Children’s Health Coverage Observations from Louisiana Children’s Health Coverage—A Primer Luncheon Briefing Alliance for Health Reform Kaiser Commission on Medicaid & the Uninsured Washington, DC February 2, 2009 J. Ruth Kennedy La. Dept of Health & Hospitals

Lessons From Our Decade of Increasing Coverage for Children Focus equally on Medicaid and SCHIP Administrative simplification matters Retaining eligible children at renewal is essential Needs differ in 2009 than in 1997 Covering (virtually) all kids is achievable 2

3 Children’s Health Coverage in Louisiana a Decade Ago High rate of poverty and poor health outcomes Absolute minimum levels of coverage for children Onerous application and verification requirements Nation’s third highest percentage of uninsured kids Almost 1 in 3 low income children had no health coverage

4 “A Rising Tide Lifts All Boats” —John F. Kennedy Streamlining/Simplifying SCHIP Eligibility & Enrollment Policies Streamlining/Simplifying Medicaid Eligibility & Enrollment Policies for Children

Most Louisiana Children in Public Coverage Are Enrolled in Medicaid 5

Many Still Uninsured Kids Live Below Poverty Level Literacy issues Parental priorities—Maslow’s hierarchy of needs “Simplicity” of enrollment is relative High mobility and lack of long term attachments 6  Highest percentage of La uninsured low income children: 50 to 100% of FPL

The Case for Administrative Simplification Essential to enroll and retain most vulnerable children Possible to achieve without compromising program integrity Accelerates enrollment—access to care for eligible children Positive administrative impact for cash strapped states Advances in technology present new opportunities 7

What Difference Does “Fixing” Renewals Make? 10,425 SCHIP Kids—Couldn’t renew 90 34,214 Medicaid Kids—Couldn’t renew ,639 Total Kids—Couldn’t renew <1% (2008 Rate) August % (2001 Rate) 9,822

Unexpected Roadblock in La on the Road to 300% SCHIP reauthorization philosophical debate CMS “August 17 th ” letter set new conditions for expansion 95% of kids <200% already covered Five year ESI trend for kids in state La expansion currently at 250%

The New “Hole in the Bucket” Modest raises are putting families >200% FPL Children moving from SCHIP or Medicaid coverage to uninsured 85% of enrollees in new LaCHIP Affordable Plan Received Medicaid or LaCHIP in last 36 months Did not voluntarily drop ESI in last 12 months Increasing income limits will be essential to maintain gains 10

We Can See Light at the End of the Tunnel 11 Children with public coverage in La have more than doubled since 1999 State survey by LSU indicates uninsured rate for kids is 5.4% “Culture” of eligibility has radically changed Public and legislative support for children’s coverage SCHIP reauthorization contains additional resources

12 Ruth Kennedy LaCHIP/Medicaid Eligibility Division Director La Department of Health & Hospitals 427 N 4 th St Baton Rouge, LA Telephone: Fax: Blackberry: dhh.la.gov Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has! — Dr. Margaret Mead