the family opportunity act and children & youth with special health care needs
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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
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