Session: Informing US Health Reform
Room: Upson 215
Time: Wed 12:00-13:30

Presenter: Salam Abdus (Agency for Healthcare Research and Quality (AHRQ). )

Discussant: Anna Sommers (Center for Studying Health System Change)

Abstract

While much attention regarding health reform proposals has focused on coverage for adults and insurance exchanges – reform bills from both the House and the Senate contain changes that are relevant to low income children and their families. The proposals include changing Medicaid income eligibility thresholds to 133 or 150 percent of family poverty level (FPL). For states with programs above these thresholds, maintenance of Medicaid and Medicaid-expansion CHIP (M-CHIP) programs has been proposed. Despite the recent re-authorization of CHIP, however, the future of Separate CHIP (S-CHIP) programs is unclear.

This paper will present various statistics on children’s current eligibility for Medicaid/CHIP and their insurance coverage that will inform implementation of reform proposals. Data from the 1996 through 2008 Medical Expenditure Panel Survey (MEPS) are used in conjunction with the Agency for Healthcare Research and Quality’s KIDSIM eligibility model to predict changes in children’s eligibility and coverage under potential changes in thresholds. The paper will also address options for children who may lose eligibility for public coverage as a result of the reforms.

KIDSIM predicts children’s eligibility using data on income, family structure, insurance coverage and immigration status combined with state/year specific rules for Medicaid/CHIP. The model also includes valuable information on parental insurance offers and coverage.

Output from an earlier version of the KIDSIM model using 2004-05 data are presented here to illustrate the implementation of a possible 150 percent Medicaid eligibility threshold. If Medicaid income eligibility thresholds were set at 150% FPL, 30% of children who are currently eligible for Separate CHIP programs are estimated to become Medicaid eligible. This represents an estimated 40% of children currently enrolled in S-CHIP programs. These children’s families would see the elimination of CHIP premiums. This change would also reduce the incidence of mixed eligibility/coverage across family members.

Maintaining Medicaid programs in states with thresholds already above 150% FPL is estimated to result in continued eligibility for 6% of Medicaid eligible children and 5% of Medicaid enrolled children. Likewise, a continuation of Medicaid-expansion CHIP for states with higher thresholds would result in continued eligibility for an estimated 44% of M-CHIP eligible children and 42% of M-CHIP enrolled children.

The options for children in families above 150% FPL living in states running Separate CHIP programs is less clear. Those affected include an estimated 70% of current S-CHIP eligible children and 59% of current S-CHIP enrollees. Premium assistance for private coverage could be available from the federal government for many of these families. Among S-CHIP eligible children without private coverage, about 58% are estimated to have a parent with an offer; while 41% are estimated to have a parent with an offer who is privately covered.

More recent data from 2006-08 MEPS has recently been incorporated into an updated KIDSIM model and will be the basis of our presentation in June 2010. Further, the model can be used to support additional estimates as reform proposals evolve over time.

Key Terms

Children, Health Insurance, Medicaid, CHIP, Eligibility

Authors:

Julie Hudson (Agency for Healthcare Research and Quality. Center for Financing, Access, and Cost Trends) , Jessica Banthin (Agency for Healthcare Research and Quality. Center for Financing, Access, and Cost Trends) , Thomas Selden (Agency for Healthcare Research and Quality. Center for Financing, Access, and Cost Trends) and Salam Abdus (Social and Scientific Systems)