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State Child Buy-In Programs: A Snapshot

State Child Buy-In Programs: A Snapshot. Dawn Horner Georgetown Center for Children and Families http://ccf.georgetown.edu Families USA January 30, 2009. What is a State Child Buy-In Program?. State program for children with family income above Medicaid/ SCHIP.

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State Child Buy-In Programs: A Snapshot

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  1. State Child Buy-In Programs: A Snapshot Dawn Horner Georgetown Center for Children and Families http://ccf.georgetown.edu Families USA January 30, 2009

  2. What is a State Child Buy-In Program? • State program for children with family income above Medicaid/ SCHIP. • Family purchases insurance through the public plan, typically at full cost of coverage to state. • Do not operate under federal Medicaid/SCHIP rules. health GIVE Care US

  3. Where States Stand • At least 8 states have operated a program for ten years or more. • New wave of states; and others are planning or interested. • At least 3 states have launched as part of universal coverage strategy.

  4. General Characteristics • Cost • Vary by state • Typically full cost; no state subsidy • Few subsidize premium or administrative costs • Some lower costs by broadening risk pool • Income Eligibility • Above Medicaid/SCHIP levels • Some with an upper limit • Administration • Same as the SCHIP • Marketing

  5. General Characteristics • Eligibility Rules • No limits on enrollees • Few limit enrollment length • Some require children to be uninsured prior • Others, less common: • No longer eligible for SCHIP • Medically uninsurable

  6. Apples to Oranges? How Differ From Other Programs? • High Risk Pools • Family Opportunity Act: Medicaid Buy-In

  7. High-Risk Pools • For "medically uninsurable", not necessarily low-income persons. • Not child-only. • Generally contract with insurance company to administer program with state subsidies. • Typically: • premiums more expensive than sold by private insurers • benefits similar to basic individual plan • can have high deductibles and co-payments

  8. Family Opportunity Act: Medicaid Buy-In • New state option part of 2005 DRA. • Families with income below 300% FPL can buy into Medicaid. • Child must have SSI-defined disability. • Premiums on a sliding scale. • State receives regular Medicaid FMAP. • Employer coverage requirement.

  9. Child Buy-Ins: Benefits • Option for moderate-income uninsured children. • Lower cost/higher benefits than non-group market. • Universal outreach message. • “No or little cost” to state (although also challenge).

  10. Low enrollment Affordability Adverse selection Funding Child Buy-Ins: Challenges

  11. Key Policy Questions • What is the Goal of the Program? • Universal or targeted population • At what income level/linkage with MC/CHIP • How to Structure Premiums/Financing? • What is affordable for families, at what income levels • How to set premiums: Pooling, subsidies • How to finance 3. How to Address Adverse Selection? • What risk is acceptable • Setting cost sharing levels/combining with other programs/other eligibility rules • Buy-in as option for children with disabilities

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