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HomeMy WebLinkAboutMINUTES - 05152007 - SD.4 2> D. U • sEal . % F; TO: BOARD OF SUPERVISORS •�� _ Contra FROM: Supervisor Susan A. Bonilla = ___ Costa DATE: May 15. 2007 r `�-�� County \/��o M I ' n t 7 SrA rp[ti'C� V \, SUBJECT: Federal Reauthorization of State Children's Health Insurance Program ' (SCHIP) SPE-:rIC REQUEST S:OR R_OOMMENDATION(S!&BACKGROUND AN D.:JSTi=I -ON RECOMMENDATION: AMEND the County's Federal Legislative Platform to support reauthorization of the federally-funded State Children's Health Insurance Program (SCHIP) and the inclusion of adequate funding in the federal budget to sustain and expand the program. I FISCAL IMPACT: Adequate federal SCHIP funding is needed to maintain and expand health coverage for children, and reduce County costs for the uninsured. BACKGROUND: More than 100.000 Contra Costa residents lack health insurance. including 30.000 children. Nearly 68.000 children in Contra Costa County depend on public insurarwe i CONTINUED ON A-TACHWEKT x YES SiGNjt.7 /1 2 RECOVMENDr ON O=COUNTYA✓VINISTRATOR RECOMMENDATION BOARD-0ry: 4i;TEP_ APPROVE OTHER S.GN.y-IRES:: ACT,ON OF BOARO OfdO AFP3O` _AS RECOFAMENGEC OTriEP coo-TjNuEfl -'=1 oS/2a1©�. gO f90,k►eD F,>tSckssio/V O 0 *T> 1>hy. Vc-_OF S�; _RISORS ti •t 3Y CER-I= T1HL.T-i-I- 'J A TRU JN=- IMO-S .4P-SENT 1y t5 I-. N RR C OF AN 10 T{K_Pd A`ES NOES: OF S1°ERVIS 0RcS_0N-HE D-TE SHCVYN. A9S_N_: AES TAlN AT JOHN CJ_.N -_RK CF THE 300A R�_OF I SUPER `ISORSANDOOUN YADP1;N!_S.RA.TOR Contac??z soa Aras;=_s:a D�csor 5-; �Z O S JDerriscr EOruna i VV Vva:rer.FiSr l . .Airaice&Fac iva -.,- -JJT` SUBJECT: FEDERAL REAUTHORIZATION OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) programs for their health care. including 10.900 children who are enrolled in Heathy Families. the state's SCHIP program. The SCHIP program has been a success story, providing health coverage to 800.000 children in California. and helping to reduce the rate of uninsured low-income children in California by 28.7 percent between 1997 and I 2005. This program helps address some of the major challenges counties face in adequately funding health care needs. SCHIP is scheduled for federal reauthorization by September 2007. but the amount of program funding has not yet been determined. i i Current SCHIP Programs and Funding SCHIP provides a capped allotment of federal funds to states for children's health care programs. In California. SCHIP funds are available on a two-to-one federal/state matching rate. and are used primarily for the states Healthy Families program. The Healthy Families program provides health, dental and vision coverage for children with family incomes up to 250% of the Federal Poverty Level (FPL). As of March 2007, 10.900 children were enrolled in Healthy Families in Contra Costa County. j SCHIP was originally authorized by Congress in 1997 for a ten year period. For the first few years of implementation, California (like other states) did not fully expend its annual SCHIP allotment. Unexpended federal funds were rolled forward to subsequent years (unspent funds can be rolled forward for up to three years). However. since federal fiscal year 2003. California has been exceeding each year's federal allotment and has been relying on unspent federal funds from prior years to bridge the gap between expenditures and federal allotments. For federal fiscal year 2007, the state will spend approximately 51.1 billion in federal SCHIP funds. including 5791 million for its annual allotment. plus S274 million in carryover funding. SCHIP Reauthorization If Congress does not fill the SCHIP shortfall when the program is reauthorized in September 2007. 322,000 California children. 