CHIPRAPerformance

Bonusesfor Medicaid

National Covering Kids & Families NetworkWebinar – February 22, 2010

Tricia Brooks

The Performance Bonus

• To reward states for (and help offset the cost of ) enrolling low-income children in Medicaid

FFY 09 Bonus Awards

Performance Bonus - The Basics

• Enrollment Targets• Cumulative over time• Medicaid only

• Eligibility as of July 1, 2008

• Enrollment & Retention Measures• At least 5 of 8• Apply to both Medicaid and CHIP

• Exception - premium assistance

The Bonus

• The Bonus• 15% state share of cost for

enrollment > target• 62.5% state share of cost for

enrollment > 110% target

• How can it be used?• Cannot be used to draw down

federal match• Otherwise, not restricted

What Have We Learned from Guidance?

Enrollment Targets

Adjusted by increase or decrease in child population!

12-Month Continuous Eligibility

• Guarantees 12-months of coverage regardless of changes except these:• Child moves out of state, ages out or passes away• Voluntary request for disenrollment• Is determined eligible and enrolled in Medicaid with

no gap in coverage• Nonpayment of premium (temporarily allowed

pending further guidance)

• 22 states have continuous eligibility in both programs; 8 more in CHIP alone• 8 of the P/B states got credit

The Straight Forward Measures

• No asset test or administrative verification of assets• 48 states have eliminated the asset test• All 9 P/B states got credit

• No in-person interview required at enrollment or renewal• 48 states require no face-to-face interview for

both programs at enrollment, 50 at renewal• All 9 P/B states got credit

Same Application and Renewal Forms and Procedures

• Interchangeable forms are OK (“no wrong door” forms)• Form generates referral to other program• Supplemental forms to request information for

one program is only allowed if there is a difference in Federal program rules

• Information verification process • Procedure for verifying all eligibility criteria must

be the same• Timeline for verifying information must be the

same

How Do States Fare on Joint Forms and Same Verification Process?

• States that implemented CHIP as a Medicaid expansion would qualify automatically (12)

• No specific source of information available to determine precisely which states could qualify• 48 states have a joint application• 31 states have a joint renewal form• Same verification process is harder to assess• All 9 P/B states got credit

Administrative Renewals or Ex Parte Renewals

• Administrative verification of income is central to this measure• 16 States do so in both programs, 3 in CHIP alone

• 8 P/B states got credit

• Administrative renewals• Send preprinted form with eligibility information• Include notice that coverage will be renewed unless

state receives other information• Signature and return of form to confirm desire to

maintain coverage is allowed• State verifies eligibility using electronic/other means

• Ex Parte renewals• State makes a redetermination to the maximum

extent possible using information available to it• References SMD Letter 4/22/97

• Can’t close Medicaid due to loss of eligibility for cash assistance; must review other eligibility categories, use information in SDX or BENDEX

• Further guidance coming with regulations

Administrative Renewals or Ex Parte Renewals

Presumptive Eligibility

• Allows states to use trained, qualified entities to make preliminary determination pending the formal eligibility process• Ensures that kids get services while completing the

process• May include hospitals, community health centers,

WIC, HeadStart and other programs receiving federal funds

• 11 states currently meet this requirement; 3 have PE in Medicaid only

• 4 P/B states received credit

Express Lane Eligibility

• Guidance issued separate from P/B• Requires State Plan Amendment (SPA) that:

• Details the ELE agency• Identifies if it applies to new applications,

renewals or both• Describes which screen and enroll process is used

• 6 states have submitted ELE SPA’s• Not clear if it applies to both programs• No state got credit this year due to timing

Premium Assistance Programs

• Only measure that requires implementation in either Medicaid or CHIP

• Must be one of the new premium assistance programs enacted through CHIPRA• Medicaid 1906A• CHIPRA 2105(c)(10)

• 1 State has picked up new premium assistance option• No P/B state received credit

FFY 10 Performance Bonus

• If legislation is required for 1 of the 8 measures, it must be enacted by October 1, 2009

• Measure would need to be in place for at least 6months or on April 1, 2010 and remain in place through September 30, 2010

Next Steps

• Regulations will provide more detail

• Opportunity to comment on proposed regulations before final adoption

• President’s budget anticipates increase to $240 million in FFY 11

Inquiring Minds Want to Know

• Are there ways to make the performance bonuses more accessible?• Phased in

implementation?• Targets that recognize

states with low uninsured rates?• Year-to-year targets not based on cumulative gains?

• How can advocates best engage to encourage states to qualify?

Contact Information

Tricia BrooksSenior FellowGeorgetown University Center for

Children and Familiespab62@georgetown.eduhttp://ccf.georgetown.edu/http://www.theccfblog.org/202-365-9148