Sponsored by The Robert Wood Johnson Foundation's State Coverage Initiatives Program
Conducted by AcademyHealth

Q: Since the Family Health Insurance Assistance Program (FHIAP) eligibility is 100 to 170 percent FPL, what about families at 99 percent FPL?

A: [Santa] The program was designed to be for the 100 to170 percent FPL bracket, but there is no floor on the program. The family at 99 percent FPL, therefore, could either be eligible for Medicaid, but also allowed to be in FHIIAP. We do not force Medicaid eligibles into Medicaid. The reason for the absence of a floor is the large churning of people within the 90 to125 percent FPL bracket. FHIAP was designed to catch people who fall off the Medicaid cliff.

Q: Will FHIAP subsidize any employer plan?

A: [King] Yes. We decided that if state regulators approve the plan, it is good enough for FHIAP to subsidize eligible employees.

Q: Is the Oregon plan administratively expensive and cumbersome?

A: [King] Yes. Since the state acts as the biller and payer for about 5,000 people, there is 12 to 13 percent administrative cost. More members, therefore, would decrease this percentage.

Q: When you add dental to the Colorado CHP+, how will the per member per month (pmpm) cost change?

A: [Ladon] Dental will add about $10 pmpm, but we did not want to include it in the study because most employers do not offer dependent dental coverage.

Q: Looking at the overall approach of subsidizing employees, how are these budget-limited approaches much different than a tax credit? Aren't we just setting ourselves up for a situation like that in Oregon, running into problems such as long waiting lists? How far does this approach really get us?

A: [Ladon] Colorado recognizes this problem. Currently the state is studying the potential problems and trying to find strategies for multiple funding sources. This model will address the important issue of the transient nature of workers and portability of insurance.
Note: This model, when complete, will be available at the Colorado Coalition for the Medically Underserved Web site (www.ccmu.org), as well as under the "State Reports" section of the SCI Web site.

[Santa] Last year at this time, Oregon was looking at an individual mandate with a tax credit and realized that it was way too expensive.

Q: If a state offers employer buy-in using SCHIP and the family does not meet various standards, the benefit standard, or the five percent limit on out-of-pocket expenditures, is the new rule that the state can give the family the choice between employer-based coverage or public coverage?

A: [Austein Casnoff] My understanding is that without an 1115 Waiver, this is not the case.

Q: It seems that if that choice was allowed that it would be a way to help states cut administrative expenses and allow states to expand these programs.

A: [Austein Casnoff] I will raise these issues with my colleagues at CMS. I would also like to stress the importance of getting in touch with CMS before developing coverage expansion proposals. There are many specialists that can be contacted at CMS, and I recommend directing inquiries in regards to Premium Assistance to Terese Klitenic at (410) 786-5942 or Tklitenic@cms.hhs.gov