California Department of Health Services

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California Department of Health Services

• Childrens Health Coverage
• Sandra Shewry, Director
• February 2007

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Kids and Coverage
Source Health Coverage Ages 0-18, California
Health Interview Survey, 2005
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Californias Uninsured Kids
Source More than Half of Californias Uninsured
Children Eligible for Public Programs But Not
Enrolled. Shana Alex Lavarreda, E. Richard
Brown, Jean Yoon and Sungching Glenn. UCLA Center
for Health Policy.
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Childrens Coverage Medi-Cal
3.4 million
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Childrens CoverageHealthy Families Program
(HFP)
780,000
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SB 437 (Escutia)Presumptive Eligibility

• Medi-Cal to Healthy Families
• 5,000 children per month
• Applicants to Medi-Cal who appear to be HFP
  eligible
• 30,000 children per month
• Full scope Medi-Cal provided until HFP
  eligibility process is completed
• Expected implementation - 2008

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SB 437WIC Gateway

• Families will be able to apply for Medi-Cal or
  Healthy Families at the same time they apply for
  WIC
• Full scope Medi-Cal until eligibility is
  determined
• 5,000 children per month

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SB 437- Self-Cert Pilot

• 2-county, 2-year pilot project of
  Self-Certification of Income and Assets
• 10 Of statewide population
• History of timely and accurate eligibility
  determination and redetermination
• Pilot to begin July 2007
• Expect 33,000 new enrollees in first year

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Outreach, Enrollment, Utilization Retention

• County allocation program
• Funding for outreach and enrollment activities to
  enroll and retain eligible children in Medi-Cal
  and HFP
• County allocations based on the county of
  residence for children who appear to be eligible
  for, but are not enrolled in, Medi-Cal and HFP
  and the largest existing caseloads of children in
  Medi-Cal and HFP

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Outreach, Enrollment, Utilization Retention

• County allocations
• Level 1
• 93 of eligible but not yet enrolled children
• 16.68 million in 06/07
• Level 2
• Counties not included in level 1 with an
  established coalition for childrens outreach and
  enrollment that has been in place for at least
  twelve months
• 3 million on 06/07
• 29.68M in subsequent FYs subject to legislative
  approval

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Outreach, Enrollment, Utilization Retention

• Level 1 County OERU strategies
• Reach school age children through lunch programs,
  soccer leagues, classroom teachers, community
  events
• Use promotoras to reach Latino community
• Reach out to homeless shelters, churches, rural
  work locations

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Outreach, Enrollment, Utilization Retention

• Level 1 County OERU strategies
• In-reach MCAH, WIC, CHDP gateway follow-up,
  clinics, community centers, collaboration with
  probation department, social service department,
  hospitals, health plans
• Marketing multilingual media campaigns,
  translated brochures, educational videos

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Childrens InitiativesOutreach, Enrollment,
Utilization Retention

• Level 2 County OERU strategies
• Use OERU funding to hire a retired EW to train
  CAAs.
• Use small business and retail outlets for outreach

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Pediatric Palliative Care

• AB 1745 (Chang)
• Medi-Cal Policy Division and Childrens Medical
  Services will develop a Pediatric Palliative Care
  benefit
• Medi-Cal will apply for a federal waiver to
  implement the benefit as a pilot program
• Medi-Cal and CMS will evaluate the effectiveness
  of the pilot

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Pediatric Palliative Care

• November 29, 2006 workgroup convened
• CMS and Medi-Cal staff
• Childrens Hospice Palliative Care Coalition
• CA Association for Health Care at Home
• California Childrens Hospital Association (and
  many of the state childrens hospitals)
• Childrens Hospice International
• Federation of Pediatric Organizations
• Childrens Specialty Care Coalition
• Santa Barbara and Santa Clara Depts of Public
  Health
• Los Angeles DHS
• January 31, 2007 subgroup on benefit
  development
• Waiver to be developed and submitted by Sept 2007
• 12 months for implementation of benefit following
  waiver approval

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Governors Health Care Reform Proposal

• The Governors vision for health reform is an
  accessible, efficient, and affordable health care
  system that promotes a healthier California
  through prevention and wellness and universality
  of coverage.

