Medicaid SCHIP Expansion Opportunities for Specialty Health

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Medicaid SCHIP Expansion Opportunities for
Specialty Health Tuesday, May 19 100 pm EST
Richard Fenton, Deputy Director of Health
Services National Association of State Medicaid
Directors American Public Human Services
Association Richard.Fenton_at_aphsa.org 202.682.0100
Ext. 254
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Impact of Recession on State Budgets

• ? Economic downturn and massive job losses are
  contributing to significant shortfalls in state
  budgets and increases in Medicaid enrollment
• ? States must have balanced budgets
• ? Many states forced to cut funding to Medicaid
  and other crucial programs
• ? Every 1 increase in unemployment 1 million
  additional Medicaid clients

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According to the Center on Budget and Policy
Priorities
State Budget Challenges

• ? 46 states facing fiscal stress in
• their FY 2009 and/or FY 2010
• budgets
• ? 42 states and D.C. facing mid-year budget
  shortfalls
• ? Over half have already cut spending, used
  reserves, and raised revenues to balance current
  budget
• ? States fiscal problems likely to continue for
  some time

?
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Medicaid Cuts Being Considered by States

• ? Cuts in eligibility and enrollment
• ? Delays in program expansions
• ? Reductions in provider reimbursement
• ? Elimination of optional service coverage
• ? Limitation of the number of refills/prescription
  s
• ? Reductions in pharmacy reimbursement
• ? Changes in DME/DMS coverage
• ? Establishment of Prior Authorization for the
  Preferred Drug List

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CHIP Reauthorization

• ? Signed into law February 4, 2009
• ? Expands coverage to additional 4 million
  children

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CHIP Reauthorization

• Funding Changes
• ? Revises allotment formulas
• ? Establishes bonus payments
• ? Establishes contingency funds
• ? Phases out childless adults and modifies
  coverage of parents

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CHIP Reauthorization

• Eligibility Changes
• ? Establishes citizenship requirements and allows
  for alternative review process
• ? Eliminates the five-year waiting period for
  documented immigrant children and pregnant women
  to become eligible at state option
• ? Provides states the option to cover pregnant
  women
• ? Includes 100 M over FY 09-13 for outreach to
  Medicaid and CHIP eligible children

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CHIP Reauthorization

• Benefit Changes
• ? Requires states to offer dental care through
  SCHIP, and allows them to extend dental benefits
  to children who have private insurance that does
  not include dental coverage
• ? Requires Mental Health Parity
• ? Adds EPSDT to Medicaid Alternative Benefit
  Plans
• ? Coordination between private/public enrollment
• - Qualifying events
• - Modification of employer buy-in requirements

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CHIP Reauthorization

• Medicaid Coordination
• ? Adds Medicaid managed care requirements
• ? Establishes Medicaid payment methodology for
  FQHCs
• ? Requires the identification and publishing of
  core set of child health quality measures for use
  under Medicaid and CHIP by 2010
• ? Modifies CHIP PERM requirements

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Federal - State Relationship

• ? CMS and states need to rebuild partnership
• ? Relationship needs to be more collaborative
• ? Partnership is critical with current economy,
  budget constraints, and plans for healthcare
  reform
• ? Interim head at CMSO committed to working with
  NASMD

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Richard Fenton Deputy Director of Health
Services Richard.Fenton_at_aphsa.org 202.682.0100 Ext
. 254