SCHIP: Success and Ongoing Challenges

SCHIP: Success and Ongoing Challenges

At the 5^th National Health Policy Conference

Seattle, Washington-November 16, 2001

4:00 p.m. - 5:30 p.m.

Moderator:	Senator Marvin Singleton, Missouri
Speakers:	Kate Brewster, Manager, Employer Contact Unit, Affiliated Computer Services Consultant, Department of Human Services, Rhode Island
	Ed Neuschler, Senior Program Officer, Institute for Health Policy Solutions, Washington, D.C.
	Theresa Sachs, Technical Director, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, Maryland

Theresa Sachs, technical director for the Center for Medicaid and State Operations at the Centers for Medicare and Medicaid Services presented information on the Health Insurance Flexibility and Accountability (HIFA) waiver option-a Medicaid/SCHIP Section 1115 Demonstration Initiative. The purpose of HIFA is to cover more uninsured individuals and create public/private partnerships. The HIFA initiative provides states with flexibility related to populations, benefits, cost-sharing and financing. It allows for public/private partnerships through employer-sponsored insurance, vouchers or pilot programs. HIFA provides accountability through goal-setting, regular reporting and documentation of the impact on the private market. HIFA requires budget neutrality, which applies to both SCHIP and Medicaid. Ms. Sachs discussed options for financing expansions as well as the expedited review process. More information can be found at http://www.hcfa.gov/medicaid/hifa/default.htm. [Link to PowerPoint]

Kate Brewster, manager of the Employer Contact Unit in the Rhode Island Department of Human Services, presented information on the state's premium assistance program. The RIte Care Medicaid Managed Care Program was established in 1994 through an 1115 waiver. The program resulted in improved access to primary and preventative care as well as improvements in prenatal care, inter-birth intervals, lead screening and infant mortality. In 1998, the state expanded RIte Care eligibility to parents. The program experienced major increases in enrollment and in health insurance premium rates. Health reform legislation was passed in July 2000 establishing the RIte Share Program to reform and stabilize the small employer health insurance market and create stronger financial solvency accountability standards for insurers. The RIte Share Program provides eligible families with health insurance by paying both the employers and the medical providers. [Link to PowerPoint]

Ed Neuschler, senior program officer at the Institute for Health Policy Solutions, presented information on SCHIP, HIFA and employment-based insurance. Mr. Neuschler provided statistics on uninsurance and employment-based insurance in the U.S. He defined premium assistance, and explained that the program provides opportunities for cost savings, continuity of care, job stability, self-sufficiency, access to care, reduced "stigma" and reduced instances of "crowd-out." There are two ways to "buy-in" to employer coverage: 1) health insurance premium payment, or 2) premium assistance. Mr. Neuschler recommends that states put premium assistance in place before expanding coverage to parents. He encourages states not to use arbitrary eligibility cut-offs for premium assistance. He says that the process should be kept simple and transparent for employers. Mr. Neuschler also encourages giving program managers flexibility in implementing premium assistance. Finally, he discourages states from limiting eligibility for premium assistance. [Link to PowerPoint]

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