State Health Reforms for CYSHCN

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State Health Reforms for CYSHCN
Carol Tobias, Catalyst Center, Boston University
School of Public Health Family Voices
Conference May, 2009
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Healthy People 2010

• All children with special health care needs will
  have ADEQUATE health care coverage
• So, how well are we doing?
• 900,000 CYSCHN uninsured
• 3.2 million CYSHCN with inadequate insurance

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Nearly 1/5 of families of CSHCN report financial
hardship

• Not only due to uncovered medical expenses
• Nearly ¼ of families had to cut back on work or
  quit working entirely
• 2.5 million families!

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Disparities in Coverage

• of Uninsured CYSHCN by Raceethnicity

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Disparities by state
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• NATIONAL HEALTH CARE REFORM

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Covering more kids State Strategies

• SCHIP, TEFRA, HCBS
• Premium Assistance
• Private sector initiatives
• Medicaid buy-in
• Statewide, comprehensive health reform (Maine,
  Illinois, MA?)

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What about the Adequacy part of Coverage?

• 1/3 of all families report inadequate coverage
• Low income families
• Privately insured families

From National Survey of Children with Special
Health Care Needs, 2005 data
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Perpitraters of inadequacy

• Private insurance
• Limited scope of coverage
• Benefit limits
• Copays and deductibles
• Limited provider networks
• Separately administered SCHIP programs with no
  EPSDT
• Medicaid program Administrative or provider
  limitations

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Closing the benefit gaps

• Medicaid buy-in
• Mandated benefits
• Enhanced SCHIP benefits
• EPSDT
• Maximizing private coverage

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Federal FOA Legislation

• Part of the 2005 Deficit Reduction Act
• Families can purchase Medicaid coverage for a
  child
• With a severe disability SSI level
• Full Medicaid coverage if uninsured
• Partial or wrap around coverage if privately
  insured

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FOA Provisions

• Family income must be below 300 of FPL
• Premiums may be charged
• States may provide premium assistance to purchase
  private coverage.

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FOA vs. SCHIP Expansion
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Current Status of Medicaid Buy-in

• Program Implemented Massachusetts,
  Pennsylvania, Vermont, North Dakota, Louisiana
• Legislation Passed Iowa, Illinois, Texas?
• Recent Interest/Activity Arizona, Connecticut,
  Indiana, Maine, New York, Ohio, Oregon, South
  Dakota, Wyoming
• 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.

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Mandated Benefits

• Mental health parity (42 states)
• Nutritional supplements/medical food 33
  states
• Cleft palate treatment (14 states)
• Newborn hearing screening (16 states)
• Newborn sickle cell testing (3 states)

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Early Intervention

• Mandated Benefit in 8 states, at last count -
  MA, RI, NY, PA, MO, TX, VA, NH
• Caps on private sector liability
• MA, VA, RI benefit cap of 5,000-5200/child/yr
• NH, CT benefit cap of 3,200/child/yr
• Exempt payments from the lifetime benefit cap
• State funds used for insured children or those
  who exceed private benefit cap

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Catastrophic Relief or Trust Funds

• MI private funding, administered by Title V
• NJ, MA public funds (a levy on employers who
  contribute to unemployment fund)
• KS a private trust
• CO, GA Traumatic brain/spinal cord injury
  trusts funded by DUI fines

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Maximizing Private Coverage

• IL Title V employs people from health insurance
  industry to advise staff and care coordinators
• VT Title V staff works with families to
  advocate with insurers
• F2F Health Information Centers

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Other Opportunities

• Enhanced SCHIP benefits
• Integrated delivery models
• Creative use of EPSDT
• Coverage for day care and camps
• Payment for care coordination
• Identification of special needs at point of
  enrollment

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For more information contact

• Carol Tobias or Meg Comeau
• Health and Disability Working Group, Boston
  University School of Public Health
• 617-426-4447
• tcarol_at_bu.edu
• www.hdwg.org/catalyst