1. 1 SCHIP At A Crossroads: - Funding Reauthorization - SCHIP Impact on Universal Childrens Coverage Academy Health Research Meeting June 25, 2006 Lesley Cummings, Executive Director California Managed Risk Medical Insurance Board 6/2006 6/2006

2. 2 Federal Funding Reauthorization SCHIP Allocation Issues Size of the pot Size of the pot –Past funding not an indicator of future need California Managed Risk Medical Insurance Board

3. 3 California's SCHIP Allotments, Carryover Funding and Expenditures Allotments California Managed Risk Medical Insurance Board

4. 4 In 2005, 31 states spent more than their federal allotment California Managed Risk Medical Insurance Board

5. 5 SCHIP Allocation Issues (cont) Who Is Eligible for FFP? Who Is Eligible for FFP? –Income Cap for Children ? 38 states set eligibility at or below 200% 38 states set eligibility at or below 200% –Pregnant Women aka the unborn (9 states) –Parents (7 states) –Childless Adults (5 states) California Managed Risk Medical Insurance Board

6. 6 Present law says: Present law says: –Number of children –Number of low income children without health insurance –Number of all low-income children Factors weighted equally (since 2001) Factors weighted equally (since 2001) Low income means 200% FPL or lower Low income means 200% FPL or lower –State cost Based on wages of employees in the health services industry Based on wages of employees in the health services industry Allocation Among States

7. 7 California Managed Risk Medical Insurance Board What data source should be used to estimate the number of low income/uninsured children determined? What data source should be used to estimate the number of low income/uninsured children determined? –CPS : 3 year average used now to reduce sampling error 3 year average used now to reduce sampling error BBRA provided funds to increase sample size BBRA provided funds to increase sample size Still significant variation. Still significant variation. Estimates differ substantially from other representative surveys Estimates differ substantially from other representative surveys Poverty thresholds vs. poverty guidelines Poverty thresholds vs. poverty guidelines –State Surveys State cost factor State cost factor –Data source used (NAICS) does not include data on self-employed

8. 8 California Managed Risk Medical Insurance Board Other Allocation Options –Number of children enrolled in SCHIP States that expanded before SCHIP States that expanded before SCHIP –State spending Per CRS, would require 25% increase in appropriation Per CRS, would require 25% increase in appropriation Per CRS, Texas will spend $ 409 of its $ 560 million allotment for 2007 Per CRS, Texas will spend $ 409 of its $ 560 million allotment for 2007 –Funding floor Redistributions Redistributions Future coverage expansions? Future coverage expansions?

9. 9 Californias Efforts to Cover ALL Children

10. 10 Insurance Status of California Children 90 Percent of California Children Were Insured in 2003* –52.1 % by employer coverage –29.4 % in Medi-Cal or Healthy Families –8.3 % in other coverage (privately purchased or other government sponsored programs) California Managed Risk Medical Insurance Board * Data Sources: 2003 California Health Interview Survey (CHIS) and UCLA Center for Policy Research (The State of Health Insurance in California) for 0-17 year olds.

11. 11 Insurance Status of California Children (continued) The remaining 10% are Uninsured : 779,000 Eligible for Healthy Families/ Medi-Cal: 429,000 eligible but unenrolled children (204,000 for MC and 225,000 for HFP). Eligible for Healthy Families/ Medi-Cal: 429,000 eligible but unenrolled children (204,000 for MC and 225,000 for HFP). Since the 2003 CHIS, HFP has enrolled an additional 60,000 children Since the 2003 CHIS, HFP has enrolled an additional 60,000 children Children Ineligible for Federal/State Public Programs (potentially eligible for HK): 350,000: Children Ineligible for Federal/State Public Programs (potentially eligible for HK): 350,000: Children Over- Income (over 250%): 157,000 Children Over- Income (over 250%): 157,000 Undocumented Children: 193,000 Undocumented Children: 193,000

12. 12 Childrens Health Initiatives: What are they? Childrens health initiatives (CHIs) are locally- operated childrens health programs that provide services for children not eligible for full-scope no- cost Medi-Cal 1 or the Healthy Families Program 2 (HFP). Childrens health initiatives (CHIs) are locally- operated childrens health programs that provide services for children not eligible for full-scope no- cost Medi-Cal 1 or the Healthy Families Program 2 (HFP). CHIs are modeled after the HFP which offers comprehensive insurance coverage (health, dental and vision) -except only one plan provides coverage. CHIs are modeled after the HFP which offers comprehensive insurance coverage (health, dental and vision) -except only one plan provides coverage. 1 Californias Medicaid program 2 Californias S-CHIP program California Managed Risk Medical Insurance Board

