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The Family Opportunity Act Medicaid Buy-in Option Deborah Allen, ScD

The Family Opportunity Act Medicaid Buy-in Option Deborah Allen, ScD The Catalyst Center: Improving Financing of Care for CYSHCN. Children and youth with special health care needs – aren’t they covered?. The prevailing wisdom: As long as you cover uninsured children CYSHCN will be okay

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The Family Opportunity Act Medicaid Buy-in Option Deborah Allen, ScD

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  1. The Family Opportunity Act Medicaid Buy-in Option Deborah Allen, ScD The Catalyst Center: Improving Financing of Care for CYSHCN

  2. Children and youth with special health care needs – aren’t they covered? The prevailing wisdom: • As long as you cover uninsured children CYSHCN will be okay • Especially given • Early intervention • IDEA • Title V • Medicaid TEFRA/HCBS waiver programs • SSI

  3. Not quite • Yes, most children with special health care needs have health care coverage* • If low income, covered by Medicaid • At higher income, covered by private insurance • If disabilities are severe, may be covered under TEFRA or Medicaid HCBS waiver program • But…. * National Survey of Children With Special Health Care Needs

  4. More than 18% of families reported hardship in 2005-6

  5. How much hardship?

  6. Family employment and income • From National CYSHCN Survey • 1/3 of families reported that having a CYSHCN affected family employment • From National Longitudinal Survey of Youth • Mothers of children with disabilities earn less than other mothers • Families of children with disabilities earn less and have a lower net worth than other families • Families of children with disabilities reported net assets $36,000 below other families

  7. When families are the payers of last resort • Family debt, bankruptcy • Children do not receive needed services • Impact on other family members • Less for food, clothing, housing, education, health care • Marital/family stress

  8. Different pathways to hardship • High expenses for items unique to families of CYSCHN • Higher expenses for items every family needs • Loss of employment income

  9. Federal FOA Legislation • Part of the 2005 Deficit Reduction Act • Medicaid Buy-in option is just one part • Intended for: • Children with ‘severe’ disabilities • Children in families with income < 300% of FPL • Children who are privately insured or uninsured

  10. To Buy-in or Not to Buy-in: That is the Option

  11. What’s in it for families? • Better access to health care • Which can result in improved health status • Potential to address underinsurance • Medicaid offers more robust coverage than the majority of private plans • Many expenses which now fall to families could be covered • Important limitations of waivers don’t apply • No institutional level of care requirement • No enrollment cap • Employment opportunities open up for families • Opportunity to take raises, promotions, overtime, other employment

  12. What’s in it for states? • Higher Medicaid income limits may encourage families to get/keep private coverage • As primary coverage for child • As coverage for other family members • Allows for expansion of coverage to CYSHCN with federal match dollars

  13. What’s in it for states, continued • More robust coverage can result in better access and better health outcomes • Potential savings in other areas of state spending (education, uncompensated care, etc.) • Increased family earnings may serve as a stimulus to local economy, increased tax revenues

  14. Why prioritize a small group like CYSHCN? • Medical debt and family financial hardship • Family employment opportunities • Potential savings in other areas of state spending • Highlights visibility of CYSHCN as a population

  15. Other ways to expand coverage to CYSHCN • SCHIP expansion to higher income levels • Katie Beckett/TEFRA waiver creation/expansion • Medicaid buy-in program created through a waiver

  16. Pre-FOA buy-in programs

  17. Current status of state FOA legislation* • Passed: North Dakota, Iowa, Louisiana • Recent Interest/Activity: Arizona, Connecticut, Indiana, Maine, Nevada, Ohio, South Dakota, Texas, New York, Oregon, North Carolina *These are the states we are aware of. There may be work happening in other states or within these states by other stakeholders that we are not aware of.

  18. Catalyst Center TA resources re FOA • State-specific estimate of eligibles/cost • Refined estimates upon request • Technical Briefs: • “Methodology for Estimating the Impact of State Implementation of the FOA” • “Frequently Asked Questions About the FOA” • Reducing Underinsurance for CYSHCN through Medicaid Buy-in Programs

  19. …and we are making a difference.

  20. Questions?

  21. For more information, contact Meg Comeau, MHA The Catalyst Center 617-426-4447, ext. 27 mcomeau@bu.edu www.hdwg.org/catalyst

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