Putting CHIPRA to Work: Making 4 Million Kids a Reality! Tricia Brooks & Jocelyn Guyer Getting to the Finish Line Conference July 14, 2009

So what is happening with CHIPRA?

Maybe Cindy Knows! Former Queen of Child Health Advocates

Read All About It! 3 State Health Official letters CHIPRA overview, pregnant women with SPA template, tribal consultation Statement on qualifying event Final CHIP allocations announced Outreach Grant RFP released Key dates passed; guidance needed CIT-DOC changes, express lane, dental-only, performance bonus 5/8, and more

Source: As of July 1, 2009, based on a review by the Center for Children and Families of state initiatives in 2008 and States Moving Forward 2009 Implemented 2008 Legislation to Improve Child and Family Coverage (5 states) FL NC SC GA LATX AL AR KS OKAZ TN MS NV UT NM CA WY ID OR ND SD NE MT MO IN MI WI IL ME OH KY HI AK PA WV VA CT NJ DE MD RI NH VT DC MA Enacted New Legislation/Took Administrative Action to Improve Child and Family Coverage (17 states) CO NY MN WA IA

14 Things for States To Do CIT-DOC changes 30-day premium grace Qualifying events Eliminate 5-yr bar SSA citizenship match Dental only coverage Pregnant women Income eligibility expansion Dental equivalency Mental health parity Express lane Outreach grants Enhanced match for translation/interpretation Performance bonuses Requirements Options

For Discussion! What do we know? What do we need to know? What’s happening in the states? Is this a priority for your state? What’s the impact of health care reform? Need for peer-to-peer connections, messaging or technical assistance? Other questions?

Getting a Jump on Health Reform with CHIP Expansions Income eligibility expansion Up to 300% FPL >300% reverts to Medicaid match Pregnant women in CHIP Medicaid up to 185% FPL; CHIP match up to 300% FPL Can keep unborn child option

Source: As of July 1, 2009, based on a review by the Center for Children and Families of state initiatives in 2008 and CHIP Expansion Enactments or Implementations 2009 FL NC SC GA LATX AL AR KS OKAZ TN MS NV UT NM CA WY ID OR ND SD NE MT MO IN MI WI IL ME OH KY HI AK PA WV VA CT NJ DE MD RI NH VT DC MA Enacted/Implemented New Legislation Expand Coverage CO NY MN WA IA

The 5-year Bar: Heavy Lift or Piece of Cake? Lawfully Residing Children Pregnant Women Stories from the states

So the Mouth Really is Connected to the Body! Dental mandate & equivalency requirement Need benefit definition 3 benchmarks (FEP, SEP or largest private plan) Impact on cost-sharing cap? Dental-only coverage for children ineligible for CHIP only because they have medical coverage Messaging matters - is this a wrap?

Parity But Not for All No mental health mandate, but... Mental health parity required if benefits are offered Financial requirements and treatment restrictions cannot be more restrictive than medical and surgical (Public Health Service Act §2705(a)) EPSDT plans comply Effective April 1, 2009

Qualifying Event: Not an Olympic Trial Loss of Medicaid or CHIP is now a qualifying event for enrollment outside open enrollment period Clarity about ERISA plans Also amends Public Health Service Act (§2701(f)) but clarification may be needed in state law to ensure compliance for all state regulated plans

Outreach Grants: Connecting Strategies to Enrollment & Retention Strategies must result in measurable enrollment/retention gains Robust data tracking, reporting, analysis of effectiveness Must refine, revise strategies when data indicate goals are not being achieved

Outreach Grants: The Devil’s in the Details! Of particular interest or given weight/favor: Strategies that can be replicated Innovative uses of technology Specific list of target populations Proposals with in-kind or other support Conference call 7/22; proposal due 8/6 State applicants have more requirements Non-state applicants need state support or show ability to collect and report data

Can You Really Hear Me Now? Translation & Interpretation Enhanced funding (75% or CHIP match + 5%) Explicitly funds full scope of services Outreach, enrollment, retention, access to benefits

Show Me the Money! Minimum 30-day grace period for paying premiums Does policy apply to enrollment fees? Is your state implementing premiums; increasing premiums? Does your state have multiple payment options? What about affordability?

Got Cit-Doc? Already in effect (but some states awaiting guidance) Reasonable opportunity Babies born to Medicaid moms Tribal document January 1, 2010 SSA Electronic Match CHIP Implementation Require Revision of current regulations?

Get Your Motor Running! Ready for adventure, whatever comes your way? Try Express Lane Eligibility! NJ income tax project cited by Secretary Sebelius LA working on express lane renewals

Looking for a Bonus? Specific guidance needed on Medicaid Performance Bonus Express lane Adequacy of implementation of some strategies Enrollment data and targets Source Decline in child population Exclude emergency services to immigrants from target calculation

What Else?