The health of 8 million children

girls_doctor_officeThe Alliance for Health Reform and Kaiser Family Foundation held a briefing on Monday about the Children’s Health Insurance Program (CHIP). CHIP provides quality health coverage for over 8 million kids – including nearly 500,000 in New York under Child Health Plus.

The Program was extended in the ACA through 2019, but unfortunately funding for the program expires next September without congressional action. This would be bad news for kids - many could lose coverage (some due to the “family glitch“) or pay more for comprehensive coverage. Not to mention it would cut short a program that has been enormously successful in reducing the child uninsurance rate, which fell by half since the program began in 1997.

A summary of the briefing and all materials are available on the Alliance for Health Reform website, including background materials, videos, and speaker presentations. Speakers included Joan Alker, executive director at Center for Children and Families at Georgetown University, Robin Rudowitz, associate director for Kaiser Commission on Medicaid and the Uninsured, Robert Stewart, analyst at the Congressional Budget Office, and Cathy Caldwell, director of the Bureau of Children’s Health Insurance in the Alabama Department of Public Health.

Check it out!

 

 

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We already knew that nearly a million New Yorkers had enrolled through NY State of Health during the first open enrollment period from October 1 to March 31. But now we know more than ever about who they were, where they live, and how they enrolled. That’s thanks to the new enrollment report released yesterday by NY State of Health, the official health plan marketplace, which includes eagerly awaited demographics data such as age, race and ethnicity of enrollees.

HCFANY issued a press release, highlighting key findings from the data, such as the importance of in-person assistors in helping New Yorkers obtain health insurance. Nearly 50% of insurance applications were completed with help of in-person assistors, including Navigators, Certified Application Counselors, and brokers. In-person assistance was particularly critical for low-income New Yorkers: more than half (59%) of the Medicaid enrollees used in-person assistance to complete their application.

For the first time, the report offers a glimpse into the race and ethnicity, as well as preferred language, of New York enrollees. Though the data is incomplete – about one in four enrollees chose not to respond to the application on race – it nonetheless will help direct future outreach and enrollment efforts across the state. About 37% of enrollees who answered the question reported their race as Black/African American, Asian/Pacific Islander, or “other” non-white race. About 20% of Medicaid enrollees chose a language other than English, but no enrollees reported their preferred language as Korean, Russian, or French Creole, pointing to potential gaps in these communities. As useful as this data is, it only provides a statewide picture – there is still a need for race, ethnicity and preferred language by county in order to target outreach to the communities that need it most.

Financial assistance was key to the high enrollment numbers in Qualified Health Plans (private health insurance). Nearly 3/4 of enrollees got private health plans with financial assistance in the form of Advanced Premium Tax Credits (APTC) or a combination of both APTC and cost-sharing reductions. An average New Yorker who was eligible for financial assistance saved $215 per month in premium.

And, while some enrollees (about 13%) clearly benefited from the Medicaid expansion that made them newly eligible for public insurance, a whopping 93% of Medicaid enrollees were newly insured overall. That means many of those who enrolled in Medicaid were previously eligible but, for whatever reason, had been unable to enroll. New York clearly did something right in building it’s health insurance marketplace – the single, streamlined web application our State officials built is working. And, boy, did New Yorkers come.

 

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From left to right, Elisabeth Benjamin, CSSNY; Judy Arnold, NYSDOH; Kate Breslin, SCAA; Lorraine Gonzalez-Camastra, CDF-NY
 

HCFANY’s Children, Youth & Families Task Force presented the first Children’s Health Champion to Judy Arnold, Director of the Division of Eligibility and Marketplace Integration at the NYS Department of Health.  The award is well deserved. Under Ms. Arnold’s leadership, New York increased the number of children with health coverage; initiated the facilitated enrollment program, the predecessor to NY’s navigator program; and has worked to remove barriers to coverage and streamline enrollment. Congratulations to Judy!

The award presentation happened as a part of the spring meeting of HCFANY’s Children, Youth & Families Task Force on Wednesday, May 28. Advocates gathered in Albany to share important policy updates and to plan the next steps to secure universal health coverage for all children in New York.

