This week I had the pleasure of attending a gathering of policy analysts and advocates from 15 states on “Transforming Health Care Coverage for Children and Families,” convened by Georgetown University’s Center for Children and Families. The conference, which focused on the opportunities and challenges of providing coverage to the uninsured while the new health care reform law is being implemented, featured a keynote address by Cindy Mann, Director of the Center for Medicaid and State Operation within CMS, the Centers for Medicare and Medicaid Services. This post shares some of her key points. It has been cross-posted to CCF’s “Say Ahhh!” blog.
Mann started out by reminding the attendees that Medicaid is already a key source of health insurance, providing coverage to nearly 63 million Americans over the course of the year in 2008. Currently, Medicaid is of particular importance for covering children in low-income families, and has been primarily responsible for the substantial progress made in reducing the rates of uninsured children to below 10 percent nationally in 2008. Enrollment in Medicaid and CHIP, the program that covers children from moderate income families in some states, grew by 2.6 million children in 2008-09, picking up the slack for declining employer-based coverage during the initial phase of the economic downturn.
With health care reform and the emergence of a health care system that is intended to provide universal coverage, Mann stressed that Medicaid will increase in importance, serving as one leg of a “three-legged stool” of coverage for the non-elderly, along with employer-based insurance and the new health insurance exchanges for individuals and small businesses. Of the 32 million Americans expected to gain coverage under the new law, a full fifty percent, or 16 million, are expected to be added to the Medicaid program. Most new Medicaid enrollees will be low-income parents and childless adults, who are currently ineligible for Medicaid in most states and are most likely to be without insurance.
Mann acknowledged that this expansion will create challenges for state-run Medicaid programs. In particular, states will need to develop efficient and well-coordinated application and eligibility systems to help individuals and families determine which insurance program they are eligible for and to facilitate enrollment and renewal. The goal will be to develop a single system out of different components. In addition, Medicaid programs will have to ensure that beneficiaries have access to the full range of health care services and benefits. Mann acknowledged that access to some services, especially dental care and specialists, is a problem in some states, although she emphasized that, according to most key measures, access to care for Medicaid beneficiaries is comparable to those with private insurance.
While health care reform is ramping up for 2014, Mann emphasized that there is important work that can and must be done now to expand enrollment within the substantial population of children who are already eligible for coverage but remain uninsured. Of the 6 million uninsured children in America, it is estimated that 80 percent, or nearly five million, are eligible for Medicaid and CHIP. Last year’s law reauthorizing the Children’s Health Insurance Program, known as CHIPRA, provided states with important new tools for enrolling eligible children. States that enacted a number of specific best practices for simplifying enrollment and maintaining eligibility are eligible for significant performance bonuses in the form of higher federal match. The federal government has also awarded $40 million in outreach grants, including $988,177 to the Oklahoma Health Care Authority, with an additional $50 million still to be awarded. This past February, Health and Human Services Secretary Kathleen Sebelius issued “The Secretary’s Challenge: Connecting Kids to Coverage,” calling on states and local communities to engage in an effort to enroll all eligible children in coverage over the next five years.
Overall, Mann’s main message was a reminder that making more people eligible for health care coverage, while a huge achievement, in many ways is only a prelude to the really hard work ahead to make universal coverage a reality in practice. This effort will require aggressive outreach combined with simplified enrollment processes and integrated information systems. For governments, advocates, and providers, the work starts now.