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Building Blocks of Reform

• Prevention, health promotion, wellness
• Coverage for all Californians
• Affordability and cost containment

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Shared Benefits
GOVERNMENT Healthy, productive economically
competitive state
EMPLOYERS Affordable coverage Healthy, productive
workforce
DOCTORS HOSPITALS Fairly compensated
INDIVIDUALS Access to affordable
coverage Healthier CA
HEALTH PLANS Expanded market Fair compensation

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Shared Responsibility
GOVERNMENT Promote functional health care
market Provide access to affordable
coverage Fairly compensate Medi-Cal providers
EMPLOYERS Support employee access to affordable
coverage
DOCTORS HOSPITALS Provide affordable, quality
care Share cost savings
INDIVIDUALS Obtain health coverage
HEALTH PLANS Guarantee access to affordable
coverage Pass along savings

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Governors Health Care Reform Proposal Coverage
of Children

• Requires parents to obtain insurance for their
  children
• Expands childrens eligibility for Medi-Cal and
  HFP
• All uninsured children below 300 of the federal
  poverty level (FPL), regardless of immigration
  status, will be eligible for state-subsidized
  coverage
• The majority of the uninsured children who will
  enroll in either program are already eligible

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Governors Health Care Reform Proposal Coverage
of Children

• Provides public coverage for more parents
• Provider rate increases will increase access to
  services
• Medicare for hospital services
• 80 Medicare for physician services

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Health Care Reform ProposalCoverage for
Currently Uninsured Children
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Eligibility Bright Line

• Bright line based on income eligibility
  between
• Medi-Cal and the HFP
• Subsidized and unsubsidized coverage
• Simplifies the eligibility system and maintains
  family unity of coverage.
• Excludes pregnant women

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Medi-Cal and HFP Eligibility Today
AIM
Healthy Families
Medi-Cal
Notes Federal poverty level (FPL) for a family
of three is 15,670 through March 2005.
Individuals must also meet other eligibility
requirements (e.g., assets, deprivation,
residency, immigration status), California is
required to cover pregnant women and children u
to 185 FPL. For non-institutionalized elderly
and disabled beneficiaries with incomes greater
than 100 FPL, Medi-Cal provides coverage for
Medicare cost sharing.
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The Bright Line Impact

• 679,000 Medi-Cal eligible children will be served
  by the HFP as follows
• Children ages 0-1 with family incomes between
  100 and 200 of the FPL
• Children ages 1-5 with family incomes between
  100-133 of the FPL
• Coverage financed by Medicaid and subject to all
  Medicaid rules
• EPSDT wrap-around benefit
• Cost sharing through premiums

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Medi-Cal and HFP Bright Line Eligibility
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Health Care Reform Proposal Prevention and
Wellness

• Reverse obesity trends through nation-leading
  innovative and comprehensive strategies
• Sustained media campaign to encourage healthy
  choices
• Increase access to healthy food in stores
• Increase physical activity in schools and
  neighborhoods

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A Healthier California Obesity Prevention

• Reversing obesity trends through nation-leading
  innovative and comprehensive strategies

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Transform the Norm

• A sustained media campaign will motivate and
  encourage healthy choices by individuals.
  Central to any successful social change is
  community wide acceptance of new expectations
  regarding actions and the environment social
  marketing campaigns can influence this change to
  healthier nutritional and physical activity
  actions and expectations.
• 12 million

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Community Interventions

• Local assistance funding and state-based
  technical assistance will spur local efforts to
  create healthier local environments. Community
  change that shifts expectations, habits, and the
  physical environment in schools, workplaces,
  grocery and corner stores, public entertainment,
  and transportation options will make healthy
  choices the easy choice.
• 24 million in local grants
• 12 million training tech assistance tracking
  evaluation

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Healthy School Food Policies

• Foster development of substantive, measurable,
  and reasonable standards for school food service
  -including the removal of trans-fats from foods,
  the gradual removal of fried foods, increased
  availability of fresh produce and whole grains.
  Assist schools with implementation of healthy
  food policies.

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SCHIP Reauthorization

• Current Status
• California operates the largest SCHIP program in
  the country and is slated to receive over 790
  million in federal funding for FFY 2007
• In FFY 2007, California will spend 300 million
  over its federal allotment using unspent funds
  from prior years
• Federal funding for SCHIP is set to expire in
  2007, unless Congress reauthorizes it

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Current Funding Inadequate to Sustain Program
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SCHIP Reauthorization

• Federal 07 Budget Outlook Presidents Proposal
• Reauthorize SCHIP for 5 years
• Provide an increased allotment of 5 billion over
  the 5 years
• Lower SCHIP eligibility to 200 FPL

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SCHIP Reauthorization

• Action steps
• Review recommendations from the California Health
  Care Foundation (CHCF) report on SCHIP
  reauthorization analysis
• Participate in upcoming CHCF stakeholder
  convenings
• Educate Californias Congressional delegation on
  the importance of reauthorization with increased
  funding levels
• Be a voice for childrens health coverage