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The Family Opportunity Act’s Medicaid Buy-in Option for Children with Special Health Care Needs

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Meg Comeau

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Meg Comeau

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    The Family Opportunity Act’s Medicaid Buy-in Option for Children with Special Health Care Needs The Family Opportunity Act’s Medicaid Buy-in Option for Children with Special Health Care Needs Presentation Transcript

    • The Family Opportunity Act’s Medicaid Buy-in Option for Children with Special Health Care Needs Meg Comeau, MHA The Catalyst Center: Improving Financing of Care for CYSHCN NASHP Annual State Health Policy Conference October 14-16, 2007 1
    • Children and Youth with Special Health Care Needs – Aren’t They Covered? • Common policy perception – as long as you cover uninsured children (e.g. expand SCHIP) CYSHCN should be okay…… • Especially given: – Early intervention – IDEA – Title V – Medicaid TEFRA/HCBS waiver programs – SSI 2
    • Not Quite….. • Most children with special health care needs have health care coverage – If low income, covered by Medicaid – At higher incomes, covered by private insurance – If severely disabled, covered under TEFRA or Medicaid HCBS waiver program • However…. * From National Survey of Children With Special Health Care Needs 3
    • Family Financial Hardship and Income Levels 35% 0-99% FPL 100-199% FPL 30% 200-399% FPL 400% or greater FPL 25% reporting financial hardship % of families of CYSHCN 20% 15% 10% 5% 0% Nationally, over 20% of families of CYSHCN reported financial problems 4
    • Family Employment and Income – 1/3 of families reported that having a CYSHCN affected family employment – From National Longitudinal Survey of Youth • Mothers of children with disabilities earn less than other mothers • Families of children with disabilities earn less and have a lower net worth than other families 5
    • When families are the payer of last resort…. • Medical debt is responsible for 50% of all bankruptcies. • Child does not receive needed services • Other family members are affected – less funds for food, clothing, housing, education • Marital/family stress 6
    • Pathways to Hardship • Uncovered medical expenses • Higher expenses for things every family spends money on • Loss of employment income 7
    • Overview of the Federal Legislation • Part of the Deficit Reduction Act of 2005 • Focus of this presentation on Medicaid Buy-in option – Families of children with ‘severe’ disabilities – Under 300% of the FPL – Privately insured or uninsured 8
    • Advantages to Families • Better access to health care can result in improved health status • Potential to alleviate effects of underinsurance – Medicaid offers more robust coverage than the majority of private plans • No institutional level of care requirement – no cap • Family employment opportunities – Opportunity to take raises, promotions, overtime, other employment 9
    • Advantages to States • Raising income eligibility for Medicaid may incentivize obtaining or keeping private coverage • Allows for expansion of coverage to CYSHCN with federal match dollars 10
    • Advantages to States, Continued • More robust coverage can result in better access and better health outcomes; potential savings in other areas of state spending (education, uncompensated care, etc.) • Increased family earnings may serve as a stimulus to local economy, increased tax revenues 11
    • Why prioritize this small group? • Medical debt and family financial hardship • Family employment opportunities • Potential savings in other areas of state spending 12
    • What are some other ways to expand coverage to CSHCN? • SCHIP expansion to higher income levels • Katie Beckett/TEFRA waiver creation/expansion • Medicaid buy-in program created through a waiver 13
    • Existing Buy-in Programs for CYSHCN VT PA MA Income limit (FPL) 300 None None % Disability criteria None SSI SSI Privately insured children Yes Yes Yes eligible Uninsured children eligible Yes Yes Yes Premiums charged Yes No Yes 14
    • Current Status of State FOA Legislation • Passed: North Dakota, Iowa, Louisiana • Recent Interest/Activity: Arizona, Connecticut, Indiana, Maine, Nevada, Ohio, South Dakota, Texas, New York, Oregon, North Carolina These are the states we are aware of. There may be work happening in other states or within these states by other stakeholders that we are not aware of. 15
    • Technical Assistance Resources Available – State-specific first-round estimate of eligible/cost – 2d round refinement upon request – Technical Briefs: • “Methodology for Estimating the Impact of State Implementation of the FOA” • “Frequently Asked Questions About the FOA” • Reducing Underinsurance for CYSHCN through Medicaid Buy-in Programs 16
    • For more information Meg Comeau, MHA The Catalyst Center 617-426-4447, ext. 27 mcomeau@bu.edu www.hdwg.org/catalyst 17