is lawfully residing in U.S.person is lawfully residing in U.S.
As of 4/1/09As of 4/1/09
Express Lane option to use findings Express Lane option to use findings from school lunch, WIC and other from school lunch, WIC and other “public agencies” when determining “public agencies” when determining eligibility for MC or SCHIP. eligibility for MC or SCHIP.
As of 2/4/09 As of 2/4/09
State Options (continued)State Options (continued) OptionOption Date ApplicableDate Applicable
Dental Only Coverage. To use Dental Only Coverage. To use option, must cover children up option, must cover children up to highest income eligibility to highest income eligibility standard as of January 1, 2009 standard as of January 1, 2009 not impose limitations or not impose limitations or waiting lists and provide waiting lists and provide benefits to all eligible children. benefits to all eligible children.
As of 4/1/09.As of 4/1/09.
Would require Would require authorization authorization in state in state statute.statute.
Use an SSN match to meet Use an SSN match to meet citizenship documentation citizenship documentation requirements. requirements.
As of 4/1/ 09As of 4/1/ 09
State Options (continued)State Options (continued) OptionOption Date Date
ApplicableApplicable
Purchasing pool for Purchasing pool for employers with fewer than employers with fewer than 250 employees. One 250 employees. One employee must be employee must be pregnant or have an pregnant or have an eligible child. Pool must eligible child. Pool must offer two SCHIP offer two SCHIP benchmark products. No benchmark products. No SCHIP funds can be spent SCHIP funds can be spent on administrationon administration
As of 4/1/09. As of 4/1/09.
Would Would require require authorization authorization in state in state statute.statute.
State Options (continued)State Options (continued) OptionOption Date ApplicableDate Applicable
School Based Health School Based Health Centers can provide Centers can provide funding for services.funding for services.
4/1/09 unless 4/1/09 unless state law change state law change needed. needed.
Premium assistance in Premium assistance in both SCHIP and both SCHIP and Medicaid. Medicaid.
Mandatory benefit Mandatory benefit wrap. Employer must wrap. Employer must contribute 40 percent contribute 40 percent of cost. of cost.
April 1, 2009.April 1, 2009.
Would require Would require authorization in authorization in state statute.state statute.