Title: The Family Opportunity Act and Children
1The Family Opportunity Act and Children Youth
with Special Health Care Needs
- Meg Comeau, MHA
- Sally Bachman, PhD
- The Catalyst Center
- Boston University
2State-at-a-Glance Chartbook The Catalyst Center
- Educational and advocacy tool for all state
policymakers - Key indicators of health care coverage for
children and youth with special health care needs - State innovations of ways to expand coverage
3FOA Overview In the Deficit Reduction Act 2005
- State option allows families of children with
disabilities to buy in to Medicaid coverage - Home And Community-Based Waivers for children
with psychiatric disorders - Family-To-Family Health Information Centers
4Focus on Medicaid Buy-in option
- Builds on Ticket to Work, designed to help adults
with disabilities go to work without losing
Medicaid - Allows states to use Medicaid buy-in to offer
coverage to children with severe disabilities
living in middle income families - Can be phased-in by age group over four years
5Some Facts about FOA
- Targets families of children with severe
disabilities - Family income under 300 of the Federal Poverty
Level (FPL) - Privately insured families whose employers pay at
least 50 of their premium may buy-in for wrap
benefits - Uninsured families may buy-in for full benefits
- Premiums may not exceed 5 7.5 of income
6Advantages to Families
- No institutional level of care requirement no
cap - May alleviate effects of underinsurance -more
robust coverage under Medicaid - Better access to health care can result in
improved health status - Family income
- Opportunity to take raises, promotions, overtime,
other employment
7Advantages to States
- Allows for expansion of coverage to CYSHCN with
federal match dollars - More robust coverage can result in better access
and better health outcomes potential savings in
other areas of state spending (education,
uncompensated care, etc.)
8Advantages to States, Continued
- Raising income eligibility may incentivize
obtaining or keeping private coverage - Increased family earnings may serve as a stimulus
to local economy, increased tax revenues - Personal responsibility
9Development of Economic Model
- Developed methodology as result of requests for
technical assistance - Catalyst Center team with consultation by a
health care economist - Data Sources
- Numbers National Survey of Children with Special
Health Care Needs (2001) and Social Security
Administration - Cost Congressional Budget Office (CBO) per
child estimate
10Development of Economic Model, Continued
- National data used
- Built in assumptions
- Result 2nd round estimate with state-specific
cost estimate advised
11Basic Assumptions
- Fraction of CSHCN between 100-300 of FPL who are
functionally eligible for FOA will be roughly
similar to fraction under 100 who are
functionally eligible for SSI - SCHIP income ceiling is 200 FPL
- Medicaid and SCHIP benefit packages are roughly
equivalent
12Walk-through of Sample State Estimate
13Proportion of CSHCN, 0-17, receiving SSI, by
family income and private insurance status, 2001
14Proportion of CSHCN, 0-18 receiving SSI, by
family income and private insurance status,
estimates for 2005
15Estimated nationwide effect of FOA on enrollment
in Medicaid, 2005
16Estimated FOA effect on enrollment and Medicaid
expenditures, state, 2005
17Supplementary Data
18States are working to adopt the Family
Opportunity Act
19States that have expressed interest in our FOA
work
- Arizona
- California
- Colorado
- Connecticut
- Iowa
- Maine
- Montana
- Nevada
- North Carolina
- North Dakota
- New York
- Ohio
- Oregon
- Rhode Island
- South Dakota
- Texas
- Utah
- Virginia
- Wisconsin
20States that have received an estimate release
- Arizona
- Connecticut
- Colorado
- North Dakota
- Oregon
- South Dakota
- Texas
21States that have filed FOA legislation
- Connecticut
- North Dakota
- Oregon
- South Dakota
222nd Round Refinement
- Adjustment to basic assumptions specific to state
(costs, numbers of eligible CYSHCN, other
pathways to Medicaid, etc.) - Further refinement to take-up estimate
- Further refinement to target population estimates
23Implementation Questions to Date
- Crowd out
- Premium schedule
- Age phase-in
- Connection to federal policy
24For more information, contact
- Meg Comeau, MHA
- Director
- The Catalyst Center
- Health and Disability Working Group
- Boston University School of Public Health
-
- 617-426-4447, ext. 27
- mcomeau_at_bu.edu
- www.hdwg.org/catalyst