CHIPRA Performance Bonuses for Medicaid

1. CHIPRAPerformance Bonusesfor Medicaid National Covering Kids & Families Network Webinar – February 22, 2010 Tricia Brooks

2. The Performance Bonus • To reward states for (and help offset the cost of ) enrolling low-income children in Medicaid

3. FFY 09 Bonus Awards

4. Performance Bonus - The Basics • Enrollment Targets • Cumulative over time • Medicaid only • Eligibility as of July 1, 2008 • Enrollment & Retention Measures • At least 5 of 8 • Apply to both Medicaid and CHIP • Exception - premium assistance

5. The Bonus • The Bonus • 15% state share of cost for enrollment > target • 62.5% state share of cost for enrollment > 110% target • How can it be used? • Cannot be used to draw down federal match • Otherwise, not restricted

6. What Have We Learned from Guidance?

7. Enrollment Targets Adjusted by increase or decrease in child population!

8. 12-Month Continuous Eligibility • Guarantees 12-months of coverage regardless of changes except these: • Child moves out of state, ages out or passes away • Voluntary request for disenrollment • Is determined eligible and enrolled in Medicaid with no gap in coverage • Nonpayment of premium (temporarily allowed pending further guidance) • 22 states have continuous eligibility in both programs; 8 more in CHIP alone • 8 of the P/B states got credit

9. The Straight Forward Measures • No asset test or administrative verification of assets • 48 states have eliminated the asset test • All 9 P/B states got credit • No in-person interview required at enrollment or renewal • 48 states require no face-to-face interview for both programs at enrollment, 50 at renewal • All 9 P/B states got credit

10. Same Application and Renewal Forms and Procedures • Interchangeable forms are OK (“no wrong door” forms) • Form generates referral to other program • Supplemental forms to request information for one program is only allowed if there is a difference in Federal program rules • Information verification process • Procedure for verifying all eligibility criteria must be the same • Timeline for verifying information must be the same

11. How Do States Fare on Joint Forms and Same Verification Process? • States that implemented CHIP as a Medicaid expansion would qualify automatically (12) • No specific source of information available to determine precisely which states could qualify • 48 states have a joint application • 31 states have a joint renewal form • Same verification process is harder to assess • All 9 P/B states got credit

12. Administrative Renewals or Ex Parte Renewals • Administrative verification of income is central to this measure • 16 States do so in both programs, 3 in CHIP alone • 8 P/B states got credit • Administrative renewals • Send preprinted form with eligibility information • Include notice that coverage will be renewed unless state receives other information • Signature and return of form to confirm desire to maintain coverage is allowed • State verifies eligibility using electronic/other means

13. Administrative Renewals or Ex Parte Renewals • Ex Parte renewals • State makes a redetermination to the maximum extent possible using information available to it • References SMD Letter 4/22/97 • Can’t close Medicaid due to loss of eligibility for cash assistance; must review other eligibility categories, use information in SDX or BENDEX • Further guidance coming with regulations

14. Presumptive Eligibility • Allows states to use trained, qualified entities to make preliminary determination pending the formal eligibility process • Ensures that kids get services while completing the process • May include hospitals, community health centers, WIC, HeadStart and other programs receiving federal funds • 11 states currently meet this requirement; 3 have PE in Medicaid only • 4 P/B states received credit

15. Express Lane Eligibility • Guidance issued separate from P/B • Requires State Plan Amendment (SPA) that: • Details the ELE agency • Identifies if it applies to new applications, renewals or both • Describes which screen and enroll process is used • 6 states have submitted ELE SPA’s • Not clear if it applies to both programs • No state got credit this year due to timing

16. Premium Assistance Programs • Only measure that requires implementation in either Medicaid or CHIP • Must be one of the new premium assistance programs enacted through CHIPRA • Medicaid 1906A • CHIPRA 2105(c)(10) • 1 State has picked up new premium assistance option • No P/B state received credit

17. FFY 10 Performance Bonus • If legislation is required for 1 of the 8 measures, it must be enacted by October 1, 2009 • Measure would need to be in place for at least 6 months or on April 1, 2010 and remain in place through September 30, 2010

18. Next Steps • Regulations will provide more detail • Opportunity to comment on proposed regulations before final adoption • President’s budget anticipates increase to $240 million in FFY 11

19. Inquiring Minds Want to Know • Are there ways to make the performance bonuses more accessible? • Phased in implementation? • Targets that recognize • states with low uninsured rates? • Year-to-year targets not based on cumulative gains? • How can advocates best engage to encourage states to qualify?

20. Contact Information Tricia Brooks Senior Fellow Georgetown University Center for Children and Families pab62@georgetown.edu http://ccf.georgetown.edu/ http://www.theccfblog.org/ 202-365-9148