1. The Family Opportunity Act and Children & Youth with Special Health Care Needs Meg Comeau, MHA Sally Bachman, PhD The Catalyst Center Boston University

2. State-at-a-Glance Chartbook The Catalyst Center Educational and advocacy tool for all state policymakers Key indicators of health care coverage for children and youth with special health care needs State innovations of ways to expand coverage

3. FOA Overview: In the Deficit Reduction Act 2005 State option allows families of children with disabilities to buy in to Medicaid coverage Home And Community-Based Waivers for children with psychiatric disorders Family-To-Family Health Information Centers

4. Focus on Medicaid Buy-in option Builds on Ticket to Work, designed to help adults with disabilities go to work without losing Medicaid Allows states to use Medicaid buy-in to offer coverage to children with severe disabilities living in middle income families Can be phased-in by age group over four years

5. Some Facts about FOA Targets families of children with ‘severe’ disabilities Family income under 300% of the Federal Poverty Level (FPL) Privately insured families whose employers pay at least 50% of their premium may buy-in for wrap benefits Uninsured families may buy-in for full benefits Premiums may not exceed 5 – 7.5% of income

6. Advantages to Families No institutional level of care requirement – no cap May alleviate effects of underinsurance -more robust coverage under Medicaid Better access to health care can result in improved health status Family income –Opportunity to take raises, promotions, overtime, other employment

7. Advantages to States Allows for expansion of coverage to CYSHCN with federal match dollars More robust coverage can result in better access and better health outcomes; potential savings in other areas of state spending (education, uncompensated care, etc.)

8. Advantages to States, Continued Raising income eligibility may incentivize obtaining or keeping private coverage Increased family earnings may serve as a stimulus to local economy, increased tax revenues Personal responsibility

9. Development of Economic Model Developed methodology as result of requests for technical assistance Catalyst Center team with consultation by a health care economist Data Sources: –Numbers: National Survey of Children with Special Health Care Needs (2001) and Social Security Administration –Cost: Congressional Budget Office (CBO) per child estimate

10. Development of Economic Model, Continued National data used Built in assumptions Result: 2nd round estimate with state- specific cost estimate advised

11. Basic Assumptions Fraction of CSHCN between 100-300% of FPL who are functionally eligible for FOA will be roughly similar to fraction under 100% who are functionally eligible for SSI SCHIP income ceiling is 200% FPL Medicaid and SCHIP benefit packages are roughly equivalent

12. Walk-through of Sample State Estimate

13. Proportion of CSHCN, 0-17, receiving SSI, by family income and private insurance status, 2001

14. Proportion of CSHCN, 0-18 receiving SSI, by family income and private insurance status, estimates for 2005

15. Estimated nationwide effect of FOA on enrollment in Medicaid, 2005

16. Estimated FOA effect on enrollment and Medicaid expenditures, [state], 2005

17. Supplementary Data

18. States are working to adopt the Family Opportunity Act

19. States that have expressed interest in our FOA work Arizona California Colorado Connecticut Iowa Maine Montana Nevada North Carolina North Dakota New York Ohio Oregon Rhode Island South Dakota Texas Utah Virginia Wisconsin

20. States that have received an estimate release Arizona Connecticut Colorado North Dakota Oregon South Dakota Texas

21. States that have filed FOA legislation Connecticut North Dakota Oregon South Dakota

22. 2nd Round Refinement Adjustment to basic assumptions specific to state (costs, numbers of eligible CYSHCN, other pathways to Medicaid, etc.) Further refinement to take-up estimate Further refinement to target population estimates

23. Implementation Questions to Date Crowd out Premium schedule Age phase-in Connection to federal policy

24. Meg Comeau, MHA Director The Catalyst Center Health and Disability Working Group Boston University School of Public Health 617-426-4447, ext. 27 mcomeau@bu.edu www.hdwg.org/catalyst For more information, contact