Putting CHIPRA to Work: Making 4 Million Kids

a Reality!

Tricia Brooks & Jocelyn GuyerGetting to the Finish Line Conference

July 14, 2009

So what is happening with CHIPRA?

Maybe Cindy Knows!

Former Queen of Child Health Advocates

Read All About It!

• 3 State Health Official letters• CHIPRA overview, pregnant women with

SPA template, tribal consultation

• Statement on qualifying event• Final CHIP allocations announced • Outreach Grant RFP released• Key dates passed; guidance needed• CIT-DOC changes, express lane, dental-only,

performance bonus 5/8, and more

Source: As of July 1, 2009, based on a review by the Center for Children and Families of state initiatives in 2008 and 2009.

States Moving Forward2009

Implemented 2008 Legislation to Improve Child and Family Coverage (5 states)

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

PA

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

Enacted New Legislation/Took Administrative Action to Improve Child and Family Coverage (17 states)

CO

NYMN

WA

IA

14 Things for States To Do

• CIT-DOC changes• 30-day premium grace• Qualifying events

• Eliminate 5-yr bar• SSA citizenship match• Dental only coverage• Pregnant women• Income eligibility

expansion

• Dental equivalency• Mental health parity

• Express lane• Outreach grants• Enhanced match for

translation/interpretation• Performance bonuses

Requirements

Options

For Discussion!

• What do we know?• What do we need to know?• What’s happening in the states?• Is this a priority for your state?• What’s the impact of health care reform?• Need for peer-to-peer connections, messaging or

technical assistance?• Other questions?

Getting a Jump on Health Reform with CHIP Expansions

• Income eligibility expansion• Up to 300% FPL• >300% reverts to Medicaid

match

• Pregnant women in CHIP• Medicaid up to 185% FPL;

CHIP match up to 300% FPL• Can keep unborn child option

Source: As of July 1, 2009, based on a review by the Center for Children and Families of state initiatives in 2008 and 2009.

CHIP Expansion Enactments or Implementations

2009

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

PA

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

Enacted/Implemented New Legislation Expand Coverage

CO

NYMN

WA

IA

The 5-year Bar:Heavy Lift or Piece of Cake?

• Lawfully Residing• Children• Pregnant Women

• Stories from the states

So the Mouth Really is Connected to the Body!

• Dental mandate & equivalency requirement• Need benefit definition• 3 benchmarks (FEP, SEP or

largest private plan)• Impact on cost-sharing cap?

• Dental-only coverage for children ineligible for CHIP only because they have medical coverage• Messaging matters - is this a wrap?

Parity But Not for All

• No mental health mandate, but...• Mental health parity required if

benefits are offered• Financial requirements and

treatment restrictions cannot be more restrictive than medical and surgical (Public Health Service Act §2705(a))

• EPSDT plans comply• Effective April 1, 2009

Qualifying Event:Not an Olympic Trial

• Loss of Medicaid or CHIP is now a qualifying event for enrollment outside open enrollment period

• Clarity about ERISA plans• Also amends Public Health

Service Act (§2701(f)) but clarification may be needed in state law to ensure compliance for all state regulated plans

Outreach Grants: Connecting Strategies to Enrollment & Retention

• Strategies must result in measurable enrollment/retention gains

• Robust data tracking, reporting, analysis of effectiveness

• Must refine, revise strategies when data indicate goals are not being achieved

Outreach Grants:The Devil’s in the Details!

• Of particular interest or given weight/favor:• Strategies that can be replicated• Innovative uses of technology• Specific list of target populations• Proposals with in-kind or other support

• Conference call 7/22; proposal due 8/6• State applicants have more requirements• Non-state applicants need state support or

show ability to collect and report data

Can You Really Hear Me Now?

Translation & Interpretation• Enhanced funding (75% or

CHIP match + 5%)• Explicitly funds full scope

of services• Outreach, enrollment,

retention, access to benefits

Show Me the Money!

Minimum 30-day grace periodfor paying premiums• Does policy apply to enrollment

fees?• Is your state implementing

premiums; increasing premiums?• Does your state have multiple

payment options?• What about affordability?

Got Cit-Doc?

• Already in effect (but some states awaiting guidance)• Reasonable opportunity• Babies born to Medicaid moms• Tribal document

• January 1, 2010• SSA Electronic Match• CHIP Implementation Require

• Revision of current regulations?

Get Your Motor Running!

• Ready for adventure, whatever comes your way? Try Express Lane Eligibility!

• NJ income tax project cited by Secretary Sebelius

• LA working on express lane renewals

Looking for a Bonus?

Specific guidance needed on Medicaid Performance Bonus• Express lane• Adequacy of implementation of

some strategies• Enrollment data and targets

• Source• Decline in child population• Exclude emergency services to

immigrants from target calculation

What Else?