Covering ALL Children An Achievable Smart and Right

Covering ALL Children: An Achievable, Smart and Right Goal The Children’s Defense Fund Healthy Child Campaign April 13, 2007

THE IMPORTANCE OF HEALTH INSURANCE Uninsured Children Often Go Without Needed Medical Care • Uninsured children are almost 12 times as likely as insured children to have an untreated medical need. • Uninsured children are four times as likely as insured children to have an unmet dental need. • People who are uninsured receive less preventive care than the insured, are diagnosed at more advanced stages of disease, and are more likely to use the emergency room as a regular source of care.

THE IMPORTANCE OF HEALTH INSURANCE Having Health Insurance Can Improve A Child’s Life • Health coverage has been associated with: – Improvements in school performance – Reduced school absences – Improved health status – Decreased child mortality – Higher future earnings

WHO ARE THE UNINSURED? • There are 77. 9 million children in America. • 9 million children—about 11. 2% of all American children—are uninsured.

WHO ARE THE UNINSURED? Of the 9 million uninsured children: • 3. 5 million (38. 3%) are Hispanic • 3. 4 million (37. 8%) are White • 1. 5 million (16. 3) are Black • 398, 000 (4. 4%) are Asian/Pacific Islander • 143, 000 (1. 6%) are American Indian

UNINSURED CHILDREN LIVE IN WORKING FAMILIES • Of the 9 million uninsured children: • 7. 1 million (86. 6%) have at least one working parent • 5. 6 million (68. 8%) have at least one parent working full time, all year

UNINSURED CHILDREN LIVE IN FAMILIES OF ALL INCOME LEVELS • Of the 9 million uninsured children: – 2. 8 million (31. 5%) have family incomes under 100% FPL – 2. 9 million (32. 3%) have family incomes between 100% and 199% FPL – 1. 7 million (18. 6%) have family incomes between 200% and 299% FPL – 1. 6 million (17. 6%) have family incomes over 300% FPL

2007 Federal Poverty Levels FPL% 100% 150% 185% 200% 250% 300% 350% 400% Family of 3 Annual Income $17, 170 25, 755 31, 765 34, 340 42, 925 51, 510 60, 095 68, 680 Family of 4 Annual Income $20, 650 30, 975 38, 203 41, 300 51, 625 61, 950 72, 275 82, 600

HOW DO LOW-INCOME CHILDREN RECEIVE HEALTH COVERAGE? Medicaid • Nation’s major public health coverage program for low income Americans, jointly financed by state and the Federal government. Administered by states within broad federal guidelines • Covers approximately 55 million people, including almost 28 million children SCHIP Health Program • Designed to “sit on the shoulders” of Medicaid, to provide health coverage to low and middle income uninsured children. Also state and federal financial partnership administered by states with broad federal guidelines • Covers more than 6 million children

WHO IS ELIGIBLE FOR MEDICAID? • Eligibility for Medicaid varies between states • “Mandatory” Medical populations: – Pregnant women and children under age 6 up to 133% FPL – Children ages 6 -19 under 100% FPL • Some states only cover the people they are required to under federal Medicaid statute, while other states extend coverage up to 275% FPL for certain categories of eligible people.

SCHIP VARIES BETWEEN STATES • Each state has its own SCHIP program • SCHIP eligibility requirements also vary significantly between states • North Dakota: children (0 -19) are SCHIP eligible if their family income is at or below 140% FPL ($28, 910 for family of 4) • New Jersey: children (0 -19) are SCHIP eligible if their family income is at or below 350% FPL ($72, 275 for family of 4)

WHO IS ELIGIBLE FOR STATE CHILDREN’S HEALTH INSURANCE PROGRAMS? • States were permitted to use their SCHIP funds to do one of the following: • Create a separate SCHIP program, • Expand their Medicaid program, • Adopt a combination approach. • The original SCHIP funding authorization is set to expire this year, funding must be reauthorized by October 2007.

KEY DIFFERENCES BETWEEN MEDICAID AND SCHIP COVERAGE • Children who qualify for Medicaid are guaranteed coverage. • SCHIP programs are allowed to set enrollment freezes or operate waiting periods.

