The Family Opportunity Act and Children & Youth with Special Health Care Needs

Meg Comeau, MHA

Sally Bachman, PhD

The Catalyst Center

Boston University

State-at-a-Glance Chartbook The Catalyst Center

• Educational and advocacy tool for all state policymakers

• Key indicators of health care coverage for children and youth with special health care needs

• State innovations of ways to expand coverage

FOA Overview: In the Deficit Reduction Act

2005

• State option allows families of children with disabilities to buy in to Medicaid coverage

• Home And Community-Based Waivers for children with psychiatric disorders

• Family-To-Family Health Information Centers

Focus on Medicaid Buy-in option

• Builds on Ticket to Work, designed to help adults with disabilities go to work without losing Medicaid

• Allows states to use Medicaid buy-in to offer coverage to children with severe disabilities living in middle income families

• Can be phased-in by age group over four years

Some Facts about FOA

• Targets families of children with ‘severe’ disabilities

• Family income under 300% of the Federal Poverty Level (FPL)

• Privately insured families whose employers pay at least 50% of their premium may buy-in for wrap benefits

• Uninsured families may buy-in for full benefits

• Premiums may not exceed 5 – 7.5% of income

Advantages to Families• No institutional level of care requirement – no cap

• May alleviate effects of underinsurance -more robust coverage under Medicaid

• Better access to health care can result in improved health status

• Family income– Opportunity to take raises, promotions, overtime, other

employment

Advantages to States

• Allows for expansion of coverage to CYSHCN with federal match dollars

• More robust coverage can result in better access and better health outcomes; potential savings in other areas of state spending (education, uncompensated care, etc.)

Advantages to States, Continued

• Raising income eligibility may incentivize obtaining or keeping private coverage

• Increased family earnings may serve as a stimulus to local economy, increased tax revenues

• Personal responsibility

Development of Economic Model

• Developed methodology as result of requests for technical assistance

• Catalyst Center team with consultation by a health care economist

• Data Sources:– Numbers: National Survey of Children with Special Health

Care Needs (2001) and Social Security Administration – Cost: Congressional Budget Office (CBO) per child

estimate

Development of Economic Model, Continued

• National data used

• Built in assumptions

• Result: 2nd round estimate with state-specific cost estimate advised

Basic Assumptions

• Fraction of CSHCN between 100-300% of FPL who are functionally eligible for FOA will be roughly similar to fraction under 100% who are functionally eligible for SSI

• SCHIP income ceiling is 200% FPL

• Medicaid and SCHIP benefit packages are roughly equivalent

Walk-through of Sample State Estimate

Proportion of CSHCN, 0-17, receiving SSI, by family income and private insurance status, 2001

Family Income (FPL)

Number of CSHCN

% receiving SSI

Number of CSHCN % receiving SSI

< 100% 782,695 28.0% 283,255 18.4%

100-200 871,943 17.6% 998,643 8.3%

200-300 253,470 12.3% 1,288,119 3.8%

300-400 110,172 10.6% 1,293,996 3.1%

400% + 105,216 16.0% 2,302,272 2.2%

Total 2,123,496 20.4% 6,166,285 4.5%

Number of CSHCN with missing data on insurance, income, or SSI receipt 1,030,000

Proportion of CSHCN, 0-17, receiving SSI, by family income and private insurance status, 2001

Without private insurance With private insurance

Source: 2001 National Survey of CHSCN.

Proportion of CSHCN, 0-18 receiving SSI, by family income and private insurance status, estimates for 2005

Family Income (FPL)

Number of CSHCN % receiving SSI

Number of CSHCN % receiving SSI

< 100% 960,371 35.7% 347,556 23.5%

100-200 1,069,879 22.5% 1,225,341 10.6%

200-300 311,009 15.7% 1,580,529 4.9%

300-400 135,182 13.5% 1,587,741 3.9%

400% + 129,101 20.4% 2,824,901 2.8%

Total 2,605,542 26.0% 7,566,067 5.7%

Proportion of CSHCN, 0-18 receiving SSI, by family income and private insurance status, estimates for 2005

Without private insurance With private insurance

Source: 2001 National Survey of CHSCN.

Estimated nationwide effect of FOA on enrollment in Medicaid, 2005

Estimated nationwide effect of FOA on enrollment in Medicaid, 2005

Family Income

Number of CSHCN

Estimated 2005 SSI Enrollment

Estimated Enrollment in Medicaid Post-FOA

Differ-ence

Estimated Number of FOA Children

Number of CSHCN

Estimated 2005 SSI Enrollment

Estimated Enrollment in Medicaid Post-FOA

Differ-ence

Estimated Number of FOA Children Total

100%-200% 1,069,879 22.5% 32% 9.5% 101,879 1,225,341 10.6% 19% 8.4% 102,966

200-300 311,009 15.7% 28% 12.3% 38,185 1,580,529 4.9% 15% 10.1% 159,714

Total 140,065 262,680 402,745

Without private insurance With private insurance

Estimated FOA effect on enrollment and Medicaid expenditures, [state], 2005

w/o private w private

100-200% 2,038 3,298200-300% 862 4,810

100-200% 9.5% 8.4%200-300% 12.3% 10.1%

Estimated FOA effect on enrollment100-200% 194 277200-300% 106 486

FOA enrollment adjusted for SCHIP100-200% 0 277200-300% 106 486

Total 106 763 869

Estimated 2006 Medicaid expenditures per child (federal and state)

$12,800 $7,000

0.3708

Estimated annual increase in Medicaidexpenditures per child 5%

$553,805 $2,183,975 $2,737,780State General Fund Expenditures, 2008

Estimated number of State CSHCN

Estimated percentage point increase in Medicaid in State

State Medicaid Percentage

Estimated FOA effect on enrollment and Medicaid expenditures, [State], 2005

Supplementary Data

Supplementary data United States State

Number of SSI children, 2005 1,034,000 1859Number of SSI children in 2001 NSCSHCN 707,442Number of Children,0-17, 2001 73,119,741 204,640Number of CSHCN,0-17, 2001 9,356,463 22,669

2005 SSI/2005 CSHCN 10.8% 8.0%CHSCN/All children 12.8% 11.1%SSI/All children 1.4% 0.9%

CSHCNw/o private100-200% 980,281 2038200-300% 284,963 862

w private100-200% 1,122,724 3298200-300% 1,448,167 4810

CSHCN %

w/o private100-200% 10.5% 9.0%200-300% 3.0% 3.8%

w private100-200% 12.0% 14.5%200-300% 15.5% 21.2%

States are working to adopt the Family Opportunity Act

States that have expressed interest in our FOA work

• Arizona• California• Colorado• Connecticut• Iowa• Maine• Montana• Nevada• North Carolina• North Dakota

• New York• Ohio • Oregon• Rhode Island• South Dakota• Texas• Utah• Virginia• Wisconsin

States that have received an estimate release

• Arizona

• Connecticut

• Colorado

• North Dakota

• Oregon

• South Dakota

• Texas

States that have filed FOA legislation

• Connecticut

• North Dakota

• Oregon

• South Dakota

2nd Round Refinement

• Adjustment to basic assumptions specific to state (costs, numbers of eligible CYSHCN, other pathways to Medicaid, etc.)

• Further refinement to take-up estimate

• Further refinement to target population estimates

Implementation Questions to Date

• Crowd out

• Premium schedule

• Age phase-in

• Connection to federal policy

Meg Comeau, MHADirector

The Catalyst CenterHealth and Disability Working Group

Boston University School of Public Health

617-426-4447, ext. 27mcomeau@bu.edu

www.hdwg.org/catalyst

For more information, contact