America's Children Health Insurance and Access to Care (1998) / Chapter Skim
Currently Skimming:
6 State and Private Insurance Initiatives
6 State and Private Insurance Initiatives
Pages 102-119
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 102... ...
The chapter also gives examples of private sector initiatives undertaken by insurers anc3 health plans across the country. In summary, the chapter describes some of the key lessons learned from previous experiences in implementing state anc3 private chilciren's health insurance programs.
|
From page 103... ...
hac3 only private Blue Cross anc3 Blue Shield Caring Programs for Children anc3 proviclec3 no state assistance (Gauthier anc3 Schroclel, 1997; Gebshan, 1997~. Many of the states choosing Meclicaic3 expansions have consicierec3 the relative administrative anc3 fiscal advantages of altering an existing program when compared with designing anc3 implementing new state programs (Mann, 19971.
|
From page 104... ...
DESIGNING CHILDREN'S INSURANCE PROGRAMS For more than a clecacle, states have been funding programs that provide insurance for children who are not eligible for Meclicaic3 anc3 who c30 not have private insurance. State~ciesignec3, non-Meclicaic3 insurance programs typically develop contracts with private~sector health plans anc3 providers at market rates, so that the subsiclizec3 children anc3 families receive the same coverage as the privately insured groups in their communities (GAO, 1996~.
|
From page 105... ...
For example, Health Access New Jersey is a statewide program for children anc3 adults, anc3 the Massachusetts Medical Security Plan provides subsiclizec3 coverage for families whose wage earners are unemployed. However, because of resource constraints, the majority of state- sponsored insurance programs focus on children, anc3 some also extend eligibility through adolescence (see Table 6.21.
|
From page 106... ...
Dynasaur New York's Regional Pilot Projects Colorado's Child Health Plan 1993 235% ages 1-5 1-15 185% ages 6-15 1989 225% 0-17 1989 200% 0-64 1992 185% 0-12 Michigan's Caring Program for Children 1991 185% 1-18 North Carolina's Caring Program for Children 1987 185% 0-19 Montana's Caring Program for Children 1992 150% 0-19 lowa's Caring Program for Children 1989 133% 0-18 Kansas' Caring Program for Children 1989 133% 0-18 SOURCE: Gauthier and Schrodel (1997, p.18~. a Percent refers to percentage of the federal poverty level
|
From page 107... ...
Charles LaVallee Western Pennsylvania Caring Program for Children, Pittsburgh, PA Public Workshop June 2, ~ 997 There has been a lot of talk about crowd-out, but there is very limited evidence that at the lowest end of the income spectrum, you are crowding out private insurance. Private insurance largely does not exist for the parents in these working families.
|
From page 108... ...
Given a limited amount of resources, does a state choose to cover more uninsured children with a minimal set of benefits, or does the state choose to provide more comprehensive services, in which case fewer children will be covered? Most states have decided on a comprehensive benefit package rather than catastrophic coverage (see Table 6.3)
|
From page 109... ...
Florida Healthy Kids Comprehensive 8 612 Hawaii QUEST Comprehensive 5 NA MinnesotaCare Comprehensive 8 792 New Hampshire's Healthy Kids Comprehensive 1 804 Health Access New Jersey Comprehensive 6 NA New York's Child Health Plus Comprehensive 15 432-678 New York's Regional Pilot Projects Comprehensive 4 NA Pennsylvania's Children's Health Comprehensive 5 636 Insurance Program Rhode Island's Rite Care Comprehensive 4 840 Tennessee's TennCare Comprehensive 10 505 Vermont's Dr. Dynasaur Comprehensive 2 446-533 Washington's Basic Health Plan Comprehensive 18 492-720 Massachusetts' Children's Medical Basic/standard 1 NA Security Plan Colorado's Child Health Plan Limited 0 350 lowa's Caring Program for Children Limited Kansas' Caring Program for Children Limited 350 204 Massachusetts' Medical Security Plan Limited 2 450-540 Michigan's Caring Program for Limited 1 615 Children Montana's Caring Programfor Limited 1 360 Children North Carolina's Caring Program for Limited Children 1 312 SOURCE: Gauthier and Schrodel (1997, p.15~.
|
From page 110... ...
