Making CHIPRA Work:Enrolling Eligible Children

In Health Coverage

New England Alliance for Children’s HealthApril 24, 2009

Donna Cohen Ross, CBPPTricia Brooks, Georgetown CCF

Coverage Provisions

• Allows CHIP coverage for pregnant women• Removes 5-year waiting period for covering

legally residing immigrant children and pregnant women (Medicaid or CHIP)

• Gives explicit option to cover CHIP kids to 300% FPL• over 300% reverts to Medicaid match

• Phases out adults, no new parent waivers

Benefit Provisions

• Mental health parity in CHIP; but no mandate

• Dental mandate and must meet equivalency test

• Dental coverage only for privately-insured kids otherwise eligible for CHIP

Financing Provisions

• New, higher national funding levels• Change in allotment formula to

send money to states that use it• Multiple “safety valves” to avoid

shortfalls• Performance bonuses• Outreach grants• Enhanced translation match

Why is there a performance bonus?

• Help states meet the cost of enrolling eligible but not enrolled, particularly low-income children

• Bonus is calculated on number of children enrolled above specific enrollment targets which are beyond expected increases• Driven by economy• Due to growth in child population

Enrollment Targets

Who counts?

• Medicaid kids• CHIP funded Medicaid

expansions & 1115 waivers

• Expansions after July 1, 2008 not counted for three years, with a base year reset

• ICHIA expansions specifically excluded

Performance Bonus Calculation

• Two bonus levels…• On enrollment above the target (tier 1)

Bonus = 15% of state Medicaid share• On enrollment that is 10% above target (tier 2)

Bonus = 62.5% of state Medicaid share

• Calculated only on enrollment above the target

• Paid in lump sum (not from allotment) in first quarter after fiscal year end

$100 Million Outreach Fund

• Broad discretion by HHS Secretary• $10 million national campaign• Partnerships with other agencies• National hotline ensuring all states participation

• $10 million for Native American outreach• $80 million in grants to states and CBO’s• Areas with high rates of eligible but not enrolled,

including rural areas• Minorities and health disparities

What entities are eligible?

• State, county or local government• National, state, local community-based

public or nonprofit organizations• Faith-based organizations• Federal safety net providers• Elementary or secondary schools• Community health workers• Federally-funded programs like Head Start

How does the funding work?

• No match required

• MOE on prior year outreach funding for states receiving grants

• Related enhanced match for translation & interpretation• 75% or CHIP match + 5%, if higher• Outreach, enrollment, retention, access services

What must grantees do?

• Have access to and credibility with target population

• Demonstrate ability to address enrollment barriers

• Develop outcome measures• Conduct an assessment of

effectiveness• Cooperate in data

collection/reporting

Questions

• When will CMS announce when and how entities can apply?

• What are the expected range of grant awards?

• What is the expected length of grants?

• How will CMS enforce the outreach MOE?

It’s No Secret

Outreach matters!

But enrollment and retention simplification

measures are still needed!

How does CHIPRA change citizenship documentation requirements?

• Effective immediately• Three amendments to DRA

• Effective January 1, 2010• Applies to separate CHIP programs

but exempt from 10% admin cap• New option to confirm US

citizenship through match with SSA records

• Opportunity for CMS to reissue current regulations remains

CIT-DOC Changes Already in Effect

• Reasonable opportunity to provide documents• If applicant has otherwise proven eligibility, states CANNOT delay benefits

• States get federal match regardless

• Infants born to Medicaid moms exempt, including at 12 mo renewal

• Tribal documents satisfy both citizenship and identity• Retroactivity to DRA could be important

How does the new option work?

What else about the SSA match?

• SSA agreement is the “heavy lift”• Opportunity to build on current

data exchanges• Enhanced federal match• 90% - systems development and

implementation • 75% - ongoing operational cost

• “Real-time basis” exempts state from tracking and reporting % of mismatches

Simplify Current Regulations

• CMS could issue new regulations easing complexity of current requirements• Not original documents• Affidavit of identity

embedded in application• Simplify hierarchy of

documents

Express Lane Eligibility

• Allows use of information from public programs to verify eligibility; enroll & renew • Regardless of differences in

methodology• Can’t find child ineligible• Verifies immigration status but

NOT citizenship• Screen & enroll options• Use of information from tax returns allowed

What else about ELE?

• Federal match - 90% systems development/75% operational costs

• Addresses data sharing/confidentiality

• Evaluation of effectiveness and administrative cost/savings

• Sunset in September 2013

• Additional federal guidance expected

The Performance Bonus “Price of Admission”

• States must implement at least 5 out of 8 “enrollment and retention provisions”

• Must be in place throughout the entire fiscal year

• Must be applied to both Medicaid and CHIP (except premium assistance)

Questions

• For 2009 only, can the 5 of 8 provisions be counted if not in place for full year • If state legislation is required?

• What criteria will CMS use to determine if a provision is met?• Meaningful yet realistic ?• Shows progress over time ?

The Eight Enrollment and Retention Provisions (1, 2, 3)

• 12-month continuous eligibility• Required for children of all ages?

• “Liberalization” of asset test• No asset test, or• Administration verification of assets

• No in-person interview (face-to-face) required

The Eight Enrollment and Retention Provisions (4, 5)

• Use of common forms and uniform processes for Medicaid and CHIP• Joint application, renewal, supplemental forms, and• Same “information verification process”

• Automatic renewal (administrative renewal)• State sends pre-printed form, eligibility is renewed

unless changes reported by applicant (required)• Ex parte satisfies requirement

The Eight Enrollment and Renewal Provisions (6,7,8)

• Presumptive eligibility for children

• Express lane eligibility

• Premium assistance subsidies

Does Your State Have Five of Eight?

B I N G O!

For more information

• Contact information:• Donna Cohen Ross• cohenross@cbpp.org• 202-408-1080

• Tricia Brooks• pab62@georgetown.edu• 202-365-9148