The Road to Success: Outreach, Enrollment and Retention
And a Commitment to Connecting Kids to Coverage
The Federal Government is here to help
¾Our Mission: Help states make Medicaid and CHIP the best programs they can be.
¾State‐federal partnership more important than ever
Cindy Mann, JD
Director
Center for Medicaid and State Operations
Centers for Medicare & Medicaid Services
¾States are struggling; but federal resources and support are available
¾It’s a new day…
State Health Policy and Research Interest Group
Academy Health
January 8, 2010
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Continuing the Progress: Rates of Uninsured Children
CHIPRA and ARRA
¾ Increased federal funding for CHIP ¾ New “Performance Bonuses” for Medicaid
¾ New eligibility and enrollment options and federal outreach grants
¾ New quality standards and demonstrations
¾ New federally‐financed incentive payments to local hospitals and providers to adopt health information technology (HIT)
¾ Temporary increase in federal match rate (FMAP)
12.1%
11.3%
10.3%
2006
(9.4m)
2007
(8.9m)
2008
(7.3m)
Note: Each percent corresponds to the percentage of children 0‐18 without health insurance coverage in the given year. Each italicized number in ( ) represents the total number of people (in millions) in the age group without coverage in that year.
Source: John Holahan and Allison Cook, “Changes in Health Insurance Coverage 2007‐2008: Early Impact of the Recession;,”
Kaiser Commission on Medicaid and the Uninsured (October 2009); www.kff.org
Enrollment Simplification
¾ 17 States have submitted State plan amendments to streamline enrollment and renewal processes since CHIPRA was enacted.
¾ 3 States adopted new Express Lane Eligibility option
¾ 22 States now offer 12 months continuous eligibility in Medicaid and CHIP to limit cycling on and off of coverage. ¾ 25 States have online applications for Medicaid and/or CHIP.
¾ All but one state no longer requires an in‐person interview at renewal for Medicaid coverage.
¾ All States set up agreements with SSA to do data matches for citizenship verification
¾ 19 States eliminated the waiting period for lawfully residing immigrant children
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Performance Bonuses
¾ New incentive payments for States that ¾ Adopt specific eligibility and enrollment policies and procedures, or premium assistance, in Medicaid and CHIP. ¾ Demonstrate significant increases in Medicaid enrollment among children.
¾ Nine states qualified for FY 2009, totaling nearly $73 million. 6
The “5 out of 8” Requirement
¾ 12‐months continuous coverage
¾ No asset test (or simplified asset verification)
¾ No face‐to‐face interview requirement
¾ Joint application and the same verification process for Medicaid and CHIP
¾ Administrative or ex parte renewals
¾ Presumptive eligibility
¾ Express Lane eligibility
¾ New Premium assistance options
Federal Outreach & Enrollment Funding
¾ CHIPRA dedicated a total of $100 million to outreach and enrollment activities
¾ $40 million awarded in September 2009 to 69 grantees across 42 States. ¾ Grantees include State Medicaid/CHIP agencies, community‐based organizations, health centers, and faith‐based organizations
¾ Additional $10 million for Tribal health providers to be awarded in April 2010.
¾ Supporting grantees and monitoring progress education/interaction with grantees
Federal Outreach & Enrollment Funding
$10 million for a national enrollment campaign. ¾ In November 2009, the grantees joined a group of over 500 participants at a National Children’s Health Insurance Summit convened by HHS.
¾ Refurbished and expanded www.insurekidsnow.gov
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RESULTS
¾ An additional 2.6 million children gained Medicaid or CHIP coverage during FY 2009. ¾ Medicaid and CHIP together served nearly 40 million children last year.
¾ CHIP served 7.7 million children during FY 2009.
¾ Medicaid served 32.2 million children last year. ¾ Most of these gains were among the lowest income children (2.2 million of the enrollment gains were in Medicaid)
¾ Economy but also states’ commitment to enrolling eligible children
What’s Next???
Eligibility of Uninsured Children for Medicaid/CHIP Coverage, 2007
Connecting Kids to Coverage
64% of all uninsured
children are eligible
¾ Secretary’s Challenge: Connecting Kids to Coverage 0.6
millon
12%
¾ Estimated 5 million uninsured children eligible for Medicaid or CHIP under current rules ¾ National enrollment campaign
Eligible for
Medicaid
¾ Technical assistance to states
¾ Emphasis on technology and community innovations
¾ Partnering with other federal agencies
¾ Sports teams/Coaches Campaigns
¾ Measuring and reporting on progress
88% of all low-income
uninsured children are eligible
Eligible for
CHIP
Ineligible
2.8
millon
36%
3.2
million
41%
1.4
million
27%
1.8
million
23%
7.8 million uninsured children
3.2
million
61%
5.2 million low-income uninsured children
Note: Uninsured estimate reflects an adjustment for the underreporting of public coverage on the CPS.
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the
Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
Medicaid/CHIP Participation Rates by Division 90%
Percent
90%
83%
88%
84%
85%
77%
Cutting Red Tape
EXPRESS LANE
83% 81%
74% 74%
¾ Data matches/paperless verification
60%
¾ PERM revisions ¾ On‐Line applications
¾ Express Lane Eligibility 30%
0%
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ew
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an
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M
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¾ Partnerships with federal agencies
¾ Technical assistance to states
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What
Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Participation of Low‐Income Families with Uninsured Children in Other Public Programs
66%
53%
32%
School Lunch
Women,
Infants and
Children
Program
16%
Food Stamps
13%
SSDI
5%
3%
Housing
Assistance
TANF
At Least One
Program
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects
for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
The “Intractable” Challenges Are Not Intractable
• Parents who learn that their children are eligible want to enroll
• There does not have to be a “hole in the bucket”
• Disparities in enrollment can be narrowed/eliminated
Differences in Uninsured Rates Among Children by Race/Ethnicity and Income, 2000 & 2008
Retention
• Louisiana reduced procedural terminations at renewal to less than 1%
25%
20%
2000
2008
15%
– “Ex parte” renewals
– Web‐based renewals
– Automatic renewals
– Off‐cycle renewals
– Culture change
10%
5%
0%
Difference
between
Hispanic Rate
and White
Rate
Difference
between
Black Rate
and White
Rate
Difference
Difference
between Poor between Near
Rate and
Poor Rate
400%+ FPL
and 400%+
Rate
FPL Rate
SOURCE: Urban Institute analysis of the 2001 and 2009 Annual Social and Economic Supplement to the CPS.
“In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation – health care for our children is one of those obligations.”
‐‐President Barack Obama
February 4, 2009
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