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In this Issue:
1.
HIFA Waivers in the Pipeline
2. SCI Summer Meeting for State Officials, June 28
– 29, 2004
3. HRSA Provides New State Planning Grant Funding
4. Cover the Uninsured Week, May 10 – 16, 2004
5. New Tools for Monitoring Safety Net Performance
6. Studies Examine How Medicaid and Welfare Changes
Affect Pregnant Women
7. Coming Soon from SCI
8. Reports of Interest
1.
HIFA Waivers in the Pipeline
There
is little news to report on new waiver approvals, but several states
are currently working on Health Insurance Flexibility and Accountability
(HIFA) waiver applications or considering the HIFA route. We have
received many questions on the status of submitted or approved waivers,
so here’s an update:
Approved
HIFA Waivers
Michigan:
The state will cover 62,000 uninsured childless adults at or below
35 percent of the federal poverty level (FPL) through its waiver,
which was approved on January 16, 2004. Funded using the state’s
unspent State Children’s Health Insurance Program (SCHIP)
allocation, the Adults Benefits Waiver program was designed to provide
new beneficiaries with a benefits package that is less broad than
Michigan’s standard Medicaid or SCHIP coverage. In order to
meet the HIFA requirements for coordinating with private insurance,
Michigan is also offering to those beneficiaries with access to
employer-sponsored insurance a voucher that is equal in value to
the state’s cost of providing service. Enrollment in the employer-sponsored
plan is in lieu of receiving benefits through the state plan.
Two
amendments submitted in February are still pending at the Centers
for Medicare and Medicaid Services (CMS). The first requested termination
of the inpatient hospitalization benefit for the Adults Benefit
Waiver as well as elimination of the beneficiary co-payment for
emergency room care, and co-payments for prescription drugs. A separate
stand-alone amendment requests a modest Medicaid expansion through
buy-in eligibility for parents under the poverty level and significant
benefit reductions for non-disabled adults below age 65. The state
intends to provide coverage to an additional 2,000 residents with
this amendment.
New
Mexico: CMS
approved the state’s HIFA waiver in August 2002; however,
implementation has been delayed. New Mexico, an SCI
demonstration grantee, has developed a premium-assistance program
that will combine federal, state, and employer dollars to provide
health insurance to adults with incomes up to 200 percent FPL. The
model has several design features that make it less administratively
burdensome than a typical employer buy-in, including a state-created
benefits package that will greatly simplify the process of coordinating
the program with employers. State officials anticipate expanding
coverage to an estimated 40,000 uninsured New Mexicans.
Awaiting
CMS Approval
Arkansas:
The state submitted a HIFA waiver to establish the Arkansas
Safety Net Benefit Program in January 2003. Arkansas officials have
been in ongoing discussions with CMS; however, they have not yet
received formal approval on the waiver. The state's proposal, which
was developed in part through its SCI Demonstration
Grant, is to provide health insurance coverage to 79,000 Arkansas
residents of all incomes with subsidies to those with family incomes
at or below 200 percent FPL.
Employers
eligible for the employer-based program are those that have not
offered group health insurance for the 12 months prior to program
enrollment and that guarantee 100 percent employee participation.
Employers
voluntarily elect to participate in the program. They contribute
to the costs of the premium for a benefit package developed by the
state. Actuarial analyses have demonstrated that the proposed “safety
net” benefits package will cover the majority of anticipated
utilization of services. Under the proposal, the state would receive
federal matching funds for non-pregnant employees and their spouses
aged 19 – 64 with family incomes less than 200 percent FPL.
Pregnant women are covered under Medicaid up to 200 percent FPL.
Unlike traditional employer-sponsored insurance programs, which
provide premium subsidies for low-income employees to purchase coverage
through their employers, this waiver targets the two-thirds of small
Arkansas businesses unable to offer health insurance at all.
Having
gained broad bi-partisan support, officials remain optimistic that
this public/private partnership will be approved, although the timing
remains uncertain.
