New 50-State Survey Illustrates Key Role of CHIP Reauthorization and the Federal Stimulus Law in Safeguarding Coverage
WASHINGTON – Despite the deep recession, most states have managed to safeguard and, in some cases, expand health coverage for children and parents in their Medicaid and Children’s Health Insurance Programs in 2009, according to a new survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. But the gains, which could serve as a base for covering millions more people under health reform, are threatened by the impending end of key federal assistance at the end of 2010 and before health reform coverage would begin.
The annual 50-state survey of eligibility rules, enrollment and renewal procedures and cost-sharing practices in Medicaid and CHIP for children and parents found that, overall, most states in 2009 continued to expand and simplify their Medicaid and CHIP programs, the main vehicles for providing coverage to low-income children and families, even as they faced the bleakest economic picture in years and severe budget pressures. However, budget shortfalls did result in cutbacks in some states.
“The renewal of CHIP and the fiscal relief and eligibility and enrollment protections for Medicaid in the American Recovery and Reinvestment Act (ARRA) proved critical to enable states to continue their commitment to providing coverage to millions of low-income families,” said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. “However, even with signs of economic recovery, state revenues are still mired in a severe slump and, faced with the end of enhanced federal money after 2010, fiscal shortfalls are likely to cause states to consider significant cuts to Medicaid and CHIP.”
Despite National Gains, Prominent Disparities Remain
While the survey reveals significant overall progress nationally in expanding public coverage or making it easier to access, wide variations in coverage persist. Among the survey findings:
Gains Could Be Eroded By The Recession, Weakening the Coverage Base for Health Reform
States’ commitment to providing Medicaid and CHIP coverage to low-income children and families will continue to be tested in 2010 as dismal state budget circumstances persist. Recent forecasts indicate states will face even bigger shortfalls in the upcoming fiscal year. At the same time, the federal assistance that states have relied on under ARRA is scheduled to expire at the end of the 2010 calendar year, and along with it the requirement that states maintain eligibility levels and refrain from imposing enrollment barriers. That raises the prospect of substantial state cuts in Medicaid and CHIP that could reverse recent expansions and undermine the base of coverage for low-income families upon which broader health reform efforts seek to build.
The leading reform bills in Congress build on Medicaid to expand health coverage to millions of people, but differ in the scope of the expansion they envision, the level of federal support they would provide to states, and in how they treat coverage for children. These survey findings provide a baseline against which future progress can be measured. Further, as policymakers attempt to craft final legislation, they can draw on what states have learned about the importance of simplifying enrollment and renewal procedures, covering parents, and limiting cost sharing. The simple and coordinated procedures that have helped assure that eligible children and parents secure and retain coverage, and that have enabled families to transition smoothly between programs when family circumstances change, will be essential in a new health insurance system.
Today’s report, A Foundation for Health Reform: Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP for Children and Parents During 2009, and related materials, including a new issue paper on key issues to consider in health reform regarding coverage of low-income children, are available online here. In addition, an audio press briefing on the release will be available after 6 p.m. ET today.
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The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid’s role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation’s Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission’s work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.