Bridging the Insurance Gap: State Efforts for Public and Private Coverage

1. State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage Theresa Sachs Technical Director Centers for Medicare and Medicaid Services

2. Public Programs and the Uninsured • Medicaid State Plan • SCHIP Program • Health Reform Demonstrations

3. Health Insurance Flexibility and Accountability (HIFA) • Section 1115 approach • Medicaid/SCHIP • Coverage expansions

4. HIFA Flexibility • Benefits • Cost-sharing • Employer-sponsored insurance

5. Funding for Expansions • “Pass-through” expansions • Re-direct DSH • Managed care savings

6. SCHIP Funding in HIFA • Parents • Pregnant women • Childless adults • Children protected

7. HIFA Employer-Sponsored Insurance Flexibility • Wrap-around • Cost sharing • Cost effectiveness

8. HIFA in Present Environment • Unforeseeable circumstances • Rising numbers of uninsured • Great deal of activity

9. Approved HIFA Demonstrations • AZ - childless adults and parents • CA - parents • SCHIP funding

10. Utah Demonstration • Non-HIFA • Benefit package modifications • Enrollment fee • Expansion - primary care

11. HIFA Advantages • Guidance • Application template • Expedited review