Closing the Gap for Ohios Children and Families

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Closing the Gap for Ohios Children and Families

• 2006 Ohio Covering Kids
• and Families Conference
• November 28, 2006

Lorin Ranbom, Assistant Deputy Director
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Ohio, From 2000 to 2005
Medicaid Coverage of Children
Private Coverage of Children
Net Change in Coverage
180,000
-140,000
40,000
Source U.S. Current Population Survey, March
Supplement.
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What have we learned?

• We cannot expand coverage for children with
  Medicaid/SCHIP as the only mechanism.
• Low income persons who have private health
  insurance coverage are losing coverage because
• Many of their employers are no longer offering
  coverage.
• Premiums are increasing to a point that they
  cannot afford.
• Health care is becoming unaffordable for middle
  income families and small businesses.
• We cant fix the uninsured problem without also
  resolving the private health insurance issues.

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What to do?

• Governor Elect Stricklands Proposals
• Create a marketplace where affordable healthcare
  plans would be available on a voluntary basis to
  all uninsured Ohioans.
• State government would buy-in to private health
  insurance coverage for low and near low income
  employed persons to make health insurance more
  affordable for consumers and their employers.
• Reach out to the Uninsured Families and Children
  Who are Already Eligible for Medicaid/SCHIP
  Coverage

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Potentially Eligible for Medicaid/SCHIP
Ohio Family Health Survey, 2004
1,050,000 children potentially eligible for
Medicaid/SCHIP in 2004
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106,000 Children are Uninsured but potentially
eligible for Medicaid/SCHIP

• Profile He or she is most likely to be age 6 or
  older, white, without special health care needs,
  with at least one working parent, or living with
  two or more adults.
• Nearly 20,000 children with special health care
  needs without coverage could have been eligible
  for Medicaid.

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Why have they not enrolled in Medicaid/SCHIP?
Ohio Family Health Survey, 2004

• Uninsured respondents who had family income and
  structure that would meet the criteria for
  Healthy Start/Healthy Families (Medicaid) were
  asked if they had applied for Medicaid or SCHIP
  in the previous 12 months.

• Those who said that they had applied were asked
  why they didnt get coverage.
• Those who said that they had not applied were
  asked why they did not apply.

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Attempts to Participate in Medicaid/SCHIP for
Potentially Eligible uninsured children
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Attempted to Obtain Coverage
Other includes paper work delays, difficulty
meeting application requirements, unable to meet
application requirements, no response to
application.
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Did Not Attempt to Obtain Coverage
Other includes recent changes in family history
confusion about application process,
eligibility, insurance status, and religious
reasons..
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Strategies to improve coverage for children who
are potentially eligible for Medicaid
Current or planned administrative improvements

• Replace the 15 year old information technology
  infrastructure that the eligibility process is
  built upon.
• CRIS-E to BEN (Benefits Eligibility Network) in
  2010.
• Improve application timeliness
• Counties are now being held accountable for the
  timeliness of applications.
• Re-determination process
• Enlist managed care plans to remind consumers to
  submit their applications.

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Strategies to improve coverage for children who
are potentially eligible for Medicaid
Legislative agenda advanced by consumer advocates

• Presumptive eligibility for children.
• Expansion of Healthy Start Pregnant Women program
  to 200 of FPL.
• Expansion of Healthy Families to higher income
  levels.
• 12 month re-determination for adults.
• Coverage for All Children

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Building the Medicaid Budget

• BASELINE
• Minus Cost Management Initiatives
• Plus New Investment
• SOMETHING REASONABLE

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Budget Policy Development

• Governors priorities for Ohio (??)
• Medicaid growth (baseline)
• Other agencies budget needs
• External Entities Ohios Medicaid
  Administrative Council, Stakeholders, Federal
  Changes, Litigation

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(Draft) Medicaid Themes for 2008-09 Budget

• Cost containment
• Value purchasing program integrity
• Personal responsibility
• Matching consumers with appropriate benefits

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Cost Containment Where to Begin (Again?)

• Examine the largest cost drivers
• Its like squeezing a half-inflated balloon
• Be sensitive to consumer choice/demand
• Be sensitive to political concerns
• What are other states doing?
• Maintain clinical integrity
• Be fair across categories

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Juggling the Challenges

• Growing caseload
• Stalled economic recovery
• Medicare cost shifting
• Federal oversight
• Growing medical costs utilization
• Increased disability of enrollees
• State Appropriation Limit (SAL)
• Must reduce 1 spending to save 0.40 state tax
  dollars
• Many initiatives cant be implemented or
  realize savings immediately

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Medicaid The Future

• We must envision the long term
• Real change requires investment
• Reform requires federal partnership
• 13 enrollees are eligible for both Medicare and
  Medicaid consume 44 of Medicaid spending
• Medicaid must partner within the larger health
  care marketplace