Federal Enrollment Barriers
Children's Health Insurance Eligibility Forum
On April 16, Hawaii Covering Kids sponsored two national speakers, Edwin Park from the Center on Budget and Policy Priorities and Caroline Rivas from Community Health Councils, who presented information about recent federal policies and their implications for our children's health insurance programs. Topics included CHIP Reauthorization, CMS's August 17 Directive, and CMS's Payment Error Rate Measurement (PERM) program. There were also updates about the National Covering Kids & Families Network and Hawaii's progress towards covering all kids with health insurance.
Click here for a PDF copy of the presentations: April 2008 Children's Health Insurance Community Forum in Hawaii.
1. Payment Error Rate Measurement (PERM)
The Centers for Medicare & Medicaid Services (CMS) began its program in 2007. Contractors perform eligibility, medical necessity, and claims data processing reviews of selected state Medicaid and CHIP claims. CMS will audit Medicaid programs susceptible to significant erroneous payments, estimate the amount of improper payments it made to states, and report corrective actions to Congress.
Eligibility requires documentary evidence of residency, household composition, earned and unearned income, and assets. PERM guidance is more restrictive than federal regulations, therefore states are grappling with implementation to assure eligible people are enrolled in Medicaid and CHIP without limitless barriers imposed by CMS.
The Hawaii Covering Kids Process Simplification Task Force met in 2007 ( December 7 and December 27) and 2008 ( January 11, January 31, May 1, September 5, and September 17) to outline Hawaii’s procedures to comply with PERM requirements.
Reports and information:
CMS Overview and Rules
Will the Payment Error Rate Measurement (PERM) Program Affect State Efforts to Facilitate Enrollment of Eligible Children and Parents in Medicaid and CHIP? by Vikki Wachino and Donna Cohen Ross, Kaiser Commission on Medicaid and the Uninsured, February 2008.
Payment Error Rate Measurement (PERM) Policy Issues, Center for Medicare and Medicaid Services, September 2007.
Payment Error Rate Measurement (PERM) Verifying Eligibility for Medicaid and SCHIP Benefits, Centers for Medicare and Medicaid Services, October 11, 2007.
2. Citizenship, Alien Status, and Photo Identification Documentation
The Deficit Reduction Act of 2005 contains a draconian provision to burden U.S. citizens with unnecessary paperwork to get Medicaid benefits. Click here to download a PDF copy of the document.
* Hawaii Information
A task force met biweekly from April 2006-August 2007 to assure all eligible people enrolled in QUEST and Medicaid Fee-for-Service retain their benefits without going on scavenger hunts. A recent news article highlighted our work: Agencies unite for the needy (The Honolulu Star-Bulletin, July 9, 2006).
* Committee on Government Reform and Committee on Energy and Commerce
This letter quantifies potential implementation costs and eligible people being dropped from public health insurance coverage: Citizenship Letter to GAO from Two Congressional Committees.
* Department of Health and Human Services Office of Inspector General
DHHS Office of Inspector General conducted a comprehensive review of state policies on this issue and after studying the evidence, they did not recommend a new requirement for documentation of citizenship. The Centers for Medicare and Medicaid Services agreed as well, reporting it has no evidence of a problem in this area. Despite these findings the DRA demands this onerous requirement. Click here for the report explaining that self-declaration of U.S. citizenship for Medicaid is not a problem.
