Is West Virginia’s Success in Covering 98% of Children at Risk? Tricia Brooks WVAHC Medicaid Summit September 25, 2017

Children’s Coverage In West Virginia at Historic High Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016. Preliminary analysis of 2016 data from the American Community Survey.

Success in Covering Kids Largely Due to Medicaid and CHIP Source: Urban Institute analysis over time.

Eligibility for West Virginia Children Source: State Health Access Data Assistance Center (SHADAC) analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) file

Public Coverage for West Virginia Children This is SEDS ever-enrolled for Medicaid and CHIP Sources: SEDS FY 2016 Ever-Enrolled in Medicaid/CHIP “Health Insurance Marketplaces 2016 Open Enrollment Period: March Enrollment Report.” ASPE. March 11, 2016.

Coverage for West Virginia’s Most Vulnerable Children Children with income <138% FPL Children under age 6 Children with special health care needs Children in foster care Newborns Source: https://ccf.georgetown.edu/wp-content/uploads/2017/02/West-Virginia-Medicaid-CHIP-new-v1.pdf

Coverage that Helps Address Racial/Ethnic Disparities Source: State Health Access Data Assistance Center (SHADAC) analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) file

Medicaid Enrollment Resources By county: https://ccf.georgetown.edu/percent-of-children-covered-by-medicaidchip-by-county-2011-2015/ By congressional district: https://ccf.georgetown.edu/state-childrens-health-facts/percent-of-children-covered-by-medicaidchip-by-congressional-district-2015/ By school district: https://ccf.georgetown.edu/medicaidchip-coverage-by-school-districts/ In rural areas: https://ccf.georgetown.edu/map/the-percent-of-children-in-small-towns-and-rural-areas-covered-by-medicaid-201415/state/WV/

Child-Focused Benefits Medicaid benefits = Early and Periodic Screening Diagnostic and Treatment services (EPSDT) Strong focus on healthy development Early detection and treatment helps ensure school readiness

Medicaid Helps Kids Succeed in School and in Life

Medicaid Is Significant Source of Federal Funding and Driver of the WV’s Health Sector Economy

Childhood Medicaid Yields Strong Government Return on Investment Effect of childhood Medicaid in adulthood Outcome Government Savings (ROI) Better health Reduction in hospitalizations and emergency room visits Government recouped 3-5% of initial cost of expanding Medicaid in one year (savings of $22-$34 million) Higher incomes Increased tax payments and reduced receipt of Earned Income Tax Credit (EITC) The increase in tax payments alone returned nearly one-third (32 cents on the dollar) of the initial cost of expanded childhood Medicaid by the time children reached age 28 and 56 cents of each dollar by the time they reached age 60. Incredible foundational source of health coverage for kids – not only ensuring they have coverage and financial stability as children, but also healthier and more productive adulthoods that contribute to their own economic mobility as well as a successful economy. Medicaid is foundational source of health coverage for kids, but also investment in their future If benefits of childhood Medicaid eligibility continue and if other financial benefits to the government were included in the authors’ calculations (increased tax receipt, better educational outcomes, take-up rate, and lower mortality), the savings may be even more substantial. Source: A. Chester and J. Alker, “Medicaid at 50.”

Access to Care in Medicaid Source: Georgetown University Center for Children and Families, “Medicaid Provides Needed Access to Care for Children and Families,” March 2017.

Access to Care in Medicaid Source: JAMA Pediatrics, “Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families,” November 2015.

