CHIP Premium Assistance: Taking it to the States

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CHIP Premium AssistanceTaking it to the States

• Jessica Waltman SVP Government Affairs
• Megan Mamarella State Affairs Director
• Michael Keegan State Affairs Director
• NAHU Capitol Conference
• March 31, 2009

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Summary of CHIPRA Provisions

• Childrens Health Insurance Program
  Reauthorization Act of 2009 (CHIPRA) was signed
  into law by President Obama on February 4.
• Passed the Senate with a 66-32 vote.
• NAHUs goal was to ensure expansion was done in
  conjunction with the private market.
• Premium Assistance Provisions
• Allows children who have access to
  employer-sponsored plans (as most in the higher
  income bracket do) to stay in the private market.
• Allows states to create and/or improve premium
  assistance programs for employer-sponsored
  coverage.

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CHIP is the New SCHIP

• Expands authorization until 2013 at 32.8
  Billion.
• Financed through a tobacco tax increase of .62
  per pack.
• Estimates that new provisions will cover 4.1
  additional children.
• Allows states to increase income disregards to
  300 FPL.
• Speeds up process for legal immigrant to enroll
  (excludes illegals).
• Streamlines enrollment and allows auto renewals.
• Covers dental and mental health parity
  (optional).
• Statutory requirement to cover pregnant women.
• Phase-out of adults (parent and childless
  adults).

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Premium Assistance Background

• Since 1990 states have had the option of
  including premium assistance programs though
  Medicaid
• 1906 Waivers -Health Insurance Premium Payment
  Plans (HIPP).
• 1115 Waivers Health Insurance Flexibility and
  Accountability (HIFA).
• Legislative and regulatory burdens have made PA
  programs success very limited.
• NAHU was the impetus getting premium assistance
  included in the final CHIPRA bill.
• NAHU wrote the enacted bill language.

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Existing State Programs

• 9 states currently have operational CHIP premium
  assistance programs IL, MA, OR, PA, RI, TX, UT,
  VA and WI
• Many states have Medicaid PA or small business PA
  programs that could be expanded to include CHIP
  dollars.
• Georgia introduced S.B. 92 in February, which had
  bipartisan support, but failed to meet the
  crossover deadline.

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Premium Assistance in CHIPRA

• Premium Assistance provisions take effect April
  1, 2009
• Under H.R. 2, adopting states are permitted to
  enroll eligible children and in some cases
  families in qualified employer coverage.
• PA programs must prove to be cost-effective to
  the state.
• HDHPs, FSAs, and HSAs are NOT considered
  qualified employer coverage.
• Qualified employer coverage
• Employer provides 40 of parent coverage
• Must have HIPAA-qualified creditable coverage
• Coverage is available to the IRSs definition of
  reasonable classification of employees

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Premium Assistance in CHIPRA

• Benefits in the employer-sponsored coverage must
  be at least as comprehensive as the public CHIP
  plan.
• Employer and employee participation in a PA
  program is completely voluntary.
• An employer may opt-out of the PA program, by
  refusing the direct payment from the state toward
  a qualified employees premium.
• In this case, the eligible employee can pay for
  their portion of the plan through salary
  deduction and the PA payment will go directly to
  the employee.
• A PA program in no way effects a states federal
  CHIP funding.

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Employee Notification under CHIPRA

• By April 1, 2009 employers must provide employees
  notification describing existing state premium
  assistance programs and the benefits available to
  them.
• DOL and HHS must issue a model notice by February
  4, 2010.
• There is also a new notification requirement for
  HIPAA special enrollment rights in CHIPRA
• Employees who are eligible for a state PA system
  or lose their Medicaid or CHIP coverage, are
  permitted to enroll in the employer plan within
  60 days of the notification.

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Obstacles for the States

• CMS charged with developing guidance to accompany
  state implementation for PA.
• No timeline has been set and state Medicaid
  directors seem hesitant to go forward for fear of
  non-compliance.
• Many states have already passed their filing
  deadlines or have gone out of session.

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What Can a State Do Now?

• Talk with your Medicaid Director or other
  regulatory agency that oversees CHIP.
• Find out what is in your states CHIP
  statutesome states may be able to implement a PA
  program through regulation alone.
• Find a legislator who is willing to introduce
  NAHUs model PA language.
• Contact potential coalition partners in your
  state that would support PA
• Ie) carriers, providers, childrens hospitals

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NAHU Resources

• NAHU has developed model bill language states can
  use to introduce PA programs.
• One page document supporting the model language.
• FAQs document about how a premium assistance
  program works and how it would coordinate with
  existing state Medicaid and CHIP programs.
• State chart on CHIP programs, regulatory
  authorities and legislative session dates IN
  PROGRESS.
• All materials will be available on the NAHU
  website.

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NAHU PA Coalition Members

• BCBSA
• American Benefits Council
• Pediatrix Medical Group
• Coalition for Affordable Health Coverage
• UnitedHealth Group

• Mayo Clinic
• National Association for the Self-Employed
• Wellpoint
• Healthcare Leadership Council
• Cleveland Clinic
• March of Dimes

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CHIP Premium Assistance materials will be
available at www.nahu.org

• Contact NAHU for more information
• Jessica jwaltman_at_nahu.org or 610-971-2404
• Megan mmamarella_at_nahu.org or 703-276-3818
• Michael mkeegan_at_nahu.org or 703-276-3809