Past Successes. Future Challenges 2017 Annual Research Meeting - PowerPoint PPT Presentation

20 Years of CHIP: Past Successes. Future Challenges 2017 Annual Research Meeting June 27, 2017 Debbie I. Chang, MPH Senior Vice President, Policy & Prevention Nemours Children’s Health System 1

Nemours Integrated Child Health System 2

Top 5 CHIP Accomplishments: #1 Bipartisan support for a public program  CHIP is a finely crafted compromise – It was created as part of a budget deal (BBA) between a Republican Congress and a Democratic President in 1997. – It represents a partnership between states and the federal government. – It brought together advocates of a Medicaid expansion and those who favored a private insurance approach. – It balances the politics of conservatives and liberals by including elements of a block grant and an entitlement program:  Federal CHIP funds are capped with each state receiving an annual allotment  No individual entitlement under separate CHIP programs  States can choose to expand through Medicaid (in this case there is an entitlement) 3

Top 5 CHIP Accomplishments: #2 Coverage gains for children  CHIP extended insurance coverage to millions of uninsured kids. – CHIP and Medicaid are credited with reducing the number of uninsured children from 10 million in 1997 to 3.3 million in 2015. – The percentage of uninsured children is at a historic low of 5 percent. – Medicaid and CHIP play a particularly critical role in covering children in low income families and children of color.  More than ¾ of children in families with incomes below the poverty level are enrolled in Medicaid and CHIP.  CHIP and Medicaid cover more than half of all Black, Hispanic and American Indian and Alaska Native children. – CHIP made covering a “moderate income” population acceptable  Over half (56%) of children in families with incomes between 100% and 199% are enrolled in CHIP. 4

Top 5 CHIP Accomplishments: #3 Improved access for children  Enrollment in CHIP improves access to health care services.  Some studies have found that Medicaid and CHIP coverage contribute to improved health outcomes – Reductions in avoidable hospitalizations and mortality 5

Top 5 CHIP Accomplishments: #4 Innovations and spillover to Medicaid  CHIP flexibility led to innovations in enrollment, outreach and program design  CHIP has had a positive spillover effect on Medicaid 6

Top 5 CHIP Accomplishments: #5 States and Parents embraced CHIP  After enactment, states moved quickly to adopt programs.  Parents are satisfied with the coverage that CHIP is providing their children.  Most new CHIP enrollees stayed enrolled in public coverage for at least 28 months and the vast majority exited because they were no longer eligible. 7

Current Challenges for CHIP  Proposed changes to Medicaid and ACA have created much uncertainty around children’s coverage.  CHIP Funding levels and financing policy unknown. 8

What is next for CHIP?  CHIP funding is set to expire on September 30, 2017.  In order for CHIP to continue, Congress must act very soon to extend federal funding.  If no legislative action is taken, the health of millions of children will be at risk and it will increase the financial pressures for states. – States will be responsible for maintaining coverage for children in CHIP-funded Medicaid expansions under the ACA MOE requirement.  MACPAC recently recommended a 5-year extension of CHIP with the current CHIP maintenance-of-effort. More information can be found here: https://www.macpac.gov/publication/recommendations-for- the-future-of-chip-and-childrens-coverage-2/ 9

Moving to a Prevention-Oriented Health System  CHIP (and Medicaid) should focus on prevention and population health  There are many existing authorities for CHIP and Medicaid to finance prevention (e.g., CHIP Health Services Initiative)  See Nemours toolkit for many more examples at: http://movinghelathcareupstream.org/innovations/pathways- through-medicaid-to-prevention 10

A Roadmap of Medicaid Prevention Pathways: Framework 11

A Roadmap of Medicaid Prevention Pathways: Examples 12

Debbie I. Chang, MPH Senior Vice President, Nemours Policy and Prevention 1201 15 th Street, NW, Suite 520, Washington, DC 20005 (e) dchang@nemours.org www.nemours.org 13