1. Conference Call on New Children's Health Insurance Program (CHIP) Regulations
The U.S. Department of Health and Human Services will publish in the 11 January 2001 Federal Register final regulations regarding CHIP. The Center on Budget and Policy Priorities, Children's Defense Fund, and Families USA co-sponsored a conference call on Tuesday, 16 January 2001 to discuss these regulations. Cindy Mann, Family and Children's Health Program Group Director at the Health Care Financing Administration (HCFA), and Cynthia Shirk, Acting Director of the Division of the State Children's Health Insurance at HCFA, gave an overview of the regulations and answer questions from participants in the call.
2. CHIP Regulations Finalized
The long-awaited final regulations on the State Children's Health Insurance Program were finally issued by the HCFA yesterday. The 1,100 pages of regulations have not been printed in the Federal Register yet. However, HCFA's Center on Medicaid and State Operations issued a guidance letter to the states to provide an overview of the major issues in the policy. Below are links to the guidance and information to help you digest the lengthy ruling. It appears that the regulation does not depart from the standard practices and policies that states have been following to implement their programs for the past 3 years.
Information is available at: State Children’s Health Insurance Program Summary
3. President Clinton's Radio Address to the Nation: New Regulations that Will Increase Enrollment in the Children's Health Insurance Program
Announces That Over 3.3 Million Children Are Enrolled; Urges States to Finish the Job
Today, in his weekly radio address, President Clinton will announce that new state-reported data document that at least 3.3 million children are now enrolled in the State Children's Health Insurance Program (CHIP)--a 70 percent increase over the 1999 level. To further increase enrollment, the President will unveil a set of regulations that promote outreach by allowing states to use information on school lunch applications to find uninsured children and to immediately enroll children in Medicaid and CHIP at schools, child care referral centers and other convenient sites while their applications are formally processed. They also make it easier for states to help families enroll their children in private, employer-based insurance with CHIP assistance. The President will urge states to adopt these new options without delay and finish the job of enrolling every eligible, uninsured child in Medicaid or CHIP.
a. Over 3.3 Million Children Have Been Enrolled in CHIP
Today, the President will announce that 3.3 million children have enrolled in CHIP over the past year--a significant step towards his goal of covering 5 million uninsured children. Specifically, the new report shows:
* 70 percent increase in enrollment nationwide. In FY 2000, 3.3 million children nationwide received health insurance through CHIP, a 70 percent increase over the nearly 2 million children enrolled in 1999 levels. This does not include the increase in Medicaid enrollment of children that has resulted from general outreach efforts and new options to improve Medicaid coverage.
* Enrollment tripled in 3 states and more than doubled in 11 states over the past year. Enrollment more than tripled in Montana, North Dakota, and Wisconsin and more than doubled in Arizona, Arkansas, California, Georgia, Iowa, Kentucky, Louisiana, Nevada, Texas, Virginia, and West Virginia. Enrollment increased by at least one-third in 44 states during that time.
* 25 percent increase in states with eligibility set at or above 200 percent of the poverty level. At the end of FY 2000, 33 States had approved plans in place to provide CHIP coverage to children with family incomes at or above 200 percent of the Federal poverty level, compared with 25 states that had implemented coverage to 200 percent at the end of FY 1999.
b. More Needs to be Done to Finish the Job
Millions of children remain uninsured, most of whom are eligible for Medicaid or CHIP. Reasons why children remain uninsured include:
* Lack of awareness of eligibility. Many parents believe that working or not receiving welfare disqualifies their children from getting Medicaid or CHIP insurance. One study found that nearly three in five parents of uninsured children do not believe that their children would qualify despite being income eligible. Others do not even know options exist--especially with CHIP which is new and targets working families that typically do not qualify for other public programs.
* Difficult renewal and enrollment process. While states, the Administration, and Congress have made great strides in making it easy for parents to enroll their children, barriers remain. These include, in some states, long applications or renewal forms with complicated eligibility rules, requirement for in-person interviews (often at inconvenient times and places), different processes within states for Medicaid and CHIP applications, and limits on enrolling children in Medicaid at sites like schools.
c. President Clinton Releases Regulations Making It Easier to Identify and Enroll Eligible Children in CHIP
Today, President Clinton will announce the release of two new regulations: the final rule governing CHIP and a rule implementing the new option to use school lunch program data to help enroll children in Medicaid. Among other things, these regulations:
* Provide new options to find and enroll uninsured children through school lunch programs. A recent study by the Urban Institute found that approximately 60 percent of the uninsured children nationwide are currently enrolled in school lunch programs. This regulation allows school lunch programs, including the National School Lunch Program, the Special Milk Program for Children, the Summer Food Service Program, the Child and Adult Care Food Program, and the Free and Reduced Price Meals and Milk in Schools Program to share application information with Medicaid staff for the sole purpose of outreach and enrollment (this is already allowed for CHIP). This strategy may prove one of the most efficient at targeting eligible, uninsured children.
* Broaden presumptive eligibility to additional sites like child care referral centers. Over half of the parents of uninsured children do not enroll their children in Medicaid because the process is too long. In fact, over 60 percent tried to enroll their children but did not complete the process because it was too complicated or confusing. The new CHIP regulation gives states the flexibility to use additional sites to determine presumptive eligibility: schools, child care centers, homeless shelters, entities that determine eligibility for Medicaid, Temporary Assistance for Needy Families, and CHIP, and other entities approved by the Secretary. This builds on the 1997 option that allows states to let Medicaid providers, those determining eligibility for WIC, Head Start, and Child Care & Development Block Grant services to grant presumptive eligibility for children. This option provides critical health care services to children awaiting final enrollment and increases the likelihood that families complete the application process.
