Loading...
HomeMy WebLinkAboutMINUTES - 05222007 - SD.9 4 � TO: BOARD OF SUPERVISORS Contra FROM: Supervisor Susan A. Bonilla I„�,,,� Costa DATE: May 15, 2007 County SUBJECT: Federal Reauthorization of State Children's Health Insurance Program (SCRIP) SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION 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. 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 insura�rte� CONTINUED ON ATTACHMENT: X YES SIGNATURE. GI ?��LIT tbr� C Q _ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ONb��ZZ/O APPROVE AS RECOMMENDED_�OTHER fuguc.CbW%k',EIU _ SUfpalaTIP& 1'NI5 A0r1%*M fKa% tpED Sy: %A?-SAO CrNikAAN, C.C 1 SC • W AL-IfN i'toRmPra1 , Ct-r tl:b” VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED �- JOHN CULLEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Anastasia Dodson,5-1022 CC: Supervisor Bonilla W.Walker,HSD S.Hoffman,CAO Alcalde&Fay(via CAO) ,DEPUTY i 'SUBJECT: FEDERAL REAUTHORIZATION OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) programs for their health care, including 10,900 children who are enrolled in Healthy 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 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. 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 state's 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. 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 $1.1 billion in federal SCHIP funds, including $791 million for its annual allotment, plus $274 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 $1.3 to $1.6 billion annually, or roughly double the amount the state is currently receiving. Five-year funding options for SCHIP above the $25 billion base allotments include: • $4.8 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 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. -SUBJECT: FEDERAL REAUTHORIZATION OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) • $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. • $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." • $60 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 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 (D-Mich.). Proposed Language for County Federal Legislative Platform — Support Position Reauthorization of State Children's Health Insurance Program (SCHIP) — $60 billion appropriation increase over a five year period above the $25 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 $1.1 billion in federal SCHIP funds, including $791 million for its annual allotment, plus $274 million in carryover funding. An increase of $60 billion above baseline allotments would be sufficient to fund California's current SCHIP program, as well as Healthy Families program expansions proposed by 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. o o• o 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 each 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$5 billion, would are-focus"the program funds for Medicaid. To encourage states to participate in on low-income uninsured children below 200%D of the federal 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 as well as some of the specific policy changes will be 70% under SCHIP. determined by Congress as the reauthorization legislation 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 President's budget would reauthorize the SCHIP children into their SCHIP program, PeachCare. program for the next five years with the following provisions: BACKGROUND Size of Federal SCHIP Allotments. The President's budget would add$4.8 billion to the current SCHIP allotments of$25 SCHIP was established as Title XXI of the Social Security billion over five years. CBO estimated about$14 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 the 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$4.6 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$2 billion. eligible for Medicaid, typically from families with incomes up Under the President's budget proposal, enrollment for to 200%of the Federal Poverty Level (FPL)or$33,200 per children and pregnant women would fall by 1.4 million over year for a family of three in 2006. Forty-one states cover from FY 2007 to FY 2012. (Figure 2) children at or above 200%D of FPL under Medicaid and/or Figure SCHIP. In 2005, SCHIP Covered 6 million low-Income SCHIP Enrollment for Children&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 10Basell"°o presidents Budget ecMmenl negrams 28 million poor and low-income children in 2005. (Figure 1) ],6].8 7.8 a ].8>A .6 8.0 3.1 Figure l 6B • 8A K 6.7 6.6 SCHIP Builds on Medicaid for Children's Coverage ..°''" 66 6.1 Millions of Children Covered 26.3 Medicaid $CHIP Coverage:Required for new Coverage:Above Medicaid borne to age 6 up to 133% levels sr FPL;age 6-19 up to 111096 Financing:Capped; Financing:Guaranteed enhanced match Federal match Ent6lemenL To States Entitlement To benefcanes 2007 2009 20011 2010 2011 2012 and states Scope of Coverage: a e a u e a e u . °•°. Scow of Coverage: Benchmark benefi6;no idaY�d,�•peyr� Includes EPSDT mandate for EPSDT 6oLRCE Cao Mnch ml lwrne:swis sed e.d.Fee uvo2a.mol PremiunslCostSharing: Premwms/CostSharirg: Unrind Pamihed E,�„regCaps. 61 Eemllment Cap,: When SCHIP was established,federal SCHIP allotments "°`p`a `d $scHlr Pem i6ed f were set for ten years. There has always been a mismatch between state spending and available funds. In aggregate, ao a 6 r "mM�,Ma d6»w�ddad •°°•• °•°• SCHIP spending was less than total allotment levels in the IFaen lnfdda snary.eINLFFSo2,M9a,vC SEP6 day.am. tb�.