Medicaid and SCHIP Coverage of Children: Progress and Outlook

1
Medicaid and SCHIP Coverage of Children
Progress and Outlook

• Barbara Lyons, Ph.D.
• Vice President,
• Henry J. Kaiser Family Foundation
• and
• Deputy Director,
• Kaiser Commission on Medicaid and the Uninsured
• May 9, 2007

2
SCHIP Builds on Medicaid for Childrens Coverage
SCHIP
Coverage Above Medicaid eligibility levels
Financing Capped enhanced match enrollment
caps permitted
SCHIP 6 million
Scope of Coverage Benchmark benefits no
mandate for EPSDT
Premiums/Cost-Sharing Permitted
MEDICAID
Coverage Required for newborns to age 6 up to
133 FPL age 6-19 up to 100
Financing Guaranteed Federal match Enrollment
caps not permitted
Medicaid 28 million
Scope of Coverage Includes EPSDT
Premiums/Cost- Sharing Limited
2005 Enrollment (Children)
3
The Rate of Uninsured Low-Income Children Has
Declined by Over One-Third During the Last Decade
Children below 200 of poverty
23
21
14
Source L. Ku, Medicaid Improving Health,
Saving Lives, Center on Budget and Policy
Priorities analysis of National Health Interview
Survey data, August 2005.
4
Childrens Eligibility for Medicaid/SCHIP by
Income, July 2006
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
NV
WV
DE
IL
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
lt 200 FPL (10 states)
200 FPL (24 states including DC)
gt 200 FPL (17 states)
The Federal Poverty Line (FPL) for a family of
three in 2006 is 16,600 per year. IL uses
state only funds to cover children above 200
FPL PA and WV expanded coverage in
2007 SOURCE Based on a national survey
conducted by the Center on Budget and Policy
Priorities for KCMU, 2006.

5
State Progress in Streamlining Medicaid and SCHIP
Enrollment for Children
Figure 4
Number of States



Option not available for 12-Month Continuous
Eligibility and Presumptive Eligibility until
1998 In 2006 an additional 11 states apply
Continuous Eligibility only in their SCHIP
program. 2 additional states apply Presumptive
Eligibility only in their Medicaid program and 1
state applies Presumptive Eligibility only in
their SCHIP program.
Data not available for 1997
SOURCE Based on a national survey conducted by
the Center on Budget and Policy Priorities for
KCMU, 2006.
6
Childrens Access to Care, by Health Insurance
Status, 2005

MD or any health care professional, including
time spent in a hospital. All estimates are
age-adjusted. SOURCE National Center for Health
Statistics, CDC. 2006. Summary of Health
Statistics for U.S. Children National Health
Interview Survey, 2005.
7
NY SCHIP Improves Access to Care and Reduces
Racial Disparities
White Black Hispanic
Before SCHIP Enrollment
During SCHIP
During SCHIP
Before SCHIP Enrollment
NO USUAL SOURCE OF CARE
UNMET HEALTH CARE NEED
SOURCE Shone. 2005. Study of Racial and Ethnic
Disparities in NY SCHIP program
8
Improved Health Outcomes for Asthmatic Children
with SCHIP in New York
SOURCE Szilagyi et al., Pediatrics, 2006. Data
from study on Asthma Care After Enrollment in NY
SCHIP
9
Distribution of Uninsured Children by Eligibility
for Medicaid/SCHIP, 2004
Not Eligible, gt 300 FPL
Eligible for Medicaid or SCHIP
Not Eligible, lt300 FPL
The Federal Poverty Level (FPL) for a family of
three in 2004 if 15,067 per year SOURCE Urban
Institute analysis of the 2005 Annual and Social
Economic Supplements to the CPS for KCMU. Data
has been adjusted for the Medicaid undercount.
CPS does not fully account for immigration status
so estimates in the eligible category potentially
include some undocumented children.
10
Uninsured Rates for Children under 19, by State,
2004-2005
NH
VT
ME
WA
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
NE
IL
NV
DE
WV
UT
VA
MD
CO
KY
CA
MO
KS
NC
DC
TN
SC
OK
AR
AZ
NM
GA
MS
AL
TX
LA
AK
FL
HI
gt 11 (14 states)
9-11 (17 states)
US Average 11
lt 9 (20 states including DC)
SOURCE Urban Institute and KCMU analysis of the
March 2006 Current Population Survey. Two-year
pooled estimates for states and the US
(2004-2005).

11
State Actions and Strategies for Covering
Children

• Several states have passed and are implementing
  plans that provide universal coverage for
  children (IL, ME, MA, PA, VT, WA)
• Many additional states are looking to improve
  coverage by expanding eligibility and/or
  improving outreach and enrollment
• States use a combination of
• Medicaid/SCHIP eligibility increases
• Public program buy-in allowing children at higher
  incomes to purchase coverage
• Premium assistance for employer-sponsored
  insurance
• Increased funding for outreach, administrative
  simplification, and coordination
• SCHIP reauthorization debate may affect state
  efforts

12
Spending for SCHIP first outpaced SCHIP
allotments in 2002
Billions of Dollars
Projected spending SOURCE SCHIP Original
Allotments Funding Formula Issues and Options,
October 2006. Congressional Research Service.
13
Spending Expected to Exceed Allotments in 37
States in FY 2007
Spending 100 of Allotment
RI at 450
SOURCE Data on allotments and spending from CRS,
State Children's Health Insurance Program A
Brief Overview. 10/12/2006. National average is
130
14
Key Issues in SCHIP Reauthorization

• What level of federal financing will be available
  and how will it be distributed across states?
• Who will be covered and what kind of coverage
  will be provided?
• How will federal action affect state efforts to
  broaden and improve coverage, quality and use of
  IT?