Thursday, 4 January 2007 Evaluation and Identification/Outreach Present: Melba Bantay (Catholic Charities Hawaii Immigrant Services), Waynette Cabral (State Planning Council on Developmental Disabilities), Cliff Cisco (HMSA), Jennifer Diesman (HMSA), Josh Green (State Representative), Dee Helber (Hawaii State Department of Education Student Support Services), Bill Kaneko (Hawaii Uninsured Project), Barbara Luksch (Hawaii Covering Kids), Ruth Ota (Hawai‘i State Department of Health Public Health Nursing), Marika Ripke (Hawaii Kids Count), Rochelle Sparko (Legal Aid Society of Hawaii), Kathy Sthay (American Academy of Pediatrics Hawaii Chapter), Donna Tsutsumi-Ota (MothersCare), and Sylvia Yuen (University of Hawaii at Manoa Center on the Family). 1. Welcome and Introductions Barbara thanked everyone for taking time from her or his busy schedule to join our meeting. We discussed how to help the remaining uninsured “gap group” kids with a goal of reducing the number of uninsured children in Hawai‘i from 5% to less than 2%. The remaining 2% will be children in families who choose not to participate in health insurance plans. 2. Review Minutes from 10/04/06 Evaluation Task Force Meeting a. Barbara said updated data show the annual number of uninsured newborns is 363. b. We thanked HMSA for its children’s health insurance plan because it is the only low-cost option available in Hawaii. Cliff noted there are currently 1,415 participants. c. QUEST Spend-Down could be an option if a child is not eligible for QUEST because the household’s gross income is above 300% FPL. Some deductions can be calculated, however there must be parental deprivation (e.g., a parent is unemployed, absent, disabled more than thirty days, or incapacitated). Medicaid Fee-for-Service has a similar income spend-down provision for blind and/or disabled children wherein parents pay a portion of the bill (e.g., cost-share). Children’s QUEST and Medicaid Fee-for-Service spend-down situations are extremely rare, especially with Hawaii’s 300% FPL level for public health insurance. d. Jennifer explained that after a baby is discharged from a hospital, HMSA’s private plans cover newborn well-child checkups under the mother’s health insurance for the first thirty days of the baby’s life. This does not include emergency or other health care services. According to the Prepaid Health Care Act (HRS §393-7), similar health plans must follow what the prevailing plan covers. Kaiser is not considered a similar plan, therefore Barbara will research their newborn coverage. e. Barbara noted when Hawaii expanded its QUEST and Medicaid Fee-for-Service programs to 200% FPL in July 2000, it also established a state-funded component for lawful permanent resident children who have been in the United States less than five years and children from the Freely Associated States. Costs are covered within the 10% Tobacco Settlement Fund allocation required to pay for children’s health insurance. It is administered by Med-QUEST as a Medicaid-clone program using its forms and processes. f. Melba clarified most lawful permanent residents get jobs immediately after arriving in Hawai‘i and many employed by the service industry receive dependent health insurance coverage. g. Donna explained pregnant teens are covered either by their parents’ health insurance or Med-QUEST’s programs. Extensive outreach is conducted by Hawaii Covering Kids targeting pregnant teens and the challenge is assuring their newborns are enrolled in QUEST or Medicaid Fee-for-Service within five days of birth to cover all hospital expenses. 3. Hawaii Covering Kids Priorities a. State pays monthly premiums for children enrolled in QUEST-Net (251-300% FPL). This is our absolute top priority. b. Uninsured newborns ineligible for QUEST or Medicaid Fee-for-Service and unable to enroll in HMSA Children’s Plan until 31 days old. They are born to uninsured mothers or are only covered by mother’s health insurance plan for well-child care after hospital discharge until they are 30 days old. c. Immigrants with temporary visas (e.g., V, H, K, J, F2) and undocumented immigrants in Hawaii less than six months. They do not meet six-month residency requirement for HMSA Children’s Plan. 4. Other States Expanding Programs to Cover All Children Barbara mentioned some other states: a. Illinois (“All Kids”): Added health insurance option so families who do not qualify for Medicaid or Children’s Health Insurance Program can purchase coverage for their children. b. Pennsylvania (“Cover All Kids”): Children’s Health Insurance Program sliding scale premiums if annual household income is between 200-300% FPL, exceptions for some who are above 300% FPL, and assist families with private health insurance premiums. c. Washington: Expansion of Children’s Health Program for non-citizen children, develop a program to help small employers offer affordable family coverage, and payments to families for employee’s premium contribution. We are interested in their successes as well as implementation problems. 5. Brainstorm Health Insurance Solutions for Uninsured “Gap Group” Kids a. Legislative bill for a three-year pilot program to cover monthly premiums for children enrolled in QUEST-Net (251-300% FPL). This is our top priority. b. Separate legislative bill for a three-year pilot Keiki Care health plan similar to HMSA Children’s Plan: Available to uninsured children and youth; Ineligible for QUEST or Medicaid Fee-for-Service; Ages one day old to eighteen years old; Hawaii residents (no restriction on length); Free limited benefit package; Physician reimbursement on par with QUEST; and State money allocation capped subsequently enrollment capped. Notes * State funds will go to the Hawaii State Department of Human Services, however Keiki Care will be managed by a mutual benefit society. * The task force members want a simple evaluation component to determine if Keiki Care is reaching our target groups (e.g., uninsured newborns, undocumented immigrants, and immigrants with temporary visas). Barbara and Marika volunteered to design an optional anonymous application page with outreach questions. Hawai‘i Covering Kids will collate the data. * Cliff explained HMSA will continue its Children’s Plan so it is available after the three-year Keiki Care pilot program ends. 6. Next Steps Barbara will contact task force members for further ideas regarding 5b and Josh will email Barbara the draft bills for 5a and 5b to share with the task force members.