40 percent of the children currently enrolled in Healthy Families. are at risk of losing their health coverage. A recent report funded by the California HealthCare Foundation found that California alone would need between $6.7 billion and $8.1 billion over the next five years to continue funding all programs currently funded with SCHIP. That means S1.3 to S1.6 billion annually. or roughly double the amount the state is currently receiving. I Five-year funding options for SCHIP above the S25 billion base allotments include: • 54.8 billion. proposed by the President. This amount is not sufficient to sustain many state programs. including California's. The Healthy Families program would be at significant risk for reduction and potentially tens of thousands of I children would go without health care coverage. In addition, the President's proposal would limit federal SCHIP funding to only cover children in families with incomes up to 200! FPL. I SUBJECT: FEDERAL REAUTHORIZATION OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) I $14 billion. identified by the Congressional Budget Office as the amount needed to maintain current programs nationwide. This amount would probably not be enough to sustain California's Healthy Families program at current eligibility levels. i • $50 billion, included in the Senate Budget Committee non-binding fiscal year 2008 budget resolution. However, this resolution included $15 billion in offsets from "reducing certain overpayments to health care providers." • S60 billion augmentation (combined SCHIP and Medicaid funding), proposed by health and consumer stakeholders. This amount would be sufficient to fund California's current SCHIP program, as well as Healthy Families program expansions proposed by the Governor and state Legislature. The state Legislature has communicated the importance of this issue to Senators Feinstein and Boxer, as well as other members of the California delegation. Some Senate Democrats have introduced competing bills to reauthorize SCHIP, but I further discussions on reauthorization have been delayed. Reauthorization bills have been introduced by: Senate Finance Committee Chair Max Baucus (D-Mont.); Senate Finance Health Subcommittee Chair Jay Rockefeller (D-W.Va.); Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and Sen. Orrin Hatch (R-Utah); and Sen. Hillary Rodham Clinton (D-N.Y.) and Rep. John Dingell i (D-Mich.). I Proposed Language for County Federal Legislative Platform — Support Position I Reauthorization of State Children's Health Insurance Program (SCHIP) — $60 billion appropriation increase over a five year period above the S25 billion baseline allotments for the Centers for Medicare and Medicaid Services for the federally-funded State Children's Health Insurance Program (SCHIP). Originally established in 1997, SCHIP reauthorization is due by September 2007. This program provides a capped allotment of federal funds to states for children's health care programs. California uses these funds primarily for the Healthy Families program, which provides health insurance for 800.000 children in California. including 10,900 children in Contra Costa County. Since 2003. California, like many other states, has been exceeding each year's federal allotment and has been relying on unspent federal funds from prior years to bridge the gap between expenditures and federal allotments. For federal fiscal year 2007, the state will spend approximately 51.1 billion in federal SCHIP funds, including S791 million for its annual allotment, plus 5274 million in carryover funding. An increase of S60 billion above baseline allotments would be sufficient to fund Californias current SCHIP program, as well as Healthy Families program expansions proposed by i the Governor and state Legislature. If Congress does not fill the SCHIP shortfall, 322.000 California children. 