Health Insurance Enrollment for Tennessee's Children Kinika Young Director of Children’s Health Chris Coleman Staff Attorney November 30, 2017

1.5 million children in Tennessee https://www.census.gov/quickfacts/fact/table/TN/PST045216 1.5 million children in Tennessee

How many of them need health insurance?

ALL OF THEM!

Medicaid/TennCare – 793,000 CHIP/TennCare Standard & CoverKids – 106,000 Marketplace – 19,000 Privately insured – 640,000 Uninsured – 53,000 FY 2016 https://ccf.georgetown.edu/wp-content/uploads/2017/02/Tennessee-Medicaid-CHIP-new-v1.pdf; TennCare enrollment is from October 2017 report: https://tn.gov/assets/entities/tenncare/attachments/fte_201710.pdf Private insurance figure is based on 41% figure from Kaiser as the percent of TN kids with ESI- http://www.kff.org/other/state-indicator/rate-by-age-2/?currentTimeframe=0&selectedRows=%7B%22states%22:%7B%22tennessee%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D Population Reference Bureau, analysis of data from the U.S. Census Bureau, 2008-2016 American Community Survey.

Insurance Coverage for Children Almost every child is eligible for something!

Public Coverage Categories TennCare (Medicaid) CoverKids (CHIP) TennCare Standard

TennCare 793,000 children ½ the kids in the state ½ of the babies born in the state

TennCare for Children Income Limits Children up to age 19 can get TennCare. TennCare for Children Income Limits  HH Size 1 2 3 4 5 6 7 Child 6-18: 138% FPL 1387 1868 2348 2829 3310 3790 4271 Child 1-5: 147% FPL 1477 1989 2501 3014 3526 4038 4550 <1: 200% FPL 2010 2707 3403 4100 4797 5493 6190 The ACA raised the minimum income eligibility thresholds for kids age 6-19 from 100% FPL (about $20k/year for a family of 3) to 138% (about $28k/year).

CoverKids Income Limits Kids under 19 can get coverage under the state’s CHIP program, called CoverKids. Cannot be enrolled in another health plan. Apply through the federal marketplace. CoverKids Income Limits  HH Size 1 2 3 4 5 6 7 255% FPL 2502 3386 4270 5153 6038 6922 7806

TennCare Standard Children under 19 that are on TennCare but become ineligible can sometimes roll into TennCare Standard. No access to employee health insurance Eligible if they are either Below 212% FPL, or have a qualifying health condition

Applying for TennCare Explain DHS role *PE is only available for pregnant women, women with breast or cervical cancer, and newborns.

Applying for TennCare Exceptions: Presumptive Eligibility program CHOICES long-term care program Medicare Savings Programs (QMB, SLMB, QI, QDWI). Explain DHS role *PE is only available for pregnant women, women with breast or cervical cancer, and newborns.

Newborns TennCare Deeming CoverKids Deeming Newborn Presumptive Eligibility (NPE)

TennCare Deeming For moms on TennCare, the child is deemed eligible for TennCare for 1 year. The coverage starts on the date of birth. Call Tennessee Health Connection to enroll child (1-855-259-0701).

CoverKids Deeming For moms on CoverKids, the child is deemed eligible for CoverKids for 12 months. Coverage starts from the date the mother enrolled in CoverKids. Call CoverKids (1-866-620-8864) to report the birth.

Newborn Presumptive Eligibility (NPE) For babies (12 months and younger) born to mothers on private insurance or no insurance Coverage starts on the date of application. NHCHC Question: What is “Presumptive Hospital Eligibility” and how can our clients take advantage of this? Address here that hospitals in TN do not have presumptive “power”.

How to apply for NPE: Parents can call Tennessee Health Connection (1-855-259-0701) to enroll a child in presumptive eligibility. Parents must still do an application on the Marketplace. Child remains eligible until a final eligibility determination is made on the full application.

Closing the Coverage Gap 280,000 Tennesseans have no access to health care coverage. 31 other states have closed their gap.

Private Coverage Categories ACA Individual Marketplace Employer-sponsored insurance

ACA Individual Marketplace Open enrollment – Nov. 1-Dec 15 Toll-free 24/7 assistance – 844-644-5443 Applications submitted through healthcare.gov It’s important for everyone to shop the marketplace to see their options, even if you are on an auto-renewal plan. Changes from last year to this year with affordability

Employer-Sponsored Insurance 46.8% of private sector establishments in Tennessee offer health insurance benefits. 53% of Tennesseans have employer-sponsored insurance. Not all plans offer dependent benefits. If they do, they aren’t necessarily affordable. Source 1: https://www.kff.org/other/state-indicator/percent-of-firms-offering-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D   Source 2: https://www.kff.org/private-insurance/state-indicator/rate-by-employment-status-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D It’s not because people aren’t working – 73% of Medicaid recipients are in working families.

Long-term effects of comprehensive coverage for kids Do better in school Miss fewer school days due to illness or injury Are more likely to finish high school, attend college, and graduate from college Have fewer emergency room visits and hospitalizations as adults Earn more as adults

ACA = big coverage gains for children Source: CCF analysis of ACS single-year data, 2008-2015

What about the 53,000 kids who don’t have health insurance in Tennessee?

Uninsured Poverty Level 2016 Below 100% 15,000 (4%) 100%-149% 9,000 (5%) 150%-199% 7,000 (4%) 200%-299% 10,000 (4%) 300% or above 11,000 (2%)

Uninsured Age 2016 0-5 14,000 (3%) 6-17 39,000 (4%) http://datacenter.kidscount.org/data/tables/32-children-without-health-insurance-by-age-group?loc=1&loct=1#detailed/2/44/false/870,573,869,36,133/17,18,19/303,304

Threats to coverage

CHIP Reauthorization The federal government pays 99% of the cost of our CHIP combination program, TennCare Standard and CoverKids Funding expired September 30, 2017 Congress still has not reauthorized CHIP funding There is bipartisan, bicameral agreement on a clean 5-year extension BUT arguments over offsets and competing legislative priorities have crowded out CHIP

CHIP Reauthorization Several states have tapped into federal emergency funds and state rainy day funds to keep their programs operational. Tennessee would not have to take action until next spring, but our separate CHIP program, CoverKids, could be at risk if Congress does not act before the spring. The only federal parameter for notice for shutting down a program is a “reasonable” length of time. Tennessee has not announced any shutdown or contingency plans.

165,000 children and adults have lost their coverage in the past 9 months. The numbers are on the uptick by rising slower than they were cut.

House Budget Kills ACA by defunding it $200 billion in cuts to mandatory programs Medicaid per capita caps or block grants Medicaid work requirements Restructuring MediCARE, including means-testing Also cuts SNAP. Rep. Diane Black (R-TN) is chair of the House Budget Committee.

Tax Reform

Barriers Income Immigration status Parents switching employers Family glitch Death of a parent

Who can help? Tennessee Justice Center Tennessee Health Care Campaign Family and Children’s Services

How can YOU help? Join us in the new year as begin our Enroll Every Eligible Child Campaign! Sign our CHIP sign-on letter: https://www.tnjustice.org/chip-sign-on-letter/. Call our senators and tell them to vote no on the Senate Tax Cut and Jobs Act. If your work involves children and you’d like to know how to help, please reach out to kyoung@tnjustice.org.

How can YOU help?

Get involved! Join our email listserv: https://goo.gl/GSTosf Follow us on Facebook: https://www.facebook.com/tnjustice/ Follow us on Twitter: https://twitter.com/tnjusticecenter

Continuing Education Credit If you would like CLE or CEU credit, please email awalton@tnjustice.org.

Questions?

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