* Increase state flexibility and protects beneficiary rights. The new CHIP rule provides more flexibility for states to cover eligible children through employer-sponsored insurance, reducing employer incentives to drop dependent coverage. It also ensures that: children have basic patient protections in managed care; application assistance is provided; enrollment materials are linguistically appropriate; eligibility is determined within 45 days; citizenship can be self-declared; public notification is given for changes in eligibility standards and enrollment processes; and "crowd-out" policies are less rigid for states and families.
d. Builds on the Clinton-Gore Administration's Longstanding Commitment to Children's Health
President Clinton and Vice President Gore have a longstanding commitment to children's health. Because of the targeted Clinton-Gore coverage expansion strategy and a strong economy, the number of uninsured declined last year by 1.7 million, two-thirds of whom were children. The Clinton-Gore Administration launched a nationwide "Insure Kids Now" Outreach Campaign in 1998 that established a new toll-free number for children's health insurance outreach (1-877-KIDS NOW), which has received 447,000 calls through November 2000. This campaign also ran public service announcements on national television and radio; printed the Insure Kids Now toll-free number on commonly used products like grocery bags, toothbrushes, and diaper boxes; received a commitment from H&R Block to modify their tax software to alert families who appear to be eligible for CHIP about the program in the upcoming tax season; a notice on letters from the Social Security Administration encouraging the 34 million parents and grandparents who receive Cost of Living Adjustments to learn more about CHIP; and a promotion of the Insure Kids Now toll-free number in the U.S. Postal Service's moving guides. The President also created an Interagency Task Force on Children's Health Insurance Outreach and launched a back-to-school children's health outreach campaign that enlisted over 700 schools to conduct local outreach activities like signing up children on parents' nights. The Administration proposed and with bipartisan Congressional support, passed an extension of a $500 million fund for outreach, a continuous eligibility option in Medicaid to prevent children from unnecessarily becoming uninsured, and greater options for presumptive eligibility. The Administration also is working with states to grant 1115 waivers to encourage innovation and allow states with extra CHIP funds to cover uninsured parents as well as their uninsured children.
4. States Can Offer Expanded Health Coverage Under New HHS Medicaid Rule
The Department of Health and Human Services today published new rules in the Federal Register to help enable more low-income Americans with high medical expenses gain health care coverage under the Medicaid program. The change, which will allow states greater flexibility in determining Medicaid eligibility, could potentially benefit tens of thousands of Americans. It enables states to offer health coverage to low income youth who are still in school or are making the transition to jobs, as well as to more parents leaving welfare for work. It may also help the elderly, people with disabilities, and families with disabled children to obtain health coverage at home, instead of having to live in nursing care facilities.
The change addresses problems created by existing rules that limit Medicaid eligibility for certain individuals to extremely low income levels that were related to the levels used in the old Aid to Families with Dependent Children (AFDC) program, prior to welfare reform. The rule is aimed at assisting those individuals whose income is slightly above traditional Medicaid income limits, but who are strapped with significant medical bills.
Prior to this new regulation, under "medically needy" rules, a state could offer Medicaid coverage to such persons once they have spent so much of their income on medical bills that what is left over meets the states' medically needy income standard. In more than 40 percent of the states, however, that standard is significantly below the poverty level and Americans with high medical bills were often forced to keep their incomes low to qualify. Under the new rule, a state could disregard increased portions of a person's income, such as the income necessary to pay for food, clothing or housing before determining whether the individual is eligible for Medicaid.
The new rule is of special significance for the elderly and people with disabilities. Under the old rules, people in institutions could qualify for Medicaid coverage at much higher income levels than if they lived in the community. This "institutional bias" acts as a barrier to living in the community for many persons with disabilities. The change will allow states the flexibility to change their own rules so that elderly or people with a disability would not have to lose their health coverage if they move into a community setting.
"This new policy has important potential to open doors to community living for thousands of Americans who are able to live at home and do not want to be confined in nursing homes," said HHS Secretary Donna Shalala. "It can enable people to obtain the services they need to live in their own home despite a chronic illness or disability, and can also help single parents making the transition from welfare to work." The policy change can also be used by states to help low-income people who have a disability to participate in the workforce, by allowing states to disregard certain earnings or other sources of income and still retain vital health coverage under Medicaid. For example, a state might disregard income from a savings account used by a worker to save funds for the purchase of a home, automobile, or similar items that promote independence.
"This change could permit elderly people and people with disabilities to retain enough income to meet life's basic living expenses and still get help with their catastrophic medical bills," said Tim Westmoreland, director of the Center for Medicaid and State Operations in HHS' Health Care Financing Administration (HCFA), which administers the Medicaid program. "All comments we received on the notice of proposed rule-making were very favorable," said Westmoreland. "Such overwhelming support is just one indication of how important this change is to the states that already provide critical health coverage under Medicaid to millions of Americans."
New federal spending under the proposed regulation is estimated at $960 million over five years. States would also spend a similar additional amount over that period.
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