Child and Family Coverage: Where Do We Stand? Joan Alker Executive - - PowerPoint PPT Presentation

Child and Family Coverage: Where Do We Stand?

Joan Alker Executive Director, Research Professor Georgetown University Center for Children and Families December 15, 2016

The Childr The Children’ en’s Uninsur s Uninsured Rate has ed Rate has Declined T Declined To Historic Low

• Historic Low

Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016.

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Par Parent Coverage Has Impr ent Coverage Has Improved T

• ved Too
• Source: Urban Institute tabulations of 2008-2015 National Health Interview Survey data

Notes: Parents are defined as adults ages 19 to 64 living with a biological child, adoptive child, or stepchild age 18 or under. Uninsured is at time of survey. All other adults age 19 to 64 are classified as childless.

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20.8% 22.4% 23.3% 22.0% 21.5% 21.0% 16.4% 12.9% 18.7% 19.7% 21.0% 20.2% 20.3% 20.0% 16.4% 13.3%

10% 12% 14% 16% 18% 20% 22% 24% 2008 2009 2010 2011 2012 2013 2014 2015

Other Adults Parents

The Public is Not A The Public is Not Awar ware of This Success e of This Success

Source: PerryUndem Poll. National Omnibus Survey October 7-9, 2016

4 49% 28% 1% 22% In the Last 5 Years, Do You Think the Number of Uninsured Children Has Increased, Decreased, or Stayed the Same? Increased Decreased Don't Know/Refused Stayed the Same

Public Coverage for Childr Public Coverage for Children en

Source: Source: “Child Enrollment in CHIP and Medicaid by State, FY 2015.” MACPAC. “Health Insurance Marketplaces 2016 Open Enrollment Period: March Enrollment Report.” ASPE. March 11, 2016.

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Childr Children’ en’s Upper Income Eligibility s Upper Income Eligibility

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Highest State Eligibility 405% Median State Eligibility 255% Lowest State Eligibility 175%

0% 50% 100% 150% 200% 250% 300% 350% 400% 450%

Breakdown of State Eligibility FPL # of States < 200% 2 200% – 250% 21 250% - 300% 9 > 300% 19

Source: 50-State Survey on Medicaid and CHIP , Kaiser Family Foundation and Georgetown CCF

Medicaid and CHIP Cover 44% of Medicaid and CHIP Cover 44% of Childr Children Under Age Six en Under Age Six

Source: “Medicaid’s Role for Young Children.” Georgetown University Center for Children and Families, September 2016.

7 44% 54% 5% Medicaid/CHIP Private Coverage Uninsured

Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016.

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Rate of Uninsur Rate of Uninsured Childr ed Children by State, 2015 en by State, 2015

Medicaid and CHIP Structur Medicaid and CHIP Structure

Medicaid CHIP Financing

• Pays 50% to 83% of costs
• 50% of admin costs
• Open-ended federal

funding to states for eligible populations and services

• Pays 65% to 85% of costs;

with a 23% point bump in 2016

• Pays CHIP match for

admin costs, subject to 10% cap

• Block grant with built in

safety valves

Program Rules

• Minimum standards for

benefits (EPSDT)

• Cost-sharing

restrictions Fewer minimum standards than Medicaid

Coverage Guarantee

Guaranteed enrollment, if eligible None - Can freeze or cap enrollment or require waiting periods

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Medicaid and CHIP: Benefits Medicaid and CHIP: Benefits

Medicaid Medicaid

• Comprehensive services

through Early Periodic Screening Diagnostic and Treatment (EPSDT)

• All services necessary to

correct and ameliorate physical and mental health conditions

CHIP CHIP

• Medicaid expansion:

Medicaid benefit package

• Separate program -

based on Benchmark plan that is closer to private coverage

• Secretary-approved

coverage

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Medicaid and CHIP: Eligibility Medicaid and CHIP: Eligibility

Medicaid Minimum Standar Medicaid Minimum Standards ds

• Children 0-18 with income

up to 133% FPL

• Infants born to women

covered by Medicaid under pregnant women’s coverage for first year of life CHIP Maximum Standar CHIP Maximum Standards ds

• Children above Medicaid

income levels at state option

• 200% FPL upper limit, or
• 50 percentage points > Medicaid

limit in place in June 1997

• Pre-ACA, states used income

disregards and deductions to achieve higher income eligibility thresholds; those levels are grandfathered as of enactment of the ACA

• Unborn children at state option

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Medicaid is the Largest Sour Medicaid is the Largest Source of ce of Federal Funds for States Federal Funds for States

Source: State Expenditure Report: Examining Fiscal 2014-2016 State Spending, National Association of State Budget Officers (NASBO).

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Medicaid 56.1% All Other Programs 43.9%

Federal Fund Expenditures, FY 2015

Medicaid $319 Billion All Other Programs $250 Billion

Substantial Federal Medicaid Cuts Substantial Federal Medicaid Cuts ar are Looming e Looming

Source: E. Park and M. Broaddus (personal communication, December 2016); E. Park, “Medicaid Block Grant Would Add Millions to Uninsured and Underinsured,” Center on Budget and Policy Priorities (March 2016), available at http://www.cbpp.org/blog/medicaid-block-grant-would-add- millions-to-uninsured-and-underinsured.

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59%

41% ($2.1 Trillion)

Overall Medicaid Spending Over 10 Years (2017-2026) Total: $5.1 Trillion

Price’s Plan to Cut Medicaid

• Rep. Price’s plan would eliminate the

guarantee of coverage and benefits (like EPSDT)

• In the plan’s tenth year (2026), funding for

Medicaid would be 47% less than what it is under current law.

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