Eligibility Policy

1
Eligibility Policy Process Trends in Improving
Access

• Rising to the Challenge
• Texas Health Care Access Conference
• February 28, 2006
• Austin, Texas

2
2004-2005 The States Mixed Record

• Expansions
• Reversals of earlier imposition of barriers
• Eligibility retrenchment/erection of barriers
• Complicating retention
• Reducing family continuity of care

3
2004-2005 The States Mixed Record

• Expansions
• 12 states increased eligibility for children,
  pregnant women, and/or parents
• CO, CT, FL, IL, MT, NJ, NM, NC, UT, VA, WI, WY
• 8 states adopted procedural simplifications
• CT, FL, NH, NJ, NY, ND, WA, OK
• 4 states reduced premiums or penalties for
  nonpayment
• FL, GA, MI, TX

4
2004-2005 The States Mixed Record

• Reversals of earlier imposition of barriers
• 9 states reversed eligibility cuts, restored
  simplified procedures or relaxed financial
  barriers
• CT, FL, GA, MI, MT, NJ, TX, UT, WA
• Previous year no states reversed prior
  eligibility restrictions, many imposed new
  barriers to Medicaid and SCHIP coverage

5
2004-2005 The States Mixed Record

• Eligibility retrenchment/erection of barriers
• 6 states either cut eligibility levels or froze
  enrollment for parents in their Medicaid waiver
  programs
• CT, OH, MO, TN, OR, UT
• 2 states adopted procedures that make enrolling
  or renewing coverage more difficult
• CT, PA
• 10 states increased premiums for children
• CA, CT, IL, ME, MA, MN, MO, NJ, PA, VT

6
2004-2005 The States Mixed Record

• Complicating retention
• 11 states took steps that made it more difficult
  for eligible children to secure or retain
  coverage, such as imposing new financial or
  procedural barriers
• CA, CT, IL, ME, MD, MN, MO, NJ, PA, TN, VT
• Previous year nearly 50 instituted such
  measures

7
2004-2005 The States Mixed Record

• Reducing family continuity of care
• The disparity between the income levels at which
  parents and children qualify widened as 4 states
  reduced parents income eligibility for coverage,
  in some cases severely
• CT, OH, MO, TN

8
Policy Focus Continuous Coverage

• 12-months continuous coverage
• WA restored
• NJ, NY adopted in Medicaid, SCHIP
• FL extended from 6 to 12 months for SCHIP
• OK extended from 6 to 12 months for
  Medicaid-enrolled children

9
Policy Focus The Perils of Projection

• Unanticipated consequences drove some reversals
• WA restoration of 12 months
• TX rescision of premiums on poorest families,
  reduction for others
• MI six-month lockout for failure to pay premiums
  reversed because of administrative costs

10
State Focus NJ

• Restored parent coverage cut 3 years earlier
  35 to 133 FPL over next 3 years
• Relaxed verification requirements at enrollment,
  renewal
• Promotion of Medicaid, SCHIP retention
  simplified renewal forms, online enrollment
• Broadening provider base for PE
• 12 months continuous
• New outreach schools, hospitals, child care,
  community-based health care providers

11
State Focus WA

• Restoration of 12 months continuous
• Continued moratorium on imposition of premiums
• Studies
• 52 of children losing coverage under previous
  policies because did not complete eligibility
  review, did not/could not verify income
• Sharp increase in children cycling on and off 1
  in 5 returning in 3 months or less
• 40 of those leaving rolls were uninsured of
  which 90 likely to still qualify

12
State Focus WI

• Employer Verification Form (EVF) instituted in
  2004
• Employers verify income, access to
  employer-sponsored insurance
• WI Council on Children and Families study
• Enrollment declining when projected to increase
• EVF, new monthly premiums responsible
• WI Department of Health and Family Services study
• Role of EVF complication confirmed, failure to
  return form because of excess income or employer
  coverage refuted as cause
• Failure of employers to return EVF consequences
  to employees unclear lack of instructions
  clarity, esp. Spanish language version,
  pre-addressed reply envelopes not provided

13
State Focus WI (contd)

• Employer Verification Form (EVF) instituted in
  2004
• Employers verify income, access to
  employer-sponsored insurance
• WI Department of Health and Family Services study
• Role of EVF complication confirmed, failure to
  return form because of excess income or employer
  coverage refuted as cause
• Failure of employers to return EVF consequences
  to employees unclear lack of instructions
  clarity, esp. Spanish language version,
  pre-addressed reply envelopes not provided, some
  employers outsourced verification

14
State Focus NC

• Avoiding repeat of 2003 SCHIP enrollment freeze
• Expansion of Medicaid to cover children under 6
  up to 200 FPL
• State acceptance of Medicaid, rather than SCHIP
  match, averting SCHIP federal funds shortfall

15
State Focus MA

• Restoration of community-based outreach funding
• Discontinued in 2003
• 2005 restored 500,000 in grants to 22 CBOs
• Hospitals, community centers, child care
  agencies, community action agencies
• Training grantees to assist enrollees with new
  online application

16
Outlook for 2006 and Beyond State Perspectives

• There is reason for some optimism
• State revenues are recovering
• Medicaid spending and enrollment growth are
  slowing
• Significant concerns remain
• Overall health care cost growth
• Population aging and poverty rates
• Declines in employer sponsored coverage
• Implications of Medicare Part D
• Impact of impending federal Medicaid changes
• Significant unknown state-based Medicaid reform