The Family Opportunity Act Medicaid Buyin Option

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• The Family Opportunity Act Medicaid Buy-in
  Option
• Deborah Allen, ScD
• The Catalyst Center Improving Financing of Care
  for CYSHCN

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Children and youth with special health care needs
arent they covered?

• The prevailing wisdom
• As long as you cover uninsured children CYSHCN
  will be okay
• Especially given
• Early intervention
• IDEA
• Title V
• Medicaid TEFRA/HCBS waiver programs
• SSI

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Not quite

• Yes, most children with special health care needs
  have health care coverage
• If low income, covered by Medicaid
• At higher income, covered by private insurance
• If disabilities are severe, may be covered under
  TEFRA or Medicaid HCBS waiver program
• But.

National Survey of Children With Special Health
Care Needs
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More than 18 of families reported hardship in
2005-6
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How much hardship?
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Family employment and income

• From National CYSHCN Survey
• 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
• Families of children with disabilities reported
  net assets 36,000 below other families

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When families are the payers of last resort

• Family debt, bankruptcy
• Children do not receive needed services
• Impact on other family members
• Less for food, clothing, housing, education,
  health care
• Marital/family stress

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Different pathways to hardship

• High expenses for items unique to families of
  CYSCHN
• Higher expenses for items every family needs
• Loss of employment income

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Federal FOA Legislation

• Part of the 2005 Deficit Reduction Act
• Medicaid Buy-in option is just one part
• Intended for
• Children with severe disabilities
• Children in families with income lt 300 of FPL
• Children who are privately insured or uninsured

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To Buy-in or Not to Buy-in That is the Option
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Whats in it for families?

• Better access to health care
• Which can result in improved health status
• Potential to address underinsurance
• Medicaid offers more robust coverage than the
  majority of private plans
• Many expenses which now fall to families could be
  covered
• Important limitations of waivers dont apply
• No institutional level of care requirement
• No enrollment cap
• Employment opportunities open up for families
• Opportunity to take raises, promotions, overtime,
  other employment

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Whats in it for states?

• Higher Medicaid income limits may encourage
  families to get/keep private coverage
• As primary coverage for child
• As coverage for other family members
• Allows for expansion of coverage to CYSHCN with
  federal match dollars

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Whats in it for 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

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Why prioritize a small group like CYSHCN?

• Medical debt and family financial hardship
• Family employment opportunities
• Potential savings in other areas of state
  spending
• Highlights visibility of CYSHCN as a population

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Other ways to expand coverage to CYSHCN

• SCHIP expansion to higher income levels
• Katie Beckett/TEFRA waiver creation/expansion
• Medicaid buy-in program created through a waiver

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Pre-FOA buy-in programs

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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.