In the midst of the chaos being caused by the most recent effort to repeal and replace the Affordable Care Act, there is another very important program at risk: the Children’s Health Insurance Program (CHIP). CHIP covers more than 9 million children nationwide and more than 630,000 in New York State alone. Without Congressional action, federal funding for CHIP will expire on September 30 of this year. New York will exhaust its share of CHIP funds in March 2018.
But there is some good news! This morning, the Senate Finance Committee released a bill that would extend federal funding for CHIP for an additional five years – through 2022. The bill keeps the additional federal matching funds (or “the 23% bump”) for states through 2019. The bill would also extend other provisions of CHIP such as:
- Child Enrollment Contingency Fund – this is for states that predict a CHIP funding shortfall because of higher than expected enrollment
- Qualifying State Option – this is a rule that allows states to use CHIP funding to pay for the difference between Medicaid and CHIP reimbursement to providers who care for higher-income children in Medicaid expansion versions of CHIP
- Express Lane Eligibility – this option allows states to use eligibility for other public programs to make eligibility determinations for CHIP. This makes it much easier for kids to get covered!
- Affordability Standards – Premiums for CHIP cannot cost more than 5 percent of income for families earning less than 300 % of the Federal Poverty Level
New York’s kids and children across the country who rely on CHIP need this bill to make it across the finish line. Please join HCFANY for a webinar on Thursday, September 21 at 2PM to hear from Judith Arnold, Director, Division of Eligibility and Marketplace Integration at the New York State Department of Health, and some of our advocates here at HCFANY on CHIP, what it means for New York, and how you can get involved.
Check out HCFANY’s latest fact sheet on CHIP here.
Guest post by Max Hadler, Senior Health Policy Manager at the New York Immigration Coalition. On Tuesday, September 5, the Trump administration announced that it was terminating the Deferred Action for Childhood Arrivals (DACA) program in six months. The announcement sets in motion a process to further disrupt the lives of 800,000 individuals who President Trump has been threatening since he launched his campaign in 2015. Created by an executive order signed by President Barack Obama in 2012, DACA provides two-year work authorizations and deferral of deportation to DREAMers – people who came to the U.S. before the age of 16, have resided in the country continuously since 2007, do not have a criminal record, and have either graduated from high school, are currently enrolled in an educational program, or have served in the U.S. military.
The cruelty and inhumanity of Trump’s DACA decision have serious health implications. Most acutely, the stress and anxiety caused by the uncertainty around DACA have created an immediate need for mental health services for recipients and their families. The rescission undermines the powerful emotional healing effect DACA has had on U.S. citizen children with DACAmented mothers, an impact recently highlighted in this Science article.
At a time when DACA recipients most need access to comprehensive health coverage, the termination of the program profoundly threatens their eligibility for any coverage at all. As a result of the work authorizations granted by their DACA status, many of the 42,000 DACAmented New Yorkers are covered by employer-sponsored insurance. Once their work authorizations expire, these individuals will lose access to both their jobs and their health insurance.
The impending end of DACA is particularly important in New York. Our state considers DACA recipients to be “permanently residing under color of law,” or PRUCOL, and thus eligible for state-funded Medicaid. As a result, between 5,000 and 10,000 DACAmented New Yorkers have Medicaid coverage. Many advocates believe there is a legal argument that DACA recipients should still be considered PRUCOL after they lose DACA status, but it remains unclear if the State agrees.
Even without a specific legal underpinning, the state can and should continue to cover this population. The Department of Health seemed to acknowledge this by releasing a statement on Tuesday that read in part, “New York State believes it has a legal and moral obligation to exhaust every available avenue to protect immigrants and their families by providing comprehensive access to health care, regardless of circumstance.”
The Coverage 4 All campaign has proposed a number of solutions for New York State. To start, New York can ensure the continued coverage of DACA recipients through state-financed Medicaid. There are also existing policy proposals that would protect a broader range of young adult immigrants, including those who lose their employer-sponsored insurance. Assembly Bill 8054 would expand the Child Health Plus program to age 29, extending New York’s universal children’s coverage program to young adults currently excluded because of their status, including many of the DREAMers who stand to lose their coverage when their DACA authorizations expire.
The DACA decision is only the latest attack on immigrant communities from the Trump administration. In this hostile environment, it is imperative that New York State take action to meaningfully protect and promote the health coverage of its immigrant residents.
*Anyone in New York City in need of mental health services should call NYC WELL, a hotline staffed by licensed counselors trained to help with anxiety, depression, and other issues. NYC WELL counselors have been specifically trained to work with call-ins related to DACA.
Guest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY. A recent analysis by the Commonwealth Fund confirms what many women already know — the Affordable Care Act (ACA) has dramatically improved our rates of health coverage and our access to care. The Commonwealth Fund used data from its biennial health insurance surveys to compare women’s health coverage and health care experiences before and after the ACA, and the results make one thing clear: the ACA is working.
