Childrens Health Insurance in Texas: Where are We

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Childrens Health Insurance in Texas Where are
We?
900 Lydia Street - Austin, Texas 78702 Phone
[phone] fax [phone] - www.cppp.org

• Annual Outreach Conference
• January 20 21, 2004
• Austin, Texas
• Still Making A Difference in Tough Times
• Anne Dunkelberg, Senior Policy Analyst
  (dunkelberg_at_cppp.org)

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Health Care for Poor Low-Income Children

• Medicaid
• December 2003 2.5 million Texans enrolled in
  Medicaid.
• Two-thirds of Medicaid enrollees (1.665 million)
  were ages 0 to 18.
• Childrens Health Insurance Program (CHIP)
• as of September 1, 2003 -- 507,259 children
• as of January 1, 2004 -- 413,094 (416,378
  corrected)

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Texas Child Medicaid Enrollmentbefore and after
SB 43
Source Texas Health and Human Services
Commission, MED-ID files (not recip/month)
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Changes to Childrens Medicaid Simplification

• Changes to childrens Medicaid simplification
  were built into budget for 2004-05. What the
  LEGISLATION said these were
• maintaining current 6-month continuous coverage
  (rather than the phase-in of a 12-month period
  mandated by SB 43 of the 2001 session),
• more rigorous verification of asset information
  (as opposed to imposing greater documentation
  demands on parents?)
• maintain access to mail and telephone application
  and renewal for most children, but DHS is given
  discretion to request in-person interviews in
  selected cases.
• As such, there is reason to hope that the
  application and renewal process can continue to
  be relatively simple for most parents.
• These changes are assumed to slow growth in
  childrens Medicaid enrollment to a very
  (unrealistically?) low rate.
• HHSC estimates these policy changes would reduce
  projected 2005 Medicaid enrollment by 332,198
  children.
• In addition, the conference committee adopted
  House Medicaid caseload assumptions (which the
  House used to reduce Medicaid state General
  Revenue funding by 524 million), which actually
  assume child Medicaid caseloads even lower than
  those projected to result from the changes to
  Medicaid simplification.
• In sum, child Medicaid enrollment, projected in
  February 2003 to grow by 17.3 in 2004 and 8.4
  in 2005, is now assumed to grow by only 2 and
  1.

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What Will these Changes Mean?

• Under Childrens Medicaid Simplification
• Approval of initial applications increased from
  about 58 to 70,
• Renewals increased from 73 to 78, and
• Cases denied for failure to return requested
  information dropped from almost 13 to less than
  2.
• Will the new policies reverse this progress?
• We believe that program integrity can be
  maintained and improved without driving up the
  number of procedural denials. BUT, adequate
  staffing levels at DHS are a MUST.

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Latest on Childrens Medicaid

• December enrollments are typically lower because
  of early cut-off dates.
• Early indications of January enrollment suggest
  an actual net DROP in child enrollment may have
  occurred.
• BUT, we will need another month or 2 of data
  before we know if this is a trend.
• Possible Causes
• In October 2003, DHS began mailing out NEW child
  Medicaid renewal packets, which require parents
  to complete the entire 4-page application again,
  with new income documentation.
• DHS began running data broker checks on child
  Medicaid renewals (and apps?) in August or
  September (BEFORE they began requesting a full
  update) compare to credit records and vehicle
  registration databases. If info is inconsistent,
  parents are asked for additional info and/or
  documents, and eligibility can be cut off if
  they do not respond quickly enough.
• Recent computer system changes automatically
  close child cases (in simplified groups) at 6
  months unless a renewal is processed (opposite of
  old system).

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Texas CHIP EnrollmentMay 2000 to January
2004With projected FY 2004-2005 enrollment
before and after 78th Texas Legislature
Source All figures from Texas Health and Human
Services Commission
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Changing Texas CHIP PopulationIncome
Distribution December 2003
12/00 73 below 150 FPL 12/02 71 below 150
FPL 12/03 66 below 150 FPL
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Changes to CHIP

• CHIP benefits are eliminated
• Dental services Hospice Care Services Skilled
  Nursing Facilities Tobacco Cessation programs
  Vision benefit, including eyeglasses and exams,
  and Chiropractic services.
• Mental Health Restoration Governor announced on
  10/20/03 that MH coverage will be restored to
  include 30 inpatient MH days, 30 outpatient
  visits, detox services, 30 days of inpatient drug
  treatment, and 30 outpatient substance abuse
  visits.
• This will be added to the limited psychiatric
  benefits 1 outpatient diagnostic visit per
  enrollment period, 6 medication management visits
  per enrollment period, and Consultation in an
  inpatient or emergency setting after
  stabilization of an emergency condition.
• Federal CHIP authorities encouraged Texas to
  increase this benefit, as Texas would have set a
  precedent by eliminating MH coverage.
• There is a proposal to try to have Community MHMR
  authorities provide mental health services to
  CHIP children who exhaust their covered MH
  benefits, using the Centers existing funds to
  draw the CHIP federal match. However, this is
  very preliminary.

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Changes to CHIP

• Changes to Co-payments and Premiums
• Families below 100 Poverty now have 3 office
  visit co-pay, 10 hospital inpatient co-pay,
  1.25-of-income annual cap on co-pays (was 100).
  (NO premium, and E.R., and Rx stay the same.)
• Families 101-150 FPL 15 monthly premium for
  family (replaces 15 annual enrollment fee)
  office visit co-pay increased to 5
  1.25-of-income annual cap on co-pays (was 100).
  (All other charges unchanged.)
• Families 151-185 FPL Monthly premium increased
  to 20 office visit co-pay increased to 7.
  (All other charges unchanged.)
• Families 185-200 FPL Monthly premium increased
  to 25. (All other charges unchanged.)
• Asset Test for 150 FPL
• Modeled after Texas Food Stamp Policy.
• 5,000 countable limit, includes checking,
  savings, and countable vehicle values.
• Exempt 15,000 of best vehicles trade-in
  value exempt 4,650 of each additional vehicle
  value. A vehicle used for work (not just to get
  to and from work) MAY be exempted completely.
• Six-Month Coverage Period Renewal packets began
  to go out to families in month number 4 or 10 of
  coverage this month (9/03). All new enrollees
  after 10/31/03 will have 6-month coverage.
• Income Disregards Eliminated No more earned
  income, child support paid/received, or child or
  adult day care cost deductions. State reviewed
  all cases, and families over-income under new
  rules got denial notice unless they presented
  corrected info they were terminated effective
  November.

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Changes to CHIP
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Notes on CHIP Changes

• Tho about 16,700 higher-income children were cut
  from CHIP rolls eff. 11/03 due to elimination of
  income disregards, the CHIP enrollment by
  Income table shows that enrollment in the BELOW
  150 FPL group is declining. (See Pie charts).
• CHIP enrollment, renewal, disenrollment table
  shows that New Enrollment is taking a big hit,
  but Total Disenrollment rates since 9/2003 are
  also higher.
• To understand the trends, we will need for HHSC
  to begin providing additional detail on
  disenrollment e.g., numbers due to failure to
  complete renewal, failure to remit premiums