40 percent of the children currently enrolled in Healthy Families. are at risk of losing their health coverage. j - i i APRIL 2007 PRESIDENT'S FY 2008 BUDGET AND THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) The President's FY 2008 budget would reauthorize the State SCHIP,federal funds are capped and allocated to ea& Children's Health Insurance Program (SCHIP_)for the next state. Federal funds match state spending up to each state's five years. The proposal would increase federal SCHIP allotment. There are no pre-set limits on federal matching allotments by about S5 billion. would "re-focus'the program funds for Medicaid. To encourage states to participate in on low-income uninsured children below 200%L of the federal I SCHIP. the federal government assumed a larger share of poverty level (FPL)' and would change the amount of time SCHIP financing by paying an enhanced (relative to that states have to spend SCHIP allotments from three years Medicaid) matching rate. On average. the federal to one year. The total amount of federal funding for SCHIP government's share of Medicaid spending is 57%. but it is i as well as some of the specific policy changes will be 70% under SCHIP_ determined by Congress as tae reauthorization leaislation is considered. Meanwhile. 14 states are likely to face federal SCHIP PROVISIONS IN THE PRESIDENT'S FY 2008 BUDGET funding shortfalls in FY 2007. Georgia hit an SCHIP funding shortfall in March and has recently stopped enrolling new The Presidents budget would reauthorize the SCHIP i children into their SCHIP program. PeachCare. program for the next five year with the following prov-.s:cns: BACKGROUND Size of Federal SCHIP Allotments. The Presidents-budge: j would add S4.8 billion to the Curren`SCHIP allotments o S25 SCHIP was established as Title XXI of the Social Security billion over five years. CBO estimated about S14 billion Act as part of the Balanced Budget Act of 1997(BBA)with a would be needed to maintain current programs. After ten year authorization;the program) must be reauthorized by accounting for all of the policies in tae President's budget. Congress in 2007 for federal financing to continue. SCHIP CBO estimates that to maintain current programs states builds on Medicaid to provide insurance coverage to would face a shortfall of S4.6 billion over the next five years -targeted low-income children"who are uninsured and not and in 2012. 37 states would face a shortfall of S2 billion.. i eligible for Medicaid. typically from families with incomes up Under the Presidents budget proposal. enrollment for to 200% of the Federal Poverty Level (FPL)or 533.200 per children and pregnant women would fall by 1.4 million over year for a family o`three in 2006- Forty-one states cover from FY 2007 to FY 2012. (Figure 2) children at or above 200%of FPL under Medicaid and/or SCHIP. In 2005. SCHIP covered 6 million iow-income SCHIP Enrollment for Children 8,Pregnant Women: ' children during the course of the year and about 4 million. at Baseline,President's Budget and Current Programs any point in time. Underpinning SCHIP. Medicaid covered e•-_a..,_e r.-==,= 28 million poor and low-income children in 2005. (Figure 1) _a _x7= F.c x+ -ACeI 6 E.6 [ SCHIP Builds on Medicaid for Children's Coverage I 55 L2 I Millions a Ch::Emn Cov nW 28-3 '- SCHIP Lovenoe z --. _ Loveo¢_•.__•w-ac I - 'ry"`' __Xet eves i I _ k Fvancins. I -]•a TY 2ZU 2-3; z±v _ _ — Scoce o1 Lcreniae - g �e 3T -fes-n_ [.-[[.sen..,.. _[a• ' ce PreeounsLoc+Sne�ng _ �.ar_. ;Les:Svn,g- a�n .:,,s E =- E' _'°'_n�. ' When SCHIP was established. federal SCHIP aliotmenrs ....ern„= —_-- - -°- -__. SCHIP j I were set for ten years. There has always been a mismatch between state spending and available funds. Ir: aggregate. SCHIP spendina was less than total allotment levels ir. he ; early years of the program: but.wher.the SCHIP programs Like Medicaid. the federal government matches state matured and aliotment levels fell from 54.2 billion to S3.' spending on eligible program beneficiaries: but under billion in 2002. spending exceeded annual allotment ievels- n - C?