The uninsured rate for women in the U.S. is at an all-time low
Thanks to the ACA, the number of uninsured working-age women fell by almost half from 2010-2016, dropping from 20% (19 million) in 2010 to 11% (11 million) in 2016. Low-income women across all races and ethnicities made the greatest gains, while young women ages 19-36 made larger gains in coverage than women in other age groups. After the ACA went into effect, the percent of women reporting difficulty finding an affordable health plan that meets their needs fell by nearly half, the Commonwealth Fund found.
Women in states that expanded Medicaid under the ACA, like New York, have higher rates of insurance than women in states that chose not to expand Medicaid. As you can see in the graph below, the rates of uninsurance among women here in New York, a state that fully embraced Medicaid expansion, are five times lower than for women in Texas, a state that did not expand Medicaid. Women in New York have expanded coverage options, since our state was the first in the country to establish a Basic Health plan called the Essential Plan, as permitted under the ACA. This extremely affordable coverage option for low-income New Yorkers, which HCFANY and RWV-NY successfully advocated for, went into effect in early 2016. As of January 2017, 665,324 New Yorkers have enrolled in New York’s Essential Plan, 54% of whom are women.
ACA consumer protections and subsidies improve access to care
The ACA put in place requirements that insurers cover 10 Essential Health Benefits, including maternity and newborn care, as well as preventive services. Under this requirement, insurers must cover a number of women’s preventive services with no cost-sharing, like contraceptive coverage, cervical cancer screenings and well-woman visits. Although New York had contraceptive coverage requirements prior to the ACA, the ACA expanded them by prohibiting insurers from charging women co-pays for contraceptive coverage and counseling.
These consumer protections, along with the ACA’s health insurance subsidies, have made it easier for women to find affordable health plans that cover their needs.
New York builds on the ACA’s success by protecting and expanding key provisions of the ACA that impact women
The Cuomo Administration, responding to requests from RWV-NY and other women’s advocacy groups, recently finalized regulations to keep in place the ACA’s contraceptive coverage protections, even if the ACA is repealed. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard) and allow for the dispensing of 12 months of contraception after an initial three-month allotment.
More recently, the Cuomo Administration proposed a rule that would require insurance carriers offering health plans in New York’s individual and small group market to continue to cover the ACA’s 10 Essential Health Benefits, regardless of what happens at the federal level. The proposed rule also includes a non-discrimination provision, which includes discrimination based on race, color, creed, national origin, sex (including sex stereotyping and gender identity), age, marital status, disability and preexisting conditions. RWV-NY has joined other members of the Health Care for All NY coalition in praising these proposed measures, while urging the addition of sexual orientation to the non-discrimination policy.
There is still more work to do!
The Commonwealth Fund report adds to overwhelming evidence that the ACA is working for women here in New York and nationwide. But the survey results suggest there is still work to do to make health care more accessible and affordable for women. In the U.S., there are almost 11 million working-age women who are still uninsured and large proportions of women who find it difficult to afford comprehensive health plans. As the ACA faces new challenges, including a hostile Administration that aims to “let Obamacare fail,” it is critical that we inform the public about the ACA’s successes while continuing to advocate for affordable and quality health care for all.
Guest post by Ben Anderson, Director of Health Policy at Children’s Defense Fund-New York. The New York State Department of Health (SDOH) is embarking on a “First 1000 Days on Medicaid” initiative that aims to bring together a diverse group of stakeholders from across sectors that touch the lives of young children. The stakeholders include representatives from a range of fields from the health care to post-secondary education to child welfare. The charge of the initiative is to produce recommendations for a ten-point plan that focuses on improving outcomes and access to services during the first three years of life.
The initiative arises from advances in neuroscience which tell us that most of the basic architecture in the brain is built by the time a child reaches the age of three. This basic architecture serves as the scaffolding upon which all future learning is built. Healthy physical and emotional experiences during these early years help form connections in the brain to facilitate future growth in cognitive, emotional, and social skills. Conversely, negative experiences impede the development of these connections, which make developing cognitive, emotional, and social skills more difficult.
Research from the Institute for Social and Economic Development (ISED) show that exposure to six or more risk factors prior to the age of three results in a greater than 90 percent chance of developmental delays (Barth et al. 2008). Risk factors include poverty, poor parental mental health, parental substance use disorders, domestic violence, and certain medical conditions. Additional research links adverse childhood experiences to increased risk for diabetes, heart disease, and cancer (Dong et al. 2004). Accordingly, what happens in the earliest years of life impacts lifelong well-being.
Medicaid is uniquely positioned to address these issues because the program serves many of the children who face the greatest risks for poor health outcomes (Halfon et al 2014). In New York, 59% of children in their first 1000 days of life depend on Medicaid. Developmental screenings and many early intervention services for children with developmental delays are currently covered by Medicaid. Primary care physicians who identify risk factors or developmental delays during regular check-ups are often the first point of contact and serve an important function by referring children and families to resources in the community to address the concerns.
The First 1000 Days on Medicaid initiative will convene stakeholders several times between now and November 1 to develop their recommendations. Subsequently, DOH will release its ten-point plan. HCFANY looks forward to working with the Department on this critical venture that has the promise to change the trajectories of our youngest New Yorkers.