Newly
Submitted HIFA Waiver Application
Idaho:
The state submitted a HIFA waiver application in February 2004.
The proposed program, called the Idaho Access Card, is intended
to increase access to affordable private health insurance. To accomplish
this, the state would offer premium assistance to cover children
in families whose gross annual income is above mandatory Medicaid
levels, but below 185 percent FPL. Idaho also submitted a Title
XXI State Plan amendment to create a separate SCHIP program in conjunction
with its HIFA waiver proposal; the program will be available to
children whose parents earn incomes ranging from 150 to 185 percent
FPL.When these new programs are implemented, children in Idaho who
qualify for SCHIP- funded coverage will have a choice between a
state-sponsored direct benefit program or a premium-assistance program,
which allows parents to add their eligible dependents to their existing
employer-based insurance plan (or to an individual insurance policy)
and have the state cover the amount of the dependent's premium up
to a certain limit.
The
HIFA waiver would also offer premium assistance to adults whose
gross annual income is under 185 percent FPL and who are employed
by (or are the spouse of an employee of) an Idaho small business.
The program will be capped at 1,000 adults. For more information,
visit the Idaho
Department of Health and Welfare Web site.
For
more information about waivers that have been submitted to CMS,
please visit the CMS Web site.
Further
Reading:
HIFA at Age Two Opportunities and Limitations for States
2.
SCI Summer Workshop for State Officials
W Lakeshore Hotel Chicago
June 28 – 29, 2004
 The
Robert Wood Johnson Foundation’s State Coverage Initiatives
(SCI) program is pleased to present a summer workshop for state
officials, titled, “Pressing Forward: Cuts, Coverage, and
Creativity.”
We
are lining up a dynamic group of speakers who will address various
state health care issues, including:
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Models for building on employer-sponsored coverage;
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Managing public program premium and cost-sharing changes;
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Scaled-back benefit packages and their take-up in the public and
private markets; and
-
Controlling costs.
We
hope that you will be able to join us for this workshop, which is
only open to state officials. There is no registration fee. To access
updated meeting information or register online, visit SCI's
website.
3.
HRSA
Provides New State Planning Grant Funding
The
Health Resources and Services Administration
(HRSA) recently announced that it will make available three types
of grants through its State Planning Grant (SPG) program for Fiscal
Year (FY) 2004.
Over
the past four years, the SPG program has awarded one-year grants
to officials from 40 states, Washington, D.C., and the Virgin Islands.
The funds are intended to help states conduct in-depth research
into their uninsured population and use it to develop new coverage
plans.
With
the $15 million remaining in the program’s budget for FY 2004,
the agency will provide:
1.
Funding for up to seven new grants to states and territories that
have not yet received SPG funds, with an average grant award of
$800,000;
2.
Funding for up to 24 continuation limited competition grants to
states with an existing or former grant, with an average grant award
of $150,000; and
3.
Funding for up to eight pilot planning limited competition grants
to states with an existing or former grant, not to exceed $400,000
per grant.
Grant
applications are due June 15. For more information, visit www.hrsa.gov/osp/stateplanning/2004_Grant_Opportunities.htm.
4.
Cover the Uninsured Week, May 10 – 16, 2004
The
Robert Wood Johnson Foundation and its partners will hold the
second Cover the
Uninsured Week May 10 – 16. The week will begin with a
national kick-off event scheduled for Wednesday, May 5, at the National
Press Club in Washington, D.C., and will include more than 1,000
events held by community groups from coast to coast.
Like
last year’s initiative, the 2004 campaign will promote awareness
of the uninsured and enroll individuals in coverage programs. In
addition, this year many physicians, nurses, and other health professionals
have volunteered to donate a portion of their time during the week
to care for the uninsured. Noah Wyle, star of NBC’s “ER,”
is the national spokesperson for the 2004 campaign.
5.
New
Tools for Monitoring Safety Net Performance
Do
you need help monitoring the capacity and performance of your safety
net? The Agency for Healthcare Research
and Quality (AHRQ) and the Health
Resources and Services Administration (HRSA) are leading a joint
initiative to help local policymakers, planners, and analysts evaluate
the status of their local safety nets and the populations they serve.