13. 13 Santa Clara County launched the first Healthy Kids program in 2001. Santa Clara County launched the first Healthy Kids program in 2001. The Santa Clara approach was to provide one door to families for SCHIP, Medi-Cal or the HK programs. The Santa Clara approach was to provide one door to families for SCHIP, Medi-Cal or the HK programs. Numerous other localities established HK programs Numerous other localities established HK programs California Managed Risk Medical Insurance Board Childrens Health Initiatives: The Beginning

14. 14 California Managed Risk Medical Insurance Board Program Start Date California County 2001 Santa Clara 2002 San Francisco and Riverside 2003 San Mateo, Los Angeles, San Bernardino, and San Joaquin 2004 Santa Cruz 2005 Kern, Alameda, San Luis Obispo, Santa Barbara, Napa, Solano 2006 Fresno, Sonoma, Tulare and Yolo Data from the Institute for Health Policy Solutions Overview of Local Children's Coverage Expansions, Revised 05/09/06 Healthy Kids Current Program Status

15. 15 Healthy Kids Future Coverage Status Planned Program Start Date California County July, 2006 Sacramento, Colusa, El Dorado, and Yuba Counties To be determined Del Norte, Kings, Marin, Mendocino, Merced, Orange, San Diego, Ventura 88,000 children enrolled in HK Programs. 12,000 children waitlisted* * Institute for Health Policy Solutions California Managed Risk Medical Insurance Board

16. 16 Healthy Kids Program Funding Sources For 0-5 Year Olds: For 0-5 Year Olds: Funding is generally available because this population is the focus of the California First 5 Commission which has tobacco tax funding via a proposition*. Funding is generally available because this population is the focus of the California First 5 Commission which has tobacco tax funding via a proposition*. The State California First 5 Commission has made funding of coverage for 0-5 year olds a priority and has provided incentive grants to the 58 County First 5 Commissions so that coverage is also a local priority The State California First 5 Commission has made funding of coverage for 0-5 year olds a priority and has provided incentive grants to the 58 County First 5 Commissions so that coverage is also a local priority For children ages 6-18: Funding is challenging. Virtually all children on waitlists are between 6-18. Funding is challenging. Virtually all children on waitlists are between 6-18. * California Children and Families Commission created by the California Children and Families First Act (Proposition 10, 1998) California Managed Risk Medical Insurance Board

17. 17 Healthy Kids Program Funding Sources (contd) Funding sources have included: Governmental Health Plans Governmental Health Plans Foundations including: The California Endowment, The California HealthCare Foundation and The David and Lucile Packard Foundation Foundations including: The California Endowment, The California HealthCare Foundation and The David and Lucile Packard Foundation Local Tobacco Settlement Funds Local Tobacco Settlement Funds Cities and Counties Cities and Counties Hospitals Hospitals California Managed Risk Medical Insurance Board

18. 18 Evaluation of Healthy Kids Impact Several evaluations on the grandmother CHI (Santa Clara) were conducted by Mathematica, the Urban Institute and UCSF ( funded by the David and Lucile Packard Foundation ). Several evaluations on the grandmother CHI (Santa Clara) were conducted by Mathematica, the Urban Institute and UCSF ( funded by the David and Lucile Packard Foundation ). Evaluations found: Evaluations found: –The programs outreach efforts increased enrollment in Medi-Cal and HFP by 28% above expected levels. –SC says a critical message is We have coverage for ALL your children

19. 19 California Managed Risk Medical Insurance Board. - Enrollment increased the percent of children with a usual source of medical care ( from 49% to 89%) and preventive dental care (from 22% to 61%). - The percentage of children who did not get medical care was reduced by more than 50% (from 24% to 10%) - The program doubled the percentage of children whose parents were confident they could obtain needed care for their child (from 41% to 71%). Healthy Kids Impact (contd)

20. 20 On the Horizon: Initiatives and Legislation The Governors May Revise – $23 million proposal to fund children on CHI waiting lists. The Governors May Revise – $23 million proposal to fund children on CHI waiting lists. Tobacco Tax Initiative of 2006, headed for the November 2006 ballot, replaces CHIs with a state program. Children would be enrolled in HFP. Tobacco Tax Initiative of 2006, headed for the November 2006 ballot, replaces CHIs with a state program. Children would be enrolled in HFP. The Budget Conference Committee approved the Assemblys proposal to implement a coverage expansion even if the Initiative fails. The Budget Conference Committee approved the Assemblys proposal to implement a coverage expansion even if the Initiative fails.

21. 21 For More Information, please contact: The California Managed Risk Medical Insurance Board Ms. Lesley Cummings Executive Director 1000 G Street, Suite 450 Sacramento, California 95814 (916) 324-4695