Children’s Health Coverage Observations from Louisiana

Children’s Health Coverage—A PrimerLuncheon Briefing

Alliance for Health ReformKaiser Commission on Medicaid & the Uninsured

Washington, DCFebruary 2, 2009

J. Ruth KennedyLa. Dept of Health & Hospitals

Lessons From Our Decade of Increasing Coverage for Children

Focus equally on Medicaid and SCHIP Administrative simplification matters Retaining eligible children at renewal is

essential Needs differ in 2009 than in 1997 Covering (virtually) all kids is achievable

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Children’s Health Coverage in Louisiana a Decade Ago

High rate of poverty and poor health outcomes

Absolute minimum levels of coverage for children

Onerous application and verification requirements

Nation’s third highest percentage of uninsured kids

Almost 1 in 3 low income children had no health coverage

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“A Rising Tide Lifts All Boats” —John F. Kennedy

Streamlining/SimplifyingSCHIP Eligibility & Enrollment Policies

Streamlining/SimplifyingMedicaid Eligibility & Enrollment Policies for Children

Most Louisiana Children in Public Coverage Are Enrolled in Medicaid

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Many Still Uninsured Kids Live Below Poverty Level

Literacy issues Parental priorities—Maslow’s

hierarchy of needs “Simplicity” of enrollment is

relative High mobility and lack of long

term attachments

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Highest percentage of La uninsured low income children: 50 to 100% of FPL

The Case for Administrative Simplification

Essential to enroll and retain most vulnerable children

Possible to achieve without compromising program integrity

Accelerates enrollment—access to care for eligible children

Positive administrative impact for cash strapped states

Advances in technology present new opportunities

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What Difference Does “Fixing” Renewals Make?

10,425 SCHIP Kids—Couldn’t renew 90 34,214 Medicaid Kids—Couldn’t renew 303 44,639 Total Kids—Couldn’t renew 393

393<1%

(2008 Rate)

August 2008

22%(2001 Rate)

9,822

Unexpected Roadblock in La on the Road to 300%

SCHIP reauthorization philosophical debate

CMS “August 17th” letter set new conditions for expansion 95% of kids <200% already

covered Five year ESI trend for kids

in state La expansion currently at

250%

The New “Hole in the Bucket”

Modest raises are putting families >200% FPL

Children moving from SCHIP or Medicaid coverage to uninsured

85% of enrollees in new LaCHIP Affordable Plan Received Medicaid or LaCHIP in last 36 months Did not voluntarily drop ESI in last 12 months

Increasing income limits will be essential to maintain gains

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We Can See Light at the End of the Tunnel

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Children with public coverage in La have more than doubled since 1999

State survey by LSU indicates uninsured rate for kids is 5.4%

“Culture” of eligibility has radically changed

Public and legislative support for children’s coverage

SCHIP reauthorization contains additional resources

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Ruth KennedyLaCHIP/Medicaid Eligibility Division DirectorLa Department of Health & Hospitals427 N 4th StBaton Rouge, LA 70802Telephone: 225 342 3032Fax: 225 342 9508Blackberry: 225 241-1437E-Mail: rkennedy @ dhh.la.gov www.lachip.org

Never doubt that a small group of thoughtful, caring people can change the world. Indeed, it is the only thing that ever has! — Dr. Margaret Mead