Wednesday, 4 October 2006 Evaluation Present: Kimberly Click, Rebecca Delafield, Mark Forman, Laurel Johnston, Barbara Luksch, and Sylvia Yuen The purpose of the meeting was to update the Hawaii Uninsured Project’s policy briefs about children’s health insurance with current information. Our agenda focused on determining kids who are currently uninsured. The details below reflect our discussion and subsequent research. 1. Med-QUEST Update Effective 1 October 2006, household income limits for the QUEST and Medicaid Fee-for-Service programs for children and youths ages 0 through 18 years old increased: up to 250% FPL--FREE 251-265% FPL QUEST-Net--premium share is $15 per month per child 266-280% FPL QUEST-Net--premium share is $30 per month per child 281-300% FPL QUEST-Net--premium share is $60 per month per child Currently, the gross family income limits for free public insurance (250% FPL) is $57,504 per year for a family of four. The maximum gross income for premium-share public health insurance (300% FPL) is $69,011 for a family of four. 2. HMSA Children’s Plan This individual plan provides affordable medical care to children ages thirty-one days through eighteen years who are currently uninsured and have been Hawaii residents for at least six months. It gives children basic health care benefits such as preventive services, immunizations, and doctor visits for a current monthly fee of $51.00. There are no citizenship or immigration status requirements. 3. University Health Insurance Plans 2006-2007 School Year (Dependent Coverage) a. The University of Hawaii and Chaminade University Student Plan is sponsored by HMSA and includes prescription drug coverage. The rates per semester are approximately $1,739 for the student and one dependent and $2,457 for the student and two or more dependents. Summer 2007 costs are $1,159 for the student and one dependent and $1,638 for the student and two or more dependents. b. Hawaii Pacific University offers health insurance through HMSA and Kaiser Permanente. The rates per semester for HMSA’s comprehensive plan, including drug and vision coverage, are $2,025 for the student and one dependent and $2,966 for the student and two or more dependents. HMSA’s basic plan, without drug and vision coverage, costs $1,206 for the student and one dependent and $1,793 for the student and two or more dependents per semester. The rates per semester for Kaiser’s comprehensive plan, including drug and vision coverage, is $1,703 for the student and one dependent and $2,552 for the student and two or more dependents. Kaiser’s basic plan, without drug and vision coverage, is $1,433 for the student and one dependent and $2,147 for the student and two or more dependents per semester. c. BYU-Hawaii Student Health Plan costs per semester are $406 for a single student and dependent(s), $913 for a married student and dependent(s) with maternity coverage, and $558 for a married student and dependent(s) without maternity coverage. 4. Uninsured Newborns Barbara distributed two Hawaii Health Information Corporation data reports: "Hawaii's Newborn Discharges Insured v. Uninsured Newborns 1995-1999” (issued February 2001) and "Hawaii's Newborn Discharges Insured v. Uninsured Newborns 2000-2003” (issued September 2006). The state’s total number of uninsured newborns discharges from 1995-1999 averaged 520 and from 2000-2003 averaged 452. Barbara will post the reports on the Hawaii Covering Kids web site when HHIC issues its 2004-2005 data later this year. We surmised if the baby was listed as self-pay, the mother is uninsured and an outreach campaign strategy must target both pregnant women and newborns. If a pregnant woman has private health insurance, it has been assumed by policymakers the baby is covered by her plan for the first thirty days. We discovered contrary language in the Hawai‘i Revised Statutes (bold added by our task force): §432:1-602 (Mutual Benefit Society Statute) Newborn children coverage. (a) All individual and group hospital and medical service corporation contracts which provide coverage for a family member of the subscriber shall, as to such family member's coverage, also provide that the benefits applicable for children shall be payable or provided with respect to a newly born child of the subscriber from the moment of birth; provided that the coverage for newly born children shall be limited to the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. If payment of a specific subscription fee or premium is required to provide coverage for the child, the contract may require that notification of birth of a newly born child and payment of the required fee or premium must be furnished to the service corporation within thirty-one days after the date of birth in order to have coverage continue beyond such thirty-one-day period. The requirements of this section shall apply to all subscriber contracts delivered or issued for delivery in this State more than one hundred twenty days after July 1, 1988. (b) No provision in subsection (a) shall be construed to provide or include coverage for routine well-baby services. §431:10A-115 (Accident and Health Insurance Statute) Coverage of newborn children. (a) All policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide that the benefits applicable for children shall be payable for newborn infants from the moment of birth; provided that the coverage for newly born children shall be limited to the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. If payment of a specific premium is required to provide coverage for a child, the policy may require that notification of birth and payment of the required premium must be furnished the insurer within thirty-one days after the date of birth in order to have the coverage continue beyond the thirty-one-day period. (b) This section shall not be construed to provide or include coverage for routine well-baby services. The requirements of this section shall apply to all policies delivered or issued for delivery in this State more than one hundred twenty days after June 12, 1974. [L 1987, c 347, pt of §2; am L 1997, c 383, §6] The mother’s private health insurance covers the baby’s hospital charges, however once the baby is discharged she/he is not covered by the mother’s plan. 5. “Gap Group” Kids We concluded the following children and youths might currently be uninsured: Household income 251-300% FPL, eligible for QUEST-Net, and parent or guardian cannot afford premium payment; Temporary visa (V, H, K, etc.) and in Hawaii less than six months*; Undocumented immigrant and in Hawaii less than six months*; Student’s dependent (F2 visa), in Hawaii less than six months*, and parent cannot afford university’s dependent coverage; Baby born to uninsured pregnant woman (approximately 450 newborns annually)**; and Parent or guardian choice (Kingdom of Hawaii citizens, hippie groups, etc.). *Must be Hawai‘i resident for at least six months to enroll in HMSA Children’s Plan. **Must be at least 31-days old to enroll in HMSA Children’s Plan.