WV Reporting on Child Health Quality Key quality initiative in Medicaid and CHIP – Child Core Set of Health Care Quality Core set reporting allows comparison on key child health measures across states and programs WV reported 19 of 24 measures that address key aspects of access and quality in Medicaid and CHIP (2015) WV reported most separately for Medicaid and CHIP Source: https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html

West Virginia Compared to Other States Top Quartile (Highest) Next to Top Quartile PCP access 12-24 months PCP access 2–6 years PCP access 12-19 years Frequency of prenatal care E.D. visits Asthma med management F/U ADHD Med (maintenance) PCP access; 7-11 years Well child visits 0-15 months Well child visits 3-6 years Well-care visits 12-21 years Adolescents immunizations HPV Vaccines Timeliness of prenatal care F/U ADHD Med (initiation) 4 of 5 WV MCO Performance Measures

West Virginia Compared to Other States Next to Bottom Quartile Not Reported Childhood immunizations F/U after mental illness hospitalization (30 days) Preventive dental service Percentage of low-weigh births Behavioral health risk assessment for pregnant women Child and adolescent suicide risk assessment CAHPS health plan Pediatric central line-associated blood stream infections Bottom Quartile (Lowest) Chlamydia screening BMI assessment F/U after mental illness hospitalization (7 days) Dental sealants 6-9 years Source: https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html

What’s at Risk?

Caps & Cuts to Medicaid = Cuts to Coverage for Kids, Families, Seniors, and People with Disabilities

Coverage for Parents is Good for Kids Children’s healthy development relies on healthy parents Covering parents provides economic security for the whole family Medicaid expansion welcome mat effect on children’s coverage

Public Opinion Favors Medicaid

Favorable Opinion of Medicaid Across Voters of All Political Stripes Total 70% Democrats, 83% Independents, 68% Republicans, 58% Source: Perry/Udem Survey 2016

Few Voters Support Cuts to Medicaid Total, 38%% Democrats, 58% Independents, 34% Republicans, 19% Total, 44% Democrats, 36% Independents, 50% Republicans, 48% Total, 16% Democrats, 4% Independents, 16% Republicans, 32% Source: Perry/Udem Survey 2016

But Where Do We Go From Here? Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016. Preliminary analysis of 2016 data from the American Community Survey.

Protecting and Preserving Medicaid Guaranteed enrollment (entitlement) Dependable federal financial partnership No enrollment caps Adjusts with health care costs Child-focused benefits (EPSDT) Cost-sharing protections (5% of family income) Parent coverage Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016. Preliminary analysis of 2016 data from the American Community Survey.

Limiting EPSDT to Disabled Children Would be Short-Sighted ~71,000 West Virginia children on Medicaid with special health care needs ~9,000 SSI children with disabilities on Medicaid Tens of thousands of kids with special health care needs left out in the cold Children with episodic need (i.e. treatable hearing problem) http://childhealthdata.org/browse/survey/results?q=2546&r=1&g=466&r2=37&a=4416 https://www.ssa.gov/policy/docs/statcomps/ssi_sc/2012/

CHIP Funding Expires in 5 Days Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016. Preliminary analysis of 2016 data from the American Community Survey.

CHIP Funding Must Be Extended CHIP is a block grant; the current appropriation expires 9/30/17 Funds coverage for children in Medicaid in W.V. with income between [138%-163%] - 300%. Most states have some carryover funds WV projects 1st quarter 2018 Graham-Cassidy has stalled bipartisan effort started in Senate (Hatch-Wyden) and planned legislative markup in House planned for 9/27 Source: J. Alker, A. Chester, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Georgetown University Center for Children and Families, October 2016. Preliminary analysis of 2016 data from the American Community Survey.

CHIP Advocates pushing for “clean” 5-year CHIP extension Key issues Enhanced match (bump of 23 percentage points) Maintenance of effort provision (expires 2019) Vehicle for other health care reform that could get messy

Hatch-Wyden 5-year funding extension with contingency funds MOE extended through 2022 Fully funds 23 percentage points bump in federal match for 2 years (2018-19); half bump 11.5 percentage points for 2020 Extends express lane eligibility Funding for grant programs Outreach Obesity Demonstration projects Pediatric Quality Measures Program

For More Information Tricia Brooks pab62@georgetown.edu Center for Children and Families website ccf.georgetown.edu Say Ahhh! Our child health policy blog http://ccf.georgetown.edu/blog/ 31