KEY DIFFERENCES BETWEEN MEDICAID AND SCHIP BENEFIT PACKAGES • Children enrolled in Medicaid are guaranteed all medically necessary services • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), is a comprehensive benefit package that includes all medically necessary care that a child has been determined to need, including mental health care. • Federal SCHIP benefit standards are much weaker. • SCHIP enrollees often receive scaled-back “benchmark” benefit packages that provide a more limited set of benefits.

WHY ARE MILLIONS OF CHILDREN UNINSURED? • The majority of uninsured children are eligible for either Medicaid or SCHIP • Approximately 7 out 10 uninsured children are eligible for either Medicaid or SCHIP, but are not enrolled. • Families face many barriers when they try to enroll their children, even when their children are eligible.

How Can Congress Provide All Uninsured Children with Access to Health Insurance? • CDF is supporting legislation that builds on the lessons learned from Medicaid and SCHIP, and creates one combined, simplified child health coverage program that will ensure access to comprehensive health and mental health care for all children in America.

HR 1688: THE ALL HEALTHY CHILDREN ACT • On March 26, 2007 Representative Bobby Scott from Virginia introduced the All Healthy Children Act (HR 1688) • Co-sponsors (as of April 11, 2007): – – – – G. K. Butterfield (NC) Emanuel Cleaver, II (MO) John Conyers (MI) Keith Ellison (MN) Jesse L. Jackson, Jr. (IL) Barbara Lee (CA) Sheila Jackson Lee (TX)

WHO WOULD BE ELIGIBLE? • All children with family incomes below 300% FPL ($60, 000 for a family of four) would be eligible. Children with family incomes over this level could buy into the program • Pregnant women below 300% FPL would be eligible for prenatal, delivery, and postpartum care for at least 60 days after birth • Youth who have transitioned from the foster care system through age 20, and other children with special health care needs covered by current law, would be eligible

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688)

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (1. ) National benefit standard that guarantees that children receive all medically necessary health and mental health services

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (2. ) National eligibility standard that will eliminate the “lottery of geography” • State-by-state eligibility requirements create inequities and confusion, leaving children unnecessarily uninsured

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (3. ) Simplified, streamlined enrollment processes • Culturally, linguistically competent outreach • Prohibit states from implementing barriers to enrollment, such as face to face interviews • Self-declaration of income, 12 month certification, elimination of premiums below 300% FPL, and no co-pays below 200% FPL

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (3. ) New auto-enrollment mechanisms (con. ) • • Children enrolled in other meanstested government programs are automatically covered under this program unless they choose to “optout” At various junctures in a child’s life, such as birth, the parent is asked whether the child has health coverage – if not, they are given the opportunity to opt-out of coverage, or be enrolled at that time

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (4. ) Responsible cost-sharing that includes parental contributions based upon ability to pay, but doesn’t create barriers to children receiving services

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (5. ) Mechanisms to ensure that all children have access to coverage, including “buy-in” for children in families with incomes greater that 300% FPL

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (6. ) Significant new federal funds that will ensure that states have incentives to enroll children, and to ensure that children get access to needed health services • States would be “held harmless” so they wouldn’t spend more on coverage for children than they are spending in 2006, but they could cover more children. The federal government would pick up the rest of the costs.

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (7. ) Guaranteed coverage for all eligible children so that children aren’t put on waiting lists or turned down for coverage

KEY ELEMENTS OF THE ALL HEALTHY CHILDREN ACT (HR 1688) (8. ) Substantial increase in provider rates so that children served by programs are not denied needed and mental health services payment public health

THE ALL HEALTHY CHILDREN ACT (HR 1688) IS THE ONLY LEGISLATION THAT: • Guarantees every eligible child all medically necessary care. • Combines SCHIP and Medicaid into a single program, with a streamlined enrollment process to facilitate enrollment and retention. • Provides access to health coverage for ALL children and pregnant/post-partum women as well as youth transitioning from foster care.

Please contact CDF with any questions: Alison Buist Abuist@childrensdefense. org 202. 662. 3586