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State Children's Health Insurance Program


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Coverage For Low-Income Immigrant Children Increased 24.5 Percent In States That Expanded CHIPRA Eligibility (Article)
Brendan Saloner, Neel Koyawala, Genevieve M. Kenney

By 2011, twenty states and the District of Columbia had expanded eligibility for federally funded public insurance to low-income immigrant children within their first five years of legal residence in the United States under the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. Data from the National Survey of Children's Health shows that compared to immigrant children in states that did not expand eligibility, children in states expanding eligibility experienced a 24.5 percent increase in insurance coverage, largely due to greater enrollment in public insurance. These immigrant children also experienced significant reductions in unmet health care needs, compared to their counterparts in non-expansion states. Disparities relative to children in nonimmigrant families were substantially reduced in states that expanded eligibility, compared to states that did not. Expanding eligibility for federally funded public insurance to immigrant children within their first five years of legal residence in other states could improve coverage for immigrant children and might also increase access to care.

Posted to Web: May 06, 2014Publication Date: May 01, 2014

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model (Methodology Report)
Jennifer M. Haley, Victoria Lynch, Genevieve M. Kenney

The Urban Institute Health Policy Center's Medicaid/CHIP Eligibility Simulation Model is a microsimulation that uses rules about Medicaid/CHIP eligibility to approximate adults' and children's eligibility for Medicaid and CHIP. It has been used to simulate eligibility in the 50 states and Washington DC for the years 2008-2012 (before the Affordable Care Act [ACA] was implemented) and 2014 (simulating the new coverage provisions of the ACA). It has also been used to simulate eligibility in Puerto Rico in 2011 and enrollment under hypothetical statehood. It relies on the American Community Survey (ACS) and the Puerto Rico Community Survey (PRCS).

Posted to Web: March 26, 2014Publication Date: March 26, 2014

Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act (Research Report)
Stan Dorn, Julia Isaacs, Sarah Minton, Erika Huber, Paul Johnson, Matthew Buettgens, Laura Wheaton

The Affordable Care Act (ACA) has created new opportunities for health and human services programs to integrate eligibility determination, enrollment, and retention. Using two large microsimulation models—the Transfer Income Model, Version 3, and the Health Insurance Policy Simulation Model—we find considerable overlaps between expanded eligibility for health coverage and current receipt of human services benefits, particularly with Earned Income Tax Credits, the Supplemental Nutrition Assistance Program, and the Low-Income Home Energy Assistance Program. In an appendix, we identify specific data sharing strategies that seek to increase participation, lower administrative costs, and prevent errors.

Posted to Web: February 18, 2014Publication Date: December 01, 2013

Tax Preparers Could Help Most Uninsured Get Covered (Policy Briefs/Timely Analysis of Health Policy Issues)
Stan Dorn, Matthew Buettgens, Jay Dev

More than 74% of uninsured consumers who qualify for ACA health coverage file federal income tax returns. This includes over 90% of consumers under age 35 who qualify for subsidies in health insurance marketplaces. Most low-income taxpayers use tax preparers, including 64.6% of EITC claimants, more than 78% of whom file by March 31, the final day of open enrollment. State and federal officials and private leaders concerned about ACA enrollment should seriously explore partnering with commercial and nonprofit tax preparers to reach the eligible uninsured and move towards a healthy, balanced risk pool.

Posted to Web: February 18, 2014Publication Date: February 18, 2014

Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP (Article)
Kelly J. Devers, Additional Authors

We examine quality improvement (QI) collaboratives in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation. Overall, practice staff highly valued aspects of the collaboratives and supplemental strategies but also reported a variety of challenges.

Posted to Web: December 19, 2013Publication Date: December 01, 2013

Confronting the Child Care Eligibility Maze: Simplifying and Aligning With Other Work Supports (Research Report)
Gina Adams, Hannah Matthews

This report, a product of the Work Support Strategies (WSS) initiative, helps states confront burdensome administrative processes that make it difficult for low-income families to get and keep child care benefits, and the cumulative challenges eligible clients face in trying to access other benefits (i.e. SNAP/Medicaid). Through concrete policy ideas and examples from states across the country, it offers an in-depth guide to help states not only simplify child care subsidy policies, but also to align child care policies with other work supports. With this information, states can improve service delivery for clients and staff, and reduce administrative burden.

Posted to Web: December 09, 2013Publication Date: December 04, 2013

How the CHIPRA quality demonstration elevated children on State health policy agendas (Research Brief)
Nicole Cafarella Lallemand, Elizabeth Richardson, Kelly J. Devers, Additional Authors

This Evaluation Highlight is the fourth in a series that presents descriptive and analytic findings from the national evaluation of the CHIPRA Quality Demonstration Grant Program. The CHIPRA quality demonstration grants have provided a unique opportunity not only to advance child health quality in the short term, but also to link child health quality issues to broader Federal and State health reforms. In this Highlight, we give examples of activities in five States—Maine, Maryland, Massachusetts, Vermont, and Oregon—and how they used their CHIPRA quality demonstration grants to elevate children's health care issues on their States' health policy agendas.

Posted to Web: October 22, 2013Publication Date: October 01, 2013

Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States: Final Report to the Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services (Research Report)
Brigette Courtot, Teresa A. Coughlin, Emily Lawton

This study of Medicaid and CHIP managed care programs in 20 states indicates that capitation rate-setting became more data-driven and transparent during the time period 2001-2010. Benefit packages were fairly consistent over time and among states, with carve outs in every state for a least one acute service. Total spending on managed care services for Medicaid enrollees varied considerably across states and subgroups; nondisabled children had the lowest average monthly spending and adults with disabilities had the highest.

Posted to Web: October 17, 2013Publication Date: December 01, 2012

Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
Stan Dorn, Matthew Buettgens, Christopher Hildebrand, Habib Moody

Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.

Posted to Web: October 14, 2013Publication Date: October 14, 2013

Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
Stan Dorn, Matthew Buettgens

When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.

Posted to Web: October 14, 2013Publication Date: October 14, 2013

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