Kids’ Health Insurance Coverage: Where are we now and how can we get all kids covered?

1. Kids’ Health Insurance Coverage:Where are we now and how can we get all kids covered? June 30, 2010 All Kids Covered Initiative www.allkidscoveredinitiative.org

2. Colorado All Kids Covered Initiative • History and evolution • 2006 – Present • Clear and enduring focus on • Developing Sound Policy • Building Public Will • Supported by a infrastructure of a funded leadership team and a diverse membership .

3. 5 key Questions

4. Kids Coverage in Colorado • Public coverage programs experiencing all time high levels of enrollment. • 2010 Update • 860,000 Privately Insured • 214,000 Public/Other • 176,000 Uninsured Source: The Colorado Health Institute, Colorado Children’s Health Insurance Status: 2010 Update which analyzed the 2008 US Census Bureau American Community Survey.

5. Colorado’s Uninsured Children • 176,000 “best estimate” of uninsured • 115,000 Eligible but not enrolled (EBNE) • 12,000 newly eligible (205-250% expansion, May 1) • 33,500 uninsured – in the gap between public and private • 16,000 ineligible for public coverage because of immigration/documentation

6. Remarkable Gains • 2007 - Medical Home, state level advisory committee, presumptive eligibility • 2008 – Administrative renewal, CHP+ expansion • 2009 – Ex-parte renewal, major expansions through Colorado Healthcare Affordability Act, eligibility modernization efforts • 2010 – Patient Protection and Affordable Care Act • 2010 – Maternity coverage mandate, birth certificate fee waiver, food stamp program improvements

7. Colorado Healthcare Affordability Act • Eligibility Expansions • Parents with children in Medicaid with incomes up to 100% FPL – May 1, 2010 • CHP+ children and pregnant women with incomes up to 250% FPL – May 1, 2010 • Program Improvements • Quality incentive and increased payments - 2010 • 12 months continuous eligibility – Spring 2012

8. Patient Protection and Affordable Care Act • Private Market Regulation • Provider Payment/Care Delivery • Medicaid Expansion and Improvement • Exchange based coverage • CHIP

9. Private Market Regulation • Children under 19 with private insurance can no longer be denied coverage for pre-existing conditions – September 23, 2010. • New plans must provide free preventive services to enrollees. • Plans can no longer impose lifetime caps or annual limits and can not rescind coverage when a person becomes ill.

10. Provider Payment/Care Delivery • Increase in Medicaid payments for primary care services provided by primary care doctors with 100% federal funding. Jan 1, 2013 – December 31, 2014. • Patient Centered Outcomes Research Institute • Center for Medicare and Medicaid Innovation • Pediatric Accountable Care Organizations

11. Medicaid • Creates maintenance of effort requirements. • Eliminates the stairstep allowable under current Medicaid law so that all children under 19 living in families with incomes below 133% of FPL become eligible for Medicaid. • Designates Medicaid as the coverage pathway for low-income Americans, situating firmly in the national coverage framework.

12. Exchange Based Coverage • American Health Benefit Exchanges – 1.1.14 • Small Business Health Options Program Exchanges – businesses up to 100 employees • Only way to buy subsidized private coverage for individuals/families with income between 133% - 400% FPL. • Four levels of qualified plans – Bronze, Silver, Gold and Platinum.

13. CHP+ • Creates maintenance of effort requirements • Reauthorizes CHIP (Child Health Plan Plus) through 2019 with full funding through 2015. • In 2015, states can choose to continue program or close and kids will be required to get coverage through exchange or in the private market.

14. Timeline

15. Key Issues • Public Understanding and Support • Creating a Culture of Coverage • Eligibility Determination and Enrollment • Ensuring System Capacity

16. Public Engagement • 19% trust the federal government to do the right thing most of the time. • 44% of public “confused” about reform in May • Understanding of impact related to family income • Main reason for favorable opinion: Expanding access to health insurance and access to care • Main reason for unfavorable opinion: Financial and cost considerations and govt. related issues

17. Message “Health reform is a major victory for children and families. It delivers what families need: affordable reliable health coverage that won’t disappear if they lose a job or get sick.”

18. Creating a Culture of Coverage • 49th in the nation covering kids living in poverty!!! Fully one-third of our most vulnerable children are uninsured. • Parent expansion under the Colorado Healthcare Affordability Act – Cover Families • “Strategic moment to recast Medicaid as an affordable health coverage program for working people and families.”

19. Eligibility Systems • “To put it bluntly, 36 million Americans cannot be enrolled in Medicaid or the new exchanges by relying upon…the cumbersome and intrusive processes of the welfare eligibility system.” • Parents expansion glitch • System and community capacity

20. Delivery System Capacity • 58,000 estimated uninsured kids without a usual source of care (33% of 176,000) • 53,000 estimated eligible parents - CHI • 120,000 estimated eligible adults without dependent children - CHI • Community clinic and private provider capacity, human services capacity

21. Why We Must Succeed • The Colorado Health Foundation Report Card D+ • Kids Count • Stewardship – taking responsibility to protect something fragile and precious and deliver it for the future Our Opportunity is now. Colorado kids can’t wait.

22. Start Today • Jeff Bontrager, CHI • Heather Hewitt, HCPF • Breakout Sessions • Parents • Updates • Reconvene sharing, inspiration and food!