* Centers for Medicare & Medicaid Services
CMS Issues Final Citizenship Guidelines for Medicaid Eligibility (2 July 2007)
Fact Sheet: Medicaid Citizenship Guidelines (2 July 2007)
Medicaid Program: Citizenship Documentation Requirements Final Rule (13 July 2007)
* National News of Interest
Center on Budget and Policy Priorities (10 April 2010)
New Citizenship Documentation Option for Medicaid and CHIP Is Up and Running
Center on Budget and Policy Priorities (23 April 2009)
New Children's Health Law Reduces the Harmful Impact of Documentation Requirement
Commonwealth Fund (12 January 2009)
Citizenship Documentation Rules Hampering Children's Coverage
AARP Bulletin (March 2008)
Are You an American? Prove It: A citizenship rule costs states millions but nets few illegals
Baltimore Sun (20 June 2007)
American Medical News (18 June 2007)
Medicaid citizenship rules costing health centers
Virginia Health Care Foundation (24 May 2007)
Center on Budget and Policy Priorities (13 March 2007)
New Medicaid Citizenship Documentation Requirement Is Taking A Toll
New York Times (12 March 2007)
Lacking Papers, Citizens are cut from Medicaid
Center on Budget and Policy Priorities (11 December 2006)
Administration Policy Change Threatens Health Care Coverage for Poor Infants
Metro West Daily News (13 November 2006)
Medicaid Paper Trail to Illegals
Kaiser Family Foundation (3 November 2006)
New Policy Ends Automatic Medicaid Eligibility for U.S.-Born Infants of Low-Income, Undocumented Immigrants
Southern Maryland Online (25 October 2006)
Procedures to Foil Illegal Immigrants Also Confound Maryland Citizens
Washington Post (8 October 2006)
Virginia: Rules Deter Poor Children From Enrolling in Medicaid
Center for Children and Families (6 October 2006)
Lawsuit May Help Secure Coverage for 500,000 Foster Kids
Center on Budget and Policy Priorities (1 September 2006)
Documenting Citizenship and Identity Using Data Matches
CCH (24 August 2006)
Panel weighs impact of new DRA citizenship rules
LA Health Action (11 August 2006)
Collaborative Letter to CMS on Interim Final Rule for the Medicaid Citizenship Requirement
The Roanoke Times (11 August 2006)
Red tape could choke a budding success story
Project Inform (10 August 2006)
Comments to CMS
The Roanoke Times (6 August 2006)
Mandate endangers children's health
Center on Budget and Policy Priorities (13 July 2006)
New HHS Regulations Focus Medcaid Documentation Requirements on U.S. Citizen Families
Families USA (7 July 2006)
Court Expedites Litigation Schedule on Medicaid Citizenship Documentation
Washington Post (1 July 2006)
D.C. to Delay Enforcing Medicaid Rule
SFGATE.com (29 June 2006)
Lawsuit Challenges New Medicaid Rule
The Times-Picayne (28 June 2006)
New Medicaid routine addresses citizenship: Act could affect people whose records are lost
National Mental Health Association (27 June 2006)
Legislation Needed to Fix New Medicaid Citizenship Documentation Requirement
The Enquirer (22 June 2006)
Citizen Medicaid rule waits
Kaiser Commission on Medicaid and the Uninsured (19 June 2006)
New Requirements for Citizenship Documentation in Medicaid Fact Sheet
Kaiser Commission on Medicaid and the Uninsured (19 June 2006)
Lessons From New York
Center on Budget and Policy Priorities (16 June 2006)
HHS Guidance Will Exacerbate Problems Caused by New Medicaid Documentation Requirement
Las Vegas Sun (11 June 2006)
Indigent may lose Medicaid benefits
Kaiser Daily Health Policy Report (7 June 2006)
California To Delay Enforcement of Federal Rule Requiring Proof of Citizenship for Medicaid Eligibility
Arizona Daily Star (4 June 2006)
ID law could hurt rightful Medicaid clients, states fear
Center on Budget and Policy Priorities (17 February 2006)
New Requirement for Birth Certificates or Passports Could Threaten Medicaid Coverage for Vulnerable Beneficiaries: A State-by-State Analysis
August 17 Directive
It was rescinded by President Obama on 4 February 2009. Here is information from Inside Washington Publishers:
The infamous August 17, 2007 memo required states to ensure that 95 percent of children under 200 percent of the Federal Poverty Level (FPL) are enrolled in CHIP before offering coverage to children above that threshold. But because a total of zero states met that guideline--and because the directive also banned states from enrolling for one year any eligible children who lose their private insurance--it was instantly a source of strong contention in the health care community.
Among the other requirements included in the August 17 directive that drew the ire of advocacy groups were: restrictions on the ability of states to disregard certain income sources when calculating a resident’s CHIP eligibility and language aimed at preventing employers from changing dependent coverage policies that would favor a shift to private coverage.
As Obama's rescinding letter notes, since CHIP's creation in 1997, states have had the authority to set up their own income eligibility levels. In recent years, the letter says, the cost of private insurance has increased and so too have states raised eligibility levels to offer health care coverage to more families with families paying shares of that cost based on income.
In April 2008, the Government Accountability Office (GAO) issued a report that said the August 17 memo violated the Congressional Review Act because it carried with it the force of a proposed rule and thus should have been treated as rulemaking--a process that requires congressional notification before enactment. [Seth Freedland, 02/05/09]
For more details, go to CMS August 17 Directive.