PROFILES OF STATE-SPONSORED PROGRAMS This section describes some of the state-sponsorec3 programs that were cievelopec3 in the early 1990s: Florida Healthy Kicis, Massachusetts' Chilciren's Medical Security Plan, MinnesotaCare, New York's Child Health Plus, anc3 TennCare. These programs were chosen because of their variety of approaches to eligibility, financing, anc3 outreach anc3 enrollment anc3 because their experiences can provide guidance for other states in developing anc3 mollifying SCHIP in the years ahead.
|
From page 111... ...
NJ Health Access NY Child Health Plus Full subsidy NY OR TN VT Regional Pilot Projects Oregon Health Plan Children's Health Full subsidy Insurance Program TennCare Health Access Plan WA Basic Health Plan Full subsidy Full subsidy Partial subsidy Partial subsidy Full subsidy Full subsidy Partial subsidy Partial subsidy Partial subsidy Partial subsidy/Not eligible as income nears 200% FPL Partial subsidy Partial subsidy Full subsidy/Partial subsidy as income nears 200% FPL Partial subsidy Partial subsidy Partial subsidy Not eligible Not eligible Not eligible Not eligible Not eligible No subsidy No subsidy No subsidy Not eligible Not eligible Not eligible Partial subsidy Partial subsidy Partial subsidy Partial subsidy Partial Not eligible subsidy/Not eligible as income nears 300% FPL Not eligible Not eligible Partial subsidy/Not eligible as income nears 300% FPL No subsidy No subsidy Not eligible Not eligible Not eligible Partial subsidy Not eligible Not eligible Not eligible Full subsidy/Not Not eligible Not eligible eligible as income nears 200% FPL Full subsidy Partial subsidy Full Not eligible subsidy/Partial subsidy as income nears 50% Partial subsidy Partial subsidy Partial subsidy Partial subsidy Not eligible Not eligible No subsidy No subsidy NOTE: FPL = federal poverty level. SOURCE: Gauthier and Schrodel, 1997, Table 6.
|
From page 112... ...
in 1994 in response to the state's growing Meclicaic3 costs and the growing number of uninsured children. At that
|
From page 113... ...
Chilciren's health insurance expansions in Massachusetts have been financed through a reallocation of the state's pool of money for uncompensated care anc3 through a 25- cent increase in the cigarette tax (Greenberg anc3 Zuckerman, 19971. In Massachusetts, the Meclicaic3 program is available to uninsured children anc3 adults with incomes up to 133 percent of the federal poverty level.
|
From page 114... ...
New York still has one of the highest rates of uninsured children: about 557,200 children still have no coverage, anc3 state officials plan to double the number of children enrolled in Child Health Plus over the next 3 years (Johnson anc3 McDonough, 19981. Based on legislation that was enacted in 1996, all children aged 2 to 19 whose family income is below 120 percent of the federal poverty level are eligible for comprehensive benefits, anc3 those with incomes from 120 to 222 percent of the federal poverty level are eligible with a slicling scale.
|
From page 115... ...
Among the plans that have been involved in children's health programs are Aetna Health Plan, Atlanta; Blue Shield Plans in California, Colorado, Georgia, North Carolina, and Ohio; Group Health Cooperative of Puget Sound; Harvard Pilgrim Health Plan; Kaiser Permanente in California, Colorado, Maryland, Virginia, and the District of Columbia; Physicians Health Plan of Greater St. Louis; Prudential Health Care Plan of the Mid-Atlantic; US Healthcare; and others (AAHP, 19981.
|
From page 116... ...
"Kaiser Permanente Cares for Kicis," which was started in California in 1997, is part of a national subsidy program for uninsured people that will be expanclec3 by Kaiser Permanente in the next few years. Caring Programs Blue Cross anc3 Blue Shielc3 Caring Programs offer subsiclizec3 coverage for primary anc3 preventive services for low- income children in 25 states.
|
From page 117... ...
Beginning in 1999, Kaiser Permanente will increase its funding for subsiclizec3 care, including an aciclitional $10 million allocated to covering uninsured children in other Kaiser Permanente divisions, for a total of $30 million being cievotec3 to covering uninsured children. Children's Programs in Other Health Plans In abolition to Caring Programs anc3 Kaiser Permanente, several other insurers anc3 health plans across the country have smaller chilciren's health initiatives (AAHP, 1997~.
|
From page 118... ...
REFERENCES AAHP (American Association of Health Plans)
|
From page 119... ...
Using Child Health Farads to Expand Coverage Through the Medicaid Program. Washington, D.C.: Center for Budget and Policy Priorities.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.