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

2. 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 Preliminary analysis of 2016 data from the American Community Survey.

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

4. 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

5. 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.

6. 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:

7. 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

8. Medicaid Enrollment Resources
By county:
By congressional district:
By school district:
In rural areas:

9. 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

10. Medicaid Helps Kids Succeed in School and in Life

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

12. 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.”

13. 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.

14. 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.

15. 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:

16. West Virginia Compared to Other States
Top Quartile (Highest)
Next to Top Quartile
PCP access months
PCP access 2–6 years
PCP access 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 years
Adolescents immunizations
HPV Vaccines
Timeliness of prenatal care
F/U ADHD Med (initiation)
4 of 5 WV MCO Performance Measures

17. 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:

18. What’s at Risk?

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

20. 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

21. Public Opinion Favors Medicaid

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

23. 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

24. 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 Preliminary analysis of 2016 data from the American Community Survey.

25. 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 Preliminary analysis of 2016 data from the American Community Survey.

26. 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)

27. 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 Preliminary analysis of 2016 data from the American Community Survey.

28. 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 Preliminary analysis of 2016 data from the American Community Survey.

29. 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

30. 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 ( ); half bump 11.5 percentage points for 2020
Extends express lane eligibility
Funding for grant programs
Outreach
Obesity Demonstration projects
Pediatric Quality Measures Program

31. For More Information Tricia Brooks
Center for Children and Families website
ccf.georgetown.edu
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