OHIO TO COVER CHILDREN WITH SERIOUS HEALTH CONDITIONS

Volume 29, Issue 514 April 28, 2008

Anna Wolke

While proposed expansions of its Medicaid program and SCHIP remain in holding patterns, Ohio is taking an incremental step forward toward covering all uninsured children in the state. The state has created a unique health insurance buy-in program, targeting children from middle-class families with serious health conditions that make private coverage unaffordable or unavailable.

Enacted as part of the 2007 budget bill (HB 119), the Children’s Buy-in Program is aimed at children under the age of 19, who are eligible if they meet one of the following criteria:

they were unable to purchase health insurance due to a preexisting condition;
they have lost coverage by exceeding their policy’s life-time benefit costs;
premiums for any available insurance policies are more than twice the cost of the state buy-in program; or
the child participates in Ohio's Program for Medically Handicapped Children, which links families with handicapped children to comprehensive care and services.

To be eligible, the families of participating children must earn above 300 percent of the federal poverty level. Premiums will be based on a sliding income scale, and each family will pay from $250 to $500 per month in premiums. Once enrolled, the children's coverage will be provided by CareSource, a managed-care plan.

Because the program subsidizes premiums for children with income levels well above those for Medicaid or SCHIP, Ohio will use state-only funds to help pay for the program. "We are not aware of any similar state-funded programs that target a group of children at this income level,” said John Corlett, deputy director of Ohio Medicaid.

Many states have sought to expand coverage to uninsured children but have approached this goal in different ways. Pennsylvania, Illinois, Tennessee, Wisconsin, and Washington all have implemented buy-in programs with similarities to Ohio's program.

"About 5.4 percent of children in Ohio were uninsured in 2004, and of all the uninsured kids, approximately 1 in 5 had special health care needs," said Maureen Corcoran, Medicaid assistant deputy, citing a 2004 Ohio Family Health Survey.

Ohio officials estimate that a total of 5,000 children will enroll, costing the state an estimated $10 million over the next 15 years.

SCHIP Controversy

The decision to create a buy-in program targeting this specific subset of children was made after lawmakers held several hearings on the issue of children's health coverage. Legislators noticed a pattern in the testimony of parents with uninsured children. "The testimony revealed that many children who were uninsured had faced serious medical conditions and found available coverage to be unaffordable,” said Corlett. “The legislature then made the decision to focus a coverage program more narrowly to include children with extraordinary health problems."

He also noted, "So far, we have had to deny most of the applications we have received for the buy-in program, because the families' incomes were too low. Right now, there is a gap in (coverage) eligibility for these kids."

This gap might be filled if Ohio succeeds in solving its difficulty with expanding its SCHIP. A year ago, Governor Strickland unveiled his comprehensive Healthcare Coverage Reform Initiative, announcing his intention to give every child access to health coverage. However, as the state moved forward plans to meet this objective, it met with considerable push-back from the federal government.

Last December, the Centers for Medicare & Medicaid Services (CMS) rejected Ohio's attempt to carry out legislation that would have expanded its Medicaid program to all children in families earning up to 300 percent of the federal poverty level. CMS cited new guidelines, issued in an August 2007 letter, that say before expanding SCHIP or Medicaid eligibility to children in families with incomes greater than 250 percent of poverty, states must demonstrate that they have enrolled in Medicaid or SCHIP at least 95 percent of children in the state below 200 percent of the poverty. The state continues to negotiate with CMS over a proposed expansion.