Cover All Kids

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Cover All Kids

• Jim Hardy
• Deputy Secretary
• Office of Medical Assistance Programs
• Department of Public Welfare

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The Uninsured Health Care Population

• Estimated to be approximately 1 million people
• 15 of the uninsured are children

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Uninsured Children are of Particular Concern

• Lack access to timely and appropriate primary and
  preventive care
• As a result
• Health care is delayed or forgone
• Increased risk of developing more severe
  conditions
• Higher human and financial costs later

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Pennsylvanias Success with Childrens Access to
Health Care

• PA currently administers 2 programs that provide
  coverage to 1,080,000 children
• Medicaid
• 940,000 up from 700,000 in 1998
• Childrens Health Insurance Program (CHIP)
• 140,000 up from 60,000
• Still over 133,000 children without coverage

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Components of CHIP

• Free Chip
• Part of the National SCHIP system
• Participants do not contribute to monthly
  premiums for coverage
• 133,000 children currently enrolled
• Subsidized CHIP
• State only program
• Parents/guardians of enrollees contribute to
  monthly premiums
• 9,000 children currently enrolled

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Some of the 133,500 children that remain
uninsured already qualify for publicly funded
health care coverage, including the Medical
Assistance program and CHIP. Others are children
of working parents who are caught between public
programs that they are not eligible for because
of their parents income limits and private
health insurance their parents cannot afford
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Cover All Kids

• Will provide access to affordable, comprehensive
  health care coverage for all uninsured children
  in Pennsylvania
• Cover All Kids will be launched January 1, 2007
  with an investment of 14.6 million in State and
  Federal Funds in FY 06-07
• Could grow as high as 144 million in 5 years
  (54M State,90M Federal)
• Initial Goal enrolling 15,000 uninsured children
  in the first year

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Covered Children

• No changes to program for children with family
  income of 200 FPL or less they remain in
  Medicaid or free CHIP
• For children with family income of 200 FPL, but
  no greater than 350 FPL, a subsidized CHIP
  coverage will be instituted by utilizing a
  sliding scale for premium payments
• Families with income over 350 FPL will be able
  to purchase the CHIP benefit package at the state
  negotiated rate

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Cover All Kids is Affordable
Based on Federal Poverty Income Guidelines
released January 2006 and effective March 2006
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Substitution of Coverage

• To provide protection against substitution of
  coverage, the Commonwealth will institute a
  period without coverage under a group health plan
• This protection will only apply to the expansion
  population (FPL greater than 200)

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Benefit Packageremains unchanged
Cover All Kids Offers Comprehensive Health Care

• Inpatient Outpatient Substance Abuse Treatment
  Mental Health Services
• Maternity Care
• Up to 90 Days Hospitalization per Year
• Durable Medical Equipment
• Rehabilitation Therapies
• Home Health Care

• Immunizations
• Routine check-ups, doctor visits (including
  specialists) preventative care
• Diagnostic Testing
• Prescription Drugs
• Dental, Vision, Hearing Services
• Emergency Care

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Health Insurance Premium Payment (HIPP) Program

• A HIPP component to CHIP will be initiated
• Through this effort
• We will encourage coverage in the group health
  plan market
• Maximize opportunities to blend private and
  public funding

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Procurement

• Recently renewed contracts contain language for
  the expansion of CHIP
• Children enrolled in the CHIP and expansion
  program will utilize the same CHIP contractors
  and provider networks currently available

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Marketing and Outreach

• Additional 2 million budgeted for outreach
  annually for each of the next 5 years
• Will conduct major media outreach and stakeholder
  directed outreach to enroll the expansion
  population

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Next Steps To Cover All Kids

• Companion State legislation to the 2006-07 budget
  bill
• Pursue Federal Approval
• SCHIP State Plan Amendment
• Title XXI Waiver for HIPP/premium assistance
• Estimated rollout January, 2007