1 New York’s Eligible but Uninsured Danielle Holahan United Hospital Fund April 11, 2008

2 Composition of New York’s Uninsured, million uninsured 23% 38% 40% 0.9m 0.5m Note: Data include all persons below age 65. Income (as a percent of the federal poverty level) reflects family income prior to any deductions or exclusions that would be taken into account when determining eligibility for public coverage. Estimates reflect an adjustment for the underreporting of public coverage on the Current Population Survey. Date do not sum to 100% due to rounding. Source: United Hospital Fund/Urban Institute tabulations of Medicaid/SCHIP eligibility, derived from the 2006 Current Population Survey.

3 New York’s Eligible but Uninsured Examined characteristics of eligible but uninsured (EBU) persons Compared characteristics of the EBU to their counterparts who are enrolled in public coverage Identified issues and potential policy reforms

4 % of Federal Poverty Level (FPL) Public Assistance Need Standard (varies by county) 133% 100% 150% 200% Infants Children Age 1-5 Pregnant Women Parents † Childless Adults †† New York State Eligibility for Medicaid, Child Health Plus, and Family Health Plus, 2005* Children/Adolescents Age 6-18 *** 100% 200% 100% 87% 200% 250% 100% 82% 100% *Medicaid and Child Health Plus A eligibility are expressed in net income while Child Health Plus B and Family Health Plus eligibility are expressed in gross income, as written in HCRA 2000 and Medicaid law. The 2007 Federal Poverty Level (FPL) is $10,210 for an individual and $17,170 for a family of three. ** Children with gross family income above 160% FPL are charged an income-related premium. Premiums for children with gross family income between % FPL are $9/month/child (up to $27) and $15/month/child (up to $45) for children with gross family income between % FPL. ***Through March 2005, the Child Health Plus A eligibility level for children ages 6-18 was 133% FPL. Effective April 2005, the Child Health Plus A eligibility level for children ages 6-18 years was lowered to 100%FPL, at which time children in that age range with gross family income between 100%FPL and 133% FPL who were enrolled in Child Health Plus A were shifted into Child Health Plus B. † “Parent” is defined as a parent of a child under 21 years who lives in the household. Medicaid eligibility includes disabled adults and 19- and 20-year-olds up to 87% FPL. FHP eligibility includes 19- and 20-year-olds living with their parents up to 150% FPL. †† “Childless adult” is defined as a non-disabled adult age 21 years and over who does not have a child living in the household. FHP eligibility includes 19- and 20-year-olds not living with their parents up to 100% FPL. Note: Low-income, uninsured women who are diagnosed with breast or cervical cancer through screenings in New York’s Healthy Women Partnerships program are eligible for Medicaid coverage. Women must have income levels below 250% FPL to qualify for the screenings. Females and males of childbearing age with income up to 200% FPL are eligible for Medicaid Family Planning Services. As of July 2003, disabled workers age with net income of up to 250%FPL and non-exempt resources up to $10,000 are eligible for Medicaid coverage through the Medicaid Buy-In for Working People with Disabilities program (MBIWPD); enrollees with incomes above 150% FPL will eventually be subject to an income-related premium.

5 Notes: Child Health Plus A/Medicaid data and Child Health Plus B data include children/adolescents age 0–18. Medicaid/Family Health Plus data include adults age 19–64. Numbers may not sum to totals because of rounding. Source: United Hospital Fund-Urban Institute, “Health Insurance Coverage in New York, ” November , ,000 Estimates of Uninsured Children/Adolescents and Nonelderly Adults Eligible for Public Coverage, New York State, ,000

6 Notes: Child Health Plus A/Medicaid data and Child Health Plus B data include children/adolescents age 0–18. Adult eligibility estimates include Family Health Plus. Source: United Hospital Fund-Urban Institute, “Health Insurance Coverage in New York, ,” November Eligible but uninsured Eligible but uninsured Percentage of Uninsured Children/Adolescents and Nonelderly Adults Eligible for Public Coverage, New York State, 2005 Eligible but uninsured Child Health Plus A (Medicaid for Children)/Medicaid eligible but uninsured Child Health Plus B eligible but uninsured Ineligible Total eligible but uninsured

7 Overview: Characteristics of New York’s Eligible but Uninsured Workers/in working families In excellent/very good health Non-US citizens (relative to those enrolled) Among children/adolescents: the EBU are more likely to be adolescents Among adults: the EBU are overwhelmingly childless

8 Characteristics of EBU Children/Adolescents Ages 6-18 Poor Live in working families A mix of races/ethnicities U.S. citizens Excellent/very good health

9 Compared with their enrolled counterparts, EBU children/adolescents are more likely to be … Older (age 6-18) Non-U.S. citizens And they appear more likely to… Have income above 100% FPL Be in excellent/very good health

10 Characteristics of EBU Adults Young adults Childless Poor A mix of races/ethnicities U.S. citizens Excellent/very good health

11 Compared with their enrolled counterparts, EBU adults are more likely to be … Young adults (age 19-34) Childless Poor Workers “Other” races Non-U.S. citizens Excellent/very good health

12 Potential Issues Workers: –May misunderstand eligibility rules (e.g., workers are eligible) –May have difficulty applying if requires time off from work Immigration-related concerns include: –Misperceptions about public charge issues –Concern that government may pursue sponsors –Difficulty with work documentation requirements –Language access issues May not recognize “value” of coverage if healthy Adolescents’ privacy concerns Childless adults face more complex eligibility rules/procedures than parents

13 Findings from the Literature New York has a greater retention problem than other states Body of research documents renewal rates in New York of 50-67% Factors associated with poor retention: –Administrative barriers –S-CHIP premiums –Operating separate Medicaid and SCHIP programs –DRA citizenship documentation requirements

14 Reforms that may hold promise Administrative renewal “Ex Parte” review Telephone/internet renewal “Radical” reform will be needed to reach 95% participation rate “target”: –Automatic enrollment