�.Ve1t1� early years of the program; but,when the SCHIP programs Like Medicaid, the federal government matches state matured and allotment levels fell from $4.2 billion to$3.1 spending on eligible program beneficiaries; but under billion in 2002, spending exceeded annual allotment levels. 2400 SAND HILL ROAD MENLO PARK, CA 94025 650 854-9400 FAx 650 854-4800 www.kff.org WASHINGTON, DCOFFICE: 1330 G STREET NW Washington,DC 20005 202 347-5270 Fax 202 347-5274 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 children allotments., enrolled in SCHIP or Medicaid, although some have very limited enrollment. Five states have implemented waivers to Time States Have to Spend Allotments. The President's cover childless adults, but 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 for this purpose. The SCRIP program currently covers allotments from three years to one year. While this change approximately 600,000 adults. (Figure 4) might eliminate some of the problems associated with Flpure4 redistributing funds, states will face some new challenges SCHIP Coverage for Children and Adults, managing funds and absorbing unexpected enrollment Millions Enrolled increases if they cannot carry funds from one year to the next. 6.1 The original SCHIP law gave the Secretary of HHS authority to redistribute funds from states that did not spend their full SCHIP allotment within three years to other states that did spend their entire allotment. There have been a number of legislative changes related to how long states have to spend 06 their allotments and to the system for redistributing Children Adults unexpended funds. Even with legislative changes, over$1 billion in SCHIP funds reverted to the federal treasury in October 2004 although millions of children remained °" �'" °�"" "°"°"""` °'"""°""" •°°•• •• °•°• scNF,rNlirvrS Tm, rmaY r W Y.Y .! 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 delay federal SCHIP funding shortfalls in eleven states use SCHIP funds to cover pregnant women 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. unclear how the President's proposal would affect pregnant Groups Eligible for SCHIP. The President's budget would women in either of these categories. limit the enhanced SCHIP match to children 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 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 President's FY 2008 budget marked the beginning of the populations, they would need an additional$2.9 billion (on SCHIP reauthorization debate that now shifts to the top of the$4.6 billion mentioned above)to maintain current Congress. SCHIP has enjoyed bi-partisan support, but living programs. Seventeen states currently cover children in within the current budget rules, where new spending needs families with income above 200% FPL." (Figure 3) to be offset by savings or increased revenue, will be a major Flprrt.l challenge. In this context, Congress is developing a budget Children's Eligibility for Medicaid/SCHIP by Income, resolution that will set aside funding for SCHIP. Ultimately July 2006 the Senate Finance and House Energy and Commerce Committees will be responsible for developing reauthorization legislation. There is also pending legislation to address the FY 2007 SCHIP funding shortfalls and other PA bills that would expand SCHIP to cover more uninsured children, particularly those who are eligible but not enrolled M in public programs. M Y'fi °A R u ' 'CBO assumed that increases in SCHIP funding would offset some projected ■<,°m, FPL(10 Medicaid spending,so net federal costs over the period would be$8.3 billion. ❑ Fri I]• ....1l no X) "An additional 19 states have income eligibility levels set at 200%FPL but apply �"L(17 income disregards that allow them to effectively cover some children in families "+M Frdr.l Poh",lM IFR),"..oily d M..In N B6 F1BHOWY.w, In­r °.n,m..�+FF� with incomes above 200%FPL. Center for Children and Families: States Affected by Proposals to Reduce SCHIP Coverage Options. Feb.7,2007 reM Rur2nbr MCM Additional copies of this publication(#7635)are available on the Kaiser The original SCHIP legislation permitted the Secretary of Family Foundation's website at www.kff.org. HHS to allow Section 1115 demonstration waivers for REQUEST TO-SPEAK FORM (3 Minute Limit) I wish.to s eak on A"enda Item#: . . Complete this form and place it in the upright box near the Date: speaker's podium, and wait to be called by the Chair. My comments will be: ❑ .Gener 1 Personal it formation is optional. This speaker's card will be incorporated into the public record of this meeting . ❑ For Name(PRINT): t�yj arcs 6 Li��rt-� • ❑ Against To ensure your name is mn70101ced correctly,you may ivy nt to include its phonetic spelling I wish to speak on the subject of. Address: N 6^e City: 1 Phone: i I am speaking for: ❑ Myself Organization: � " �� ❑ I do not want to speak but would like to a leave comments for the Board to consider ! (Use the back of this form) I REQUEST TO SPEAK FORM(3 Minute Limit) I wish to speak on Agenda Item Complete this form and place it in the upright box near the Date: O s— j speaker's podium, and wait to be called by the Chair. My comments will be: �' Geier I Personal inforination is optiondl. This speaker's card Neill be incorporated into the public record of this meeting. ❑ For r J � �� � Name (PRINT): � .0 ;bt��n 0 ❑ Against 1'o ensure vour naive is aunounck con ect�ly,you may want to include its phonetic spelling 1 I wish to speak.on the subject of: Address: CO , Co, j City: j Phone: I am speaking for' ,l Myself ❑ I do not.want to speak but would like to ❑ Organization: leave comments for the Board to consider (Use the back of this form) i