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FUTURE OF THE CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP)
SENATE FINANCE SEPTEMBER 21, 2017
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Virginia’s CHIP Covers 3 Distinct Groups
MCHIP 58,224 enrollees (47%) Ages 6-19 100-143% FPL
FAMIS 65,032 enrollees (52%)
Ages 0-19 143-200% FPL
FAMIS MOMS 1,146 enrollees (1%) Pregnant women 143-200% FPL
Note: Represents total enrollment of 124,402 as of September 2017.
Timeline of CHIP
CHIP introduced
in the Balanced
Budget Act of 1997
Children’s Health
Insurance Reauthorization
Act of 2009 (CHIPRA)
amends CHIP
Funds CHIP for 5 years
Medicare Access and CHIP Reauthorization
Act of 2015 (MACRA) funds CHIP through
FFY 2017
PPACA introduces
super enhanced FMAP (88%) for
CHIP through FFY 2019
Funds CHIP
through FFY 2015
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Current CHIP funding expires
Virginia runs out of
federal CHIP funds
Additional consideration
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Maintenance of Effort (MOE) Requirements • PPACA requires that states maintain the same eligibility
levels in place as of 3/23/2010 until 9/30/2019 • If federal CHIP funding is not provided, does not apply to
FAMIS recipients • BUT, would still apply to MCHIP recipients who
would revert to a 50/50 match
Potential Scenarios for Congressional Action
Any action, other than funding CHIP at the enhanced matching rate, will increase Virginia’s costs and potentially lead to coverage losses
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Funds CHIP by 9/30/2017 Amends current law to reduce
matching rate to 65%
Funds CHIP by 9/30/2017 Maintains current law with
enhanced matching rate (88%)
Takes no action to fund CHIP
Congressional Action Impact on Virginia
FY 2018 forecast will need to be amended to increase general funds to account for reduced matching rate
No impact on current forecast Super enhanced FMAP (88%)
ends in FY 2020 (9/30/2019)
Federal funding will run out in early 2018
State policymakers will need to make decisions soon
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Scenario 1: Congress funds CHIP and does not adjust matching rate
Federal CHIP funds are provided at 88% matching rate
This scenario is current law and already incorporated in the CHIP forecast Reduction in FMAP to 65% occurs in FY 2020 (9/30/2019)
FY 2018 FY 2019
Federal matching rate as of 10/1/2017 FAMIS and FAMIS MOMS 88% 88% MCHIP 88% 88%
Additional GF costs FAMIS and FAMIS MOMS $0 $0 MCHIP $0 $0 Administration $0 $0
Total additional GF costs $0 $0
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Scenario 2: Congress funds CHIP but reduces the matching rate
Reducing the matching rate will result in additional GF costs in FY18 and FY19
FY 2018 FY 2019 Federal matching rate as of 10/1/2017
FAMIS and FAMIS MOMS 65% 65% MCHIP 65% 65%
Additional GF costs FAMIS and FAMIS MOMS $28.9M $41.8M MCHIP $24.2M $35.3M Administration $4.5M $6.0M
Total additional GF costs $57.6M $83.1M
If Congress reduces the matching rate, Virginia will experience significant unplanned expenses in FY 2018 and FY 2019 to maintain current coverage levels
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Scenario 3: Congress passes the KIDS Act
Maintains 23% bump in FFY18 and FFY19 Reduces bump to 11.5% in FFY20 Returns to original CHIP match in FFY21 and FFY22
CHIP authorized for 5 years; MOE requirement is continued through 2019 and then is only required for children under 300% FPL through 2022
FY 2018 FY 2019 FY 2020 FY 2021 FY 2022 Federal matching rate
FAMIS and FAMIS MOMS 88% 88% 76.5% 65% 65% MCHIP 88% 88% 76.5% 65% 65%
Additional GF costs FAMIS and FAMIS MOMS $0 $0 $23.5M $54.1M $58.0M MCHIP $0 $0 $21.0M $45.0M $48.0M Administration $0 $0 $2.9M $6.3M $6.7M
Total additional GF costs $0 $0 $49.2M $105.3M $112.7M
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Scenario 4: Congress does not fund CHIP but GA continues coverage
End FAMIS and extend Medicaid to cover FAMIS when funding runs out in early 2018
FY 2018 FY 2019 Federal matching rate when CHIP funding runs out in January 2018
FAMIS and FAMIS MOMS 50% 50% MCHIP 50% 50%
Additional GF costs FAMIS and FAMIS MOMS $26.5M $69.1M MCHIP $22.2M $58.3M Administration $4.1M $9.9M
Total additional GF costs $52.9M $137.3M
• No one would lose coverage • DMAS would need authority to submit a state plan amendment to CMS
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Scenario 5: Congress does not fund CHIP and FAMIS ends:
DMAS will need to engage in extensive transition planning to end FAMIS: • Notification to families (65,000+) • Notification to providers • Training of Eligibility Workers, Call Centers, Application Assistors, etc. • System changes (Eligibility rules and MMIS) • Contract changes (MCOs, prior authorization, audits, etc.) • Federal authority changes (CHIP State Plan termination, Medicaid
state plan amendment, 1915(b) waiver amendment), • State authority changes (General Assembly to repeal FAMIS & expand
Medicaid, state regulation modifications) • Plus much more
65,000 children and 1,100 pregnant women lose coverage
How Long Can We Wait?
Virginia will run out of federal funds sometime in March, 2018
We pay managed care plans retroactively for the previous month’s coverage – so there will be insufficient funds in March to pay for February
FAMIS shuts down at end of January
Termination notices to families should be sent December 1st
Training and system/contract changes developed before notices
Planning must start in October
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