A Focus on Children and Youth in the Nuts and Bolts of an Exchange

By Mike Odeh, Children Now

School might be out for summer – but not for California’s Health Benefit Exchange board! The board has scheduled at least two full meetings in June, and is absorbing a small encyclopedia’s worth of reports. These extensive analyses touch on some of the many important “nuts and bolts” decisions that Exchange board members will soon have to make – from the details in the selection of Qualified Health Plans to the strategy of the outreach and marketing campaigns. Just about every decision the Exchange board makes will affect how children enroll in coverage and access care.

But since the kids themselves won’t be the ones actually purchasing the insurance, it may be easy to forget that over a half million children will be eligible for the California Exchange – that is, about one in ten Californians eligible for the Exchange will be a child. Plus, another estimated 675,000 uninsured kids will be eligible for Medicaid or CHIP. That’s why it’s absolutely essential that the entire Exchange apparatus work well for kids – everything from the no-wrong-door eligibility system, to the health plan enrollment experience, to the accessibility of child-serving providers once enrolled.

In other words, the number of issues to consider for children and youth when building the Exchange approaches infinity. But ultimately, children’s advocates will judge the Exchange by whether it provides quality health plans for kids with assured access to important pediatric providers…and we will judge the entire system by how easy it is to connect kids with meaningful coverage, whether through Medicaid, CHIP, or the Exchange.

With that vision in mind, over 20 advocacy organizations recently submitted a package of policy recommendations for serving children and youth in the California Health Benefit Exchange. In doing so, we are making a statement that children cannot be an afterthought in the development of the Exchange systems. Our policy recommendations are by no means an exhaustive list, but we hope they will provide the board with a starting point for thinking about the impact on children and youth in the decisions they make and the contracts they enter into.

For example, Section 1302(f) of the Affordable Care Act (ACA) requires “child-only” plans to be offered in the Exchange. This provision has huge implications for the workings of the eligibility system, the way consumers shop for coverage, and which plans should participate in the Exchange marketplace. This is also particularly important for the Small Business Health Options Program of the Exchange (the “SHOP”) – when a parent enrolls in SHOP coverage for himself or herself, there must be strong linkages to individual Exchange coverage for their dependents, and the whole process should be as simple as possible for the family to complete.

Since we know that kids will enroll in Exchange coverage, it is critical that participating health plans be able to take good care of kids. To that end, we recommend a few ways in which the Exchange board can make strategic decisions to ensure kids are served well. These include things such as: explicitly including child-serving health care providers (such as school-based health centers, children’s hospitals, and pediatric subspecialists) in the definition of essential community providers that Exchange plans must contract; consideration of plan-specific pediatric access and age-appropriate quality measures that builds off the 24 initial CHIPRA core quality measures; and developing a truly seamless and coordinated enrollment system that will effectively serve children and youth and link to other enrollment pathways.

The success of the California Health Benefit Exchange will depend heavily on how well the Exchange serves children, youth, and their families. And the best way to make sure that kids really will be served well is to put them front and center now in the planning, development, and decisions around the nuts and bolts of the Exchange.