| Program Element
|
Prior to Expansion
|
Expansion 1
|
Proposed Expansion 2
|
Implementation Date
|
n/a
|
July 22, 2007
|
January 1, 2009
|
Program Type
|
Separate Medicaid and SCHIP programs
|
Separate program
|
Builds on phase 1 of expansion
|
Income Range and Population Covered
|
Medicaid: children with family incomes up to 200% of the FPL
SCHIP: children with family incomes between 200% & 250% of the FPL
|
All children under 19 with family income up to 250% FPL regardless of immigration status
|
Children under 19 with family incomes up to 300% of the FPL regardless of immigration status; children with family incomes over 300% of the FPL are eligible to buy-in at the full cost
|
Cost-Sharing
|
Up to 200% of the FPL: no premiums or co-payments
Between 200% and 250% of the FPL: monthly premiums of $15/child (max of $45/month per family); no co-payments
|
Remains the same by income level
|
Premiums and co-payments to be determined; the cost of the buy-in will be equal to the rate the state pays plus any administrative costs
|
Medicaid/SCHIP Coordination
|
Administered by Health and Recovery Services Administration, Division of Health Services; joint application for Medicaid and SCHIP; automatic transfer between programs when changes in eligibility
|
Administered by the same agency, with the same level of coordination
|
Same for expansion
|
Enrollment/Renewal Procedures
|
Application
|
Mail-in application; no face-to-face interview or asset test required
|
Same application and enrollment process; improved online application (integrated with case management system) to be studied
|
Same for expansion
|
Continuous Eligibility
|
12 months for Medicaid and SCHIP
|
Same
|
Same for expansion
|
Renewal
|
Joint renewal form for Medicaid and SCHIP; no face-to-face interview or asset test required; automatic continuation of benefits when an Eligibility Review is received, but not yet processed
|
Same renewal form and procedures
|
Same for expansion
|
Crowd-out Measures for Separate SCHIP
|
4-month waiting period for enrollment in SCHIP (incomes above 200%); state currently monitors substitution of coverage
|
Same 4-month waiting period for all children,
regardless of immigration status, with family incomes above 200% of the FPL.
Will report on the substitution resulting from this expansion by 2010.
|
Same for expansion
|
Linkage with Other Public Programs
|
Previous pilot program with Medicaid and free school lunch program; automatic renewal of Medicaid with Food Stamp renewal
|
Use of existing systems to identify eligible kids,
including free school lunch, child care, WIC, and early childhood
education to be studied
|
No change
|
Benefits
|
Benefits
|
Medicaid/SCHIP covers medical, dental, vision, and hearing, as well as mental health, alcohol and substance abuse services
|
Same
|
Same benefits for expansion
|
Service Delivery System
|
Largely managed care (immigrant children and children in certain counties with less than 3 managed care options are served in a fee-for-service model)
|
New focus on connecting beneficiaries to a medical home and developing quality measures to indicate that a child has an established and effective medical home
|
Targeted provider rate increases will be linked to the quality improvement measures established in phase 1 of the expansion
|
Other Provisions
|
Outreach
|
Outreach workers get $75 for each successful application submitted
|
Allocated additional funds for outreach for all children's programs, with a focus on hard-to-reach kids; campaign will include: media and new program information materials, contracts with community-based organizations
|
No further change
|
Premium Assistance
|
Small premium assistance program that has largely been operated as a pilot program
|
Families will be screened for access to employer-sponsored health care; the state will provide funds for purchase when cost-effective (as determined by state)
|
Same for expansion
|
Retention
|
n/a
|
Develop a targeted retention plan to improve program retention and decrease churn (pilot programs are under way)
|
Once results are available from pilots, efforts will be expanded
|
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