SCHIP Reauthorization: What’s at Stake for Michigan

Liz ArjunState Health Policy Analyst

Georgetown University Health Policy InstituteCenter for Children and Families

Michigan’s Promise & Voices for Michigan’s Children

Training

July 12, 2007

Key Policy Ingredients of Original SCHIP Legislation

• Block grant / No entitlement to coverage• No mandates / State option with

“enhanced matching funds”• Funds dedicated to NEW coverage• Medicaid treated as the base off of which

states would build• State flexibility to use Medicaid and/or a

separate state program with fewer federal standards

SCHIP Enrollment, 1997-2004 (in millions)

0.9

2.7

3.4

3.8 3.9 3.9

1.8

1997 1998 1999 2000 2001 2002 2003 2004

SCHIP adopted(August 1997)

51st state implements SCHIP; enrollment efforts are strong;

states pursue family coverage waivers

(2000)

State fiscal crisis and extensive SCHIP

cutbacks (2002 – 2004)

$1.3 billion in unspent SCHIP

funds lost (2004)

HIFA initiative allows SCHIP funds to be

used for coverage of childless adults

(2001)

Source: CCF; and enrollment data from Kaiser Commission on Medicaid and the Uninsured.

22.3%

21.5%

20.1% 20.0%

18.0%

15.8% 15.9%

14.9%15.2%

1997 1998 1999 2000 2001 2002 2003 2004 2005

Uninsured rate of low-income children under 19

Trends in the Uninsured Rate of Low-Income Children, 1997- 2005

Source: CCF analysis of National Health Interview Survey.

ESI Coverage Rates Have Declined for Children and Adults

Source: Percent with employer-sponsored insurance from E. Gould, “Health Insurance Eroding for Working Families,” Economic Policy Institute (September 2006).

65.4%

58.9%60.8%

55.4%

Children under 18 Working Adults

1999-2000 2004-2005

Coverage Gains Over the Past Decade Have Come Equally from

Medicaid & SCHIP

21.0 21.4 21.6 21.9 22.6 25.5 26.3 27.8

3.3 4.65.3

6.26.0

1.90.9

1997 1998 1999 2000 2001 2002 2003 2004

Medicaid SCHIP

Enrollment of Children in Public Coverage (Millions)

Source: CCF analysis based on CMS enrollment data for children ever-enrolled over the course of a year.

21.023.5

22.325.2

27.2

32.330.8

34.0

Coverage Gains Have Come Equally from Medicaid & SCHIP

Enrollment of Children in Public Coverage

Source: Michigan enrollment data from the Michigan Department of Community Health, Michigan Critical Health Indicators: 2007 (April 2007); U.S. enrollment data from CCF analysis of CMS data based on children ever-enrolled over the course of a year.

164

465

21.0

34.0

Michigan U.S. (Thousands) (Millions)

Michigan has been Successful in Its Effort to Cover Children

Uninsured Rate of All Children

Uninsured Rate of Low-

Income Children

Participation in Medicaid/SCHIP

Among Low-Income Children

U.S. average

11.0% 17.9% 74.2%

Michigan 5.8% 9.5% 85.2%

Source: CCF analysis of CPS 2005 and 2006 March Supplement (i.e., data from 04-05).

Michigan Has Been Successful and Innovative with its SCHIP Dollars

• One of the lowest rates of uninsured children in the country

• Significant growth in Medicaid + Unspent SCHIP Dollars = Michigan looking for ways to use its dollars

• Bush Administration encouraged states to use these resources to address issues of uninsured in states

• Obtained a waiver in 2004 to cover 65,000 childless adults with incomes less than 35% FPL

National Picture Today

• Most Uninsured Children are Eligible

• Recent Surge of Activity at the State-Level Indicates States are Ready to Move Forward

• Voters Strongly Support Efforts to Get Children Covered

• SCHIP Must be Reauthorized by September 30, 2007

7 out of 10 Uninsured Children are Eligible But Unenrolled

49% are Medicaid Eligible

19% are SCHIP Eligible

Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CT

NJ

DE

MD

RI

HI

DC

AK

SC

NMOK

GA

Source: As of July 9, 2007 based on CCF review of state initiatives.

TX

IL

FL

AL

Implemented or Recently Adopted Legislation to Improve Children’s Coverage (23 states and DC)

Considering Significant Proposal to Improve Children’s Coverage (5 states)

States are Moving Forward

Strategies

• Improving participation rates among currently eligible children

• Reaching more children by expanding income eligibility

• Eliminating/limiting restrictions based on immigration status

• Integrating public and private coverage/funding

Americans Strongly Support Covering Children

84%84%New York Times, March 2, 2007

$3.8$4.3

$4.6$5.1

$6.0$6.4

$6.9

$7.6$8.1

$8.8

$9.4

$4.2 $4.2 $4.2 $4.2

$0.1

$0.9

$2.7

$1.9

$5.0$5.0$5.0$5.0$5.0$5.0

$5.0$4.1

$3.2$3.2$3.1

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

SCHIP Spending SCHIP Allotment

(in billions)

Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006); 2007-2012 spending data from CBO March 2007 SCHIP baseline (February 2007) includes outlays plus additional SCHP spending required to maintain current programs.

SCHIP Spending is Rapidly Outpacing New Funds Being Made Available

SCHIP Reauthorization:Key Issues for Michigan

• Level of funding (up to $50 billion in promised in budget resolution)

• Stable and predictable flow of funding

• New options/financial supports to support and improve coverage/participation

• Will the state be prevented from using unspent dollars for childless adults?

• Benefits and quality

Timeline for Congressional Action??

July

August Sept30

SenateFinance

CommitteeSenateFloor

House Energy

and CommerceCommittee

House Floor Conference

No new funds available

Getting to the Finish Line

• Building on the success of the past decade, a diverse array of states are moving forward

• Different strategies, different circumstances, but children are consistently a centerpiece

Questions?

Liz ArjunPhone: (202) 784-4576

Email: eaa37@georgetown.eduwww.ccfgeorgetown.org