Through
the “Safety Net Monitoring Initiative,” officials can
access two data books that provide a broad range of measures for
assessing the status of local safety nets. With information at the
county and metropolitan levels, focusing on 30 states and Washington,
D.C., the books describe the status of the safety net in 90 metropolitan
areas and 1,818 counties.
A third
book is designed to help state and local policy analysts and planners
measure the performance and needs of their local safety nets. It
consists of a series of papers written by experts and covering a
wide variety of topics.
For
more information on the Safety Net Monitoring Initiative, please
visit www.ahrq.gov/data/safetynet.
6.
Studies
Examine How Medicaid and Welfare Changes Affect Pregnant Women
Two
projects funded by The Robert Wood Johnson Foundation’s Changes
in Health Care Financing and Organization (HCFO) program examine
how Medicaid expansions, Medicaid managed care, and welfare reform
have affected low-income pregnant women. A new brief, “Pregnant
and Poor: Did Medicaid and Welfare Policy Change Improve Care for
These Women as Intended?”, highlights research by Genevieve
Kenney, Ph.D., and colleagues at the Urban Institute, and a separate
project by E. Kathleen Adams, Ph.D., and colleagues at Emory University.
Kenney’s
study found that the effects of Medicaid managed care on prenatal
care were mixed, depending on state-specific environments and differences
in implementation. Adams’ study found that welfare reform
led to less take-up and delayed take-up of Medicaid benefits.
The
researchers hypothesize that policy interventions promoting earlier
insurance coverage for pregnant women could have a beneficial effect
on initiation of prenatal care and birth outcomes. AcademyHealth
is the national program office for HCFO.
7.
Coming
Soon from SCI
We
are currently developing several issue briefs, including those focusing
on:
-
Health Savings Accounts and their implications for states (Mila
Kofman, Georgetown University);
-
New ERISA developments and implications for states (Pat Butler,
consultant);
-
Viable reinsurance models (Deborah Chollet, Mathematica Policy
Research); and
-
States’ experiences with scaled-back benefit packages in
public and private markets (Isabel Friedenzohn, SCI).
Also,
SCI and Rutgers Center for
State Health Policy (CSHP) will host a meeting in the fall of
2004 on the implications of the new Medicare Modernization Act for
state pharmacy programs and state Medicare programs. The meeting
is only open to state officials and is sponsored by the federal
Agency for Healthcare Research and
Quality, The Robert Wood Johnson
Foundation, and The Commonwealth
Fund (through SCI and The Center
for Health Care Strategies).
Check
in with SCI's Web site
for updates on SCI’s latest publications and upcoming events.
8.
Reports of Interest
The
following are the most recently released reports on coverage, most
of which are additions to SCI's database of state reports. For a
complete list of available reports, visit the State Reports Database.
Risky
Business: When Mom and Pop Buy Health Insurance for Their Employees
The Commonwealth Fund
April 2004
SCHIP
Changes in a Difficult Budget Climate: A Three State Site Visit
Report
National Academy for State Health Policy
April 2004
Health
Coverage Tax Credits Under the Trade Act of 2002: A Preliminary
Analysis of Program Operation
The Commonwealth Fund
April 2004
The
Health Coverage Tax Credit for Trade Dislocated Workers & Retirees:
Lessons from Maine’s Early Experience
National Academy for State Health Policy
April 2004
The
Health Care Safety Net in South Carolina: A Test of Tenacity
National Health Policy Forum
February 2004
State
Experience with Enrollment Caps in Separate SCHIP Programs
National Academy for State Health Policy
February 2004
Governor’s
Task Force on Access to Affordable Health Insurance Final Report
Florida Agency for Health Care Administration
February 2004
Options
for Covering the Uninsured: A Report to the Maryland General Assembly
Maryland Department of Health and Mental Hygiene
January 2004
Send
your state's reports to sci@academyhealth.org.
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