- I in 2007- 37 states are supporting their current programs with alternative uses of SCHIP funds. In January,of 2007. eleven roll-over funding drawing on unused portions of prior year states had implemented waivers to cover parents of childrer. allotments. enrolled in SCHIP or Medicaid. although some have very I limited enrollment. Five states have implemerted waivers to Time States Have to Spend Allotments. The President's cover childless adults. bu the Deficit Reduction Act(DRA budget proposes to-target funds more efficiently to states" enacted in February 2006 prohibits any new SCHIP waivers by changing the time that states have to spend their j for this purpose. The SCHIP program currently covers i allotments from three years to one year. While this change ' for purpose. . The 0 adults. (Figure 4) might eliminate some of the problems associated with redistributing funds. states will face some new challenges SCHIP Coverage for Children and Adults, managing finds and absorbing unexpected enrollment Millions Enrolled increases if they cannot carry funds from one year to the next. E, The original SCHIP law gave the Secretary of HHS authority I _ - to redistribute funds from states that did not spend their full , ;011- j SCRIP allotment within three years to other states that did I " spend their entire allotment. There have been a number of - =y legislative changes related to how long states have to spend their allotments and to the system for redistributing ch;,:R. Ayu.n unexpended funds. Even with legislative changes. over S1 billion in SCHIP funds reverted to the federal treasury in i October 2004 although millions of children remained �` :'��- m'"" •"°°•• ` °'°' uninsured. Most recently. the National Institutes of Health Reform Act of 2006 called for another round of redistributing Five states cover pregnant women through waivers and � funds in an effort to deiay federal SCHIP funding shortfalls in eleven states use SCHIP funds to cover pregnant women j 14 states. All of these changes illustrate how complicated it through the option to define a fetus as an unborn child. It is is to design an appropriate allocation formula- I unclear how the Presidents proposal would affect pregnant Groups Eligible for SCHIP. The Presidents budget would women in either of these categories. limit the enhanced SCHIP match to chiidren and pregnant OUTLOOK women with incomes at or below 200% FPL. States would receive the lower Medicaid match rate for children and Together Medicaid and SCHIP have proven to be successful j pregnant women with incomes above 200% FPL and for at reducing the number of low-income uninsured children parents covered under SCHIP. CBO estimates that without despite continuing declines in private insurance coverage. the changes to the SCHIP match rates for certain The Presden s FY 2008 bucaet marked the beginning of the I populations. they would need an additional S2.9 biliior. (on SCHIP reauthorization debate that now shirts to the top of the$4.6 billion mentioned above;to maintain current Congress. SCHIP has enjoyed bi-partisan s::pport. but iiving programs. Seventeen states currently cover children ir. within the current budget rules.where new spending needs families with incorne above 200% FPL. (Figure 3) to be offset by savings or increased revenue.will be a major r, challenge. In this context. Congress is developin^y a budge' Children's Eligibility for Medicaid!SCHIP by Income, I resolution that will Set aside funding for SCHIP. Ultimately i July 2006 the Senate Finance and House Energy and Commerce _ - n j Committees will be responsible for developing i reauthorization legislation. There is also pending ,egislation to address the FY 2007 SCHIP funding shortfalls and otner i _�-- —{ -- bills that would expand SCHIP to cover more uninsured children.. particularly those who are eligible but not enroled 1 -� - in public Drograms. B� ^! - tr �rea.e:c:cCH P �I a��- - [= -I - i _ter - I a I so n^-[eera - ner ozAoit `- -d.w An a.a.__-a _tes ave:.eerie_ ievelq it,at 7PL.ut r I - '�^__ •� j income cisre_a:rs teat al__as:net-to e Iec7 e cover s_toe ci:.ie-:a F d ,S!-YIP Cz-etc On-_-S- .,dditic,ial co.,-_s c :his pjcl:catlor. 535:a._a,aiiatr-_ -, =Kaiser The origina; SCHIP legislation permitted the Secretary of =amily Pcuicafcr:s weos-ie at vmPw.k o.g. :-IHS to allow Section 1115 demonstration waivers for I REQUEST TO SPEAK FORM (3 Minute Limit) I«ish to s eak on Agenda Item #: I Complete this form and lace it in the upright boy near the P p p Date: MaIA1 S . 75 speaker's podium. and wait to be called by the Chair. My comments will be: ❑ General Personal information is optional. 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