The day also included a panel discussion moderated by Kate Breslin from the Schuyler Center for Analysis and Advocacy. Two important health care funders, The Atlantic Philanthropies and New York State Health Foundation, were present to share their perspectives, panel-style, on upcoming priorities for the health of NY’s children and families. Jim Knickman, President and CEO New York State Health Foundation, identified oral health, asthma, behavioral health, and obesity as top priorities for children’s health in New York. Kimberley Chin, Programme Executive at Atlantic Philanthropies, reflected upon the impact of the foundation’s work as it enters its final phase of grant making, and invests in projects that will provide sustainable solutions.

Additionally, attendees celebrated recent HCFANY budget wins and a stellar open enrollment period (over 960,000 New Yorkers enrolled)! They also heard updates from HCFANY’s Public Programs Group, which monitors Exchange implementation and challenges related to Medicaid, Child Health Plus, and other public insurance programs.

Much important work is on the horizon for this task force, including coverage for undocumented immigrants and adolescents, behavioral and oral health coverage, monitoring New York’s Delivery System Reform Incentive Payment Program (DSRIP), and other key priorities. On a national level, members will keep an eye on federal funding for the Children’s Health Insurance Program (CHIP), which provides comprehensive and affordable coverage to more the 8 million children across America. Funding expires as of September 30, 2015, unless congress takes action.

 

kid examining monkey This week, National Academy for State Health Policy and Georgetown University’s Center for Children & Families released a joint report analyzing Children’s Health Insurance Program (CHIP) coverage in 42 separate programs in 38 states. For the past 17 years, CHIP has given states federal funds to operate public health insurance programs designed for children. New York’s own version of the program, Child Health Plus, has been running even longer - 2014 marks it’s 24th year!

Why the focus on CHIP coverage now? The ACA extends CHIP funding through 2015, but after that point the future is somewhat uncertain. By April 15, 2015, the Secretary of HHS will have to determine if coverage offered under the new Qualified Health Plans is “at least comparable” to the benefits and cost-sharing in CHIP. States will soon after have the option to cover children through comparable QHPs. It’s important that advocates and consumers alike know and voice the benefits of CHIP, which has been responsible for millions of children gaining coverage since it’s inception. More children are gaining coverage through the program all the time – recent enrollment numbers show over 80,000 children enrolled in New York’s Child Health Plus program between October 1 and April 15, nearly 70,000 of whom are newly uninsured.

There are federal rules for certain aspects of CHIP coverage and costs – for example, the cost paid by families can’t be more than 5% of their income. Within these requirements States still have a fair amount of flexibility to choose benefits and cost-sharing for enrollees. The report finds that CHIP programs generally offer comprehensive coverage with low cost-sharing. About 1/3 of the programs provide benefits very like the Medicaid packages in their state, which are known for being very comprehensive. Plans generally cover basic physical, hospital, and laboratory services without limitations; all plans cover dental, vision, and hearing services, though with varying limitations. Most programs charge some sort of premium, but about 1/3 of the programs have no cost-sharing.

New York’s Child Health Plus, is one of the most generous in the country, offering subsidized coverage for any child up to 19 from families up to 400% of the Federal Poverty Level. Premiums range from $9 per child for those just above the Medicaid level, to $180 for those at the 400% of FPL who live in high cost regions of the state. New York is also one of the states with no cost-sharing beyond premiums, making Child Health Plus a particularly affordable option. And, coverage is open to any child, regardless of immigration status. Children in families with incomes above 400% FPL can still buy into the program at full price.

Child Health Plus covers most services without limitations, including physician, hospital, and lab services, prescription drugs, pre-natal care vision and dental services. Uncovered services include nursing care, case management, and care coordination, as well as non-Emergency Transport. And, a few services, like orthodontics and outpatient mental health services, are covered with limitations.

For more on coverage and costs, including a handy table for Child Health Plus on page 91, visit the full report.

Want to learn more about children’s health coverage in New York? Join HCFANY for our Children, Youth and Families Task Force Meeting on May 28 in Albany. More details here.