State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage Theresa Sachs Technical Director Centers for Medicare and Medicaid Services

Public Programs and the Uninsured • Medicaid State Plan • SCHIP Program • Health Reform Demonstrations

Health Insurance Flexibility and Accountability (HIFA) • Section 1115 approach • Medicaid/SCHIP • Coverage expansions

HIFA Flexibility • Benefits • Cost-sharing • Employer-sponsored insurance

Funding for Expansions • “Pass-through” expansions • Re-direct DSH • Managed care savings

SCHIP Funding in HIFA • Parents • Pregnant women • Childless adults • Children protected

HIFA Employer-Sponsored Insurance Flexibility • Wrap-around • Cost sharing • Cost effectiveness

HIFA in Present Environment • Unforeseeable circumstances • Rising numbers of uninsured • Great deal of activity

Approved HIFA Demonstrations • AZ - childless adults and parents • CA - parents • SCHIP funding

Utah Demonstration • Non-HIFA • Benefit package modifications • Enrollment fee • Expansion - primary care

HIFA Advantages • Guidance • Application template • Expedited review

State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage