CHIPRA Performance Bonuses for Medicaid National Covering Kids & Families Network Webinar – February 22, 2010 Tricia Brooks

The Performance Bonus To reward states for (and help offset the cost of ) enrolling low-income children in Medicaid

FFY 09 Bonus Awards

Performance Bonus - The Basics Enrollment Targets Cumulative over time Medicaid only Eligibility as of July 1, 2008 Enrollment & Retention Measures At least 5 of 8 Apply to both Medicaid and CHIP Exception - premium assistance

The Bonus 15% state share of cost for enrollment > target 62.5% state share of cost for enrollment > 110% target How can it be used? Cannot be used to draw down federal match Otherwise, not restricted

What Have We Learned from Guidance?

Enrollment Targets Base Year Mo. Ave Enrollment /- % Change in Child Pop + 4% /- % Change in Child Pop + 4% /- % Change in Child Pop + 3.5% per year /- % Change in Child Pop + 3% per year /- % Change in Child Pop + 2% per year Adjusted by increase or decrease in child population!

12-Month Continuous Eligibility Guarantees 12-months of coverage regardless of changes except these: Child moves out of state, ages out or passes away Voluntary request for disenrollment Is determined eligible and enrolled in Medicaid with no gap in coverage Nonpayment of premium (temporarily allowed pending further guidance) 22 states have continuous eligibility in both programs; 8 more in CHIP alone 8 of the P/B states got credit

The Straight Forward Measures No asset test or administrative verification of assets 48 states have eliminated the asset test All 9 P/B states got credit No in-person interview required at enrollment or renewal 48 states require no face-to-face interview for both programs at enrollment, 50 at renewal All 9 P/B states got credit

Same Application and Renewal Forms and Procedures Interchangeable forms are OK (“no wrong door” forms) Form generates referral to other program Supplemental forms to request information for one program is only allowed if there is a difference in Federal program rules Information verification process Procedure for verifying all eligibility criteria must be the same Timeline for verifying information must be the same

How Do States Fare on Joint Forms and Same Verification Process? States that implemented CHIP as a Medicaid expansion would qualify automatically (12) No specific source of information available to determine precisely which states could qualify 48 states have a joint application 31 states have a joint renewal form Same verification process is harder to assess All 9 P/B states got credit

Administrative Renewals or Ex Parte Renewals Administrative verification of income is central to this measure 16 States do so in both programs, 3 in CHIP alone 8 P/B states got credit Administrative renewals Send preprinted form with eligibility information Include notice that coverage will be renewed unless state receives other information Signature and return of form to confirm desire to maintain coverage is allowed State verifies eligibility using electronic/other means

Ex Parte renewals State makes a redetermination to the maximum extent possible using information available to it References SMD Letter 4/22/97 Can’t close Medicaid due to loss of eligibility for cash assistance; must review other eligibility categories, use information in SDX or BENDEX Further guidance coming with regulations Administrative Renewals or Ex Parte Renewals

Presumptive Eligibility Allows states to use trained, qualified entities to make preliminary determination pending the formal eligibility process Ensures that kids get services while completing the process May include hospitals, community health centers, WIC, HeadStart and other programs receiving federal funds 11 states currently meet this requirement; 3 have PE in Medicaid only 4 P/B states received credit

Express Lane Eligibility Guidance issued separate from P/B Requires State Plan Amendment (SPA) that: Details the ELE agency Identifies if it applies to new applications, renewals or both Describes which screen and enroll process is used 6 states have submitted ELE SPA’s Not clear if it applies to both programs No state got credit this year due to timing

Premium Assistance Programs Only measure that requires implementation in either Medicaid or CHIP Must be one of the new premium assistance programs enacted through CHIPRA Medicaid 1906A CHIPRA 2105(c)(10) 1 State has picked up new premium assistance option No P/B state received credit

FFY 10 Performance Bonus If legislation is required for 1 of the 8 measures, it must be enacted by October 1, 2009 Measure would need to be in place for at least 6 months or on April 1, 2010 and remain in place through September 30, 2010

Next Steps Regulations will provide more detail Opportunity to comment on proposed regulations before final adoption President’s budget anticipates increase to $240 million in FFY 11

Inquiring Minds Want to Know Are there ways to make the performance bonuses more accessible? Phased in implementation? Targets that recognize states with low uninsured rates? Year-to-year targets not based on cumulative gains? How can advocates best engage to encourage states to qualify?

Contact Information Tricia Brooks Senior Fellow Georgetown University Center for Children and Families