A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

CHIP open to children of low-income State employees

Posted on November 7, 2011 | No Comments

PDF Version
Details
Library
Implementation Briefs

Prior to passage of the Affordable Care Act (ACA), section 2110(b) of the Social Security Act excluded children who were eligible for health benefits coverage under a State health benefits program from CHIP. Over time, however, it became clear that in some States, children of State employees did not have access to affordable, comprehensive coverage options. Many of these children were within the income eligibility level of their State’s CHIP program. Section 10203(b)(2)(D) of the ACA amends the definition of a targeted low-income child by permitting States to extend CHIP eligibility to children of State employees who are otherwise eligible under the State child health plan. At least six states have taken advantage of the new provision.

No Comments

Leave a Comment

In the U.S., uninsured and low-income adults face significant health and health care inequities as compared to insured and higher-income individuals. An issue brief analyzing the Commonwealth Fund 2010 Biennial Health Insurance Survey finds that when low-income adults have access to health insurance coverage and a medical home, they are less likely to report cost-related access problems, more likely to be up-to-date with preventive screenings, and report greater satisfaction with the quality of their care. Moreover, the gaps in health care between them and higher-income populations are significantly reduced. The Affordable Care Act (ACA) includes numerous provisions that will significantly expand health insurance coverage, especially to low-income patients, as well as provisions to promote medical homes. Along with supporting the full implementation of coverage expansions, it will be important for public and private stakeholders to create opportunities that enhance access to medical homes for vulnerable populations.
The Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) along with Health Management Associates (HMA) recently published "Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends," which summarizes the results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012. The report also includes background on the Medicaid program, as well as current issues facing the program including how states are preparing for the implementation of national health reform.
An article recently published in Health Affairs, "Policy Makers Should Prepare For Major Uncertainties in Medicaid Enrollment, Costs, And Needs For Physicians Under Health Reform," presents findings from a simulation model using two nationally representative data sets to estimate Medicaid eligibility, participation, and population growth. The article warns that the number of Medicaid enrollments, associated costs, and number of new physicians needed could vary hugely under Medicaid expansion. The estimated number of people enrolling in Medicaid for the first time could vary by more than 10 million when the program changes are implemented in 2014. Additionally, costs could range from anywhere between $34 billion to $98 billion per year. The new enrollments could necessitate at least 4,500 and at most 12,100 new physicians. The study results indicate that policy makers should prepare for a great deal of unpredictability associated with Affordable Care Act's (ACA's) Medicaid reform.
The Republican Governors Public Policy Committee, a branch of the Republican Governors Association (RGA), released the proposal, "A New Medicaid: A Flexible, Innovative and Accountable Future," which refers the super committee to 31 ideas for saving and reforming Medicaid. Specifically, the governors support block grants and capped allotments outside of a waiver and the reform of multiple federal programs including workforce training programs. The RGA report opposes cost shifting and tax increases. Key areas of agreement between the GOP report and the Democratic governors include the support of "dual-eligible" health care reform and an opposition to cost shifting proposals such as "blended rates."
This update to the Medicaid Implementation and health insurance Exchange Briefs reviews a Notice of Proposed Rulemaking (NPRM) implementing the Medicaid and CHIP eligibility, enrollment simplification, and coordination provisions of the Affordable Care Act. Issued by the United States Department of Health and Human Services on August 17, 2011, the rule is comprehensive in scope; its public comment period ends October 31, 2011. The Medicaid NPRM is part of a group of three regulations, all of which are summarized at HealthReformGPS.org. Together the rules are designed to implement both the Medicaid eligibility expansions, the process of determining eligibility for premium tax credits and cost sharing assistance in the Exchange individual market, and standards for employers purchasing coverage in Exchanges. Collectively, the rules are designed to allow individuals and families to acquire and keep coverage and move more seamlessly among publicly-supported sources of health insurance as family income and circumstances change.
Medicaid provides health insurance to the poorest and most medically vulnerable populations. Low-income pregnant women, children, and very poor parents of minor children are the majority of beneficiaries; Medicaid also provides coverage for children and adults with severe disabilities, as well as “wrap-around” coverage for low-income Medicare beneficiaries who cannot pay for services and cost-sharing that Medicare does not cover, particularly institutional and home- and community-based long-term care. Medicaid is jointly funded by states and the federal government and administered by states under broad federal standards.