Post on 16-Aug-2020
DreamCare Discussion: National Perspective
Sonya Schwartz, JD Research Fellow
Center for Children and Families Georgetown University Health Policy
Institute
3 Key Questions
1. Why have other states decided to cover all kids?
2. What has the impact been?
3. Why is this important for Pennsylvania?
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WHY HAVE OTHER STATES DECIDED TO COVER ALL KIDS?
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States That Cover All Kids State Name Year
Launched How
California* Health Kids, CalKids & Kaiser Permanente Child Health Plan
2015, 2001, 1992, 1998
Incremental local programs with ups and downs, 2015 statewide
Illinois All Kids 2006 Part of broad-based effort to cover all children
Massachusetts* Children’s Medical Security Program
1996s Part of effort to cover children above Medicaid income limits before CHIP was created
New York Child Health Plus 1990 Part of state effort to cover children above Medicaid limits before CHIP was created
Washington Washington Apple Health for Kids
2007 Part of broad-based effort to cover all children
District of Columbia
Immigrant Children’s Program
2000 Timed along with start of locally-funded coverage program for immigrant adults
4 Sources: Fulfilling Pennsylvania’s Promise to Cover All Kids: Closing The Health Insurance Gap for Children, Public Citizens for Children & Youth, June 2015 CCF Conversation with Advocates, July 20, 2015
Estimated Enrollment State Name Year
Launched Number Enrolled (Year)
California* Health Kids, CalKids & Kaiser Permanente Child Health Plan
2015, 2001, 1992, 1998
120,929 (2011), 170,000 eligible in 2016
Illinois All Kids 2006 39,859 (2013)
Massachusetts* Children’s Medical Security Program
1996s 19,258 (2015)
New York Child Health Plus 1990 Not available
Washington Washington Apple Health for Kids
2007 19,074 (2015)
District of Columbia
Immigrant Children’s Program
2000 3,377 (2014)
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Sources: Fulfilling Pennsylvania’s Promise to Cover All Kids: Closing The Health Insurance Gap for Children, Public Citizens for Children & Youth, June 2015
Health Coverage Matters
• Improves access to primary and specialty care with fewer cost barriers
• Get the right care at the right time in the right setting and keep kidsout of ER
• Provides financial protection for children and their families
Source: Medicaid and CHIP Provide Needed Access to Care for Children and Families, CCF, April 2014 6
Long-Term Effects of Childhood Medicaid Coverage
Source: Medicaid at 50: A Look at the Long-Term Benefits of Childhood Medicaid, CCF, July 2015 7
Healthier Adults
Greater Academic
Achievement
Greater Economic
Success
Government Savings (ROI)
Childhood Medicaid Yields Strong Government Return on Investment
Better health Reduction in
hospitalizations and emergency room visits
Government recouped 3-5% of initial cost of
expanding Medicaid in one year (savings of
$22-$34 million)
Higher incomes
Increased tax payments and reduced receipt of
Earned Income Tax Credit (EITC)
The increase in tax payments alone returned nearly one-third (32
cents on the dollar) of the initial cost of expanded childhood
Medicaid by the time children reached age 28 and 56 cents of
each dollar by the time they reached age 60.
Effect of childhood Medicaid in adulthood
Outcome Government
Savings (ROI)
Source: Medicaid at 50: A Look at the Long-Term Benefits of Childhood Medicaid, CCF, July 2015
Recognize “Mixed Status” Families With Mixed Status Children
• At least 9 million people in the US are in “mixed-status” families that include at least one unauthorized adult and at least one U.S.-born child (as of 2010) • There are 400,000 unauthorized
immigrant children in such families who have U.S.-born siblings (as of 2010).
• As of 2013, more than half (53%) of Latino children in the U.S. have at least one parent who was born outside of the U.S.
Sources: Unauthorized Immigrants: Length of Residency, Patterns of Parenthood, Pew Research Center Hispanic Trends, December 1, 2011 America’s Hispanic Children: Gaining Ground, Looking Forward, Child Trends Hispanic Institute, September 24, 2014
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WHAT HAS THE IMPACT BEEN?
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Uninsured Rates for All Children Fall to Record Lows in 5 States
Source: CCF calculations are based on ACS data, 2009-2014 11
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
2009 2010 2011 2012 2013 2014
California
Illinois
Massachusetts
New York
Washington
United States
Uninsured Rates for Hispanic Children Fall to Record Lows in 5 States
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
2009 2010 2011 2012 2013 2014
California
Illinois
Massachusetts
New York
Washington
United States
12 Source: CCF calculations are based on ACS data, 2009-2014
WHY IS THIS IMPORTANT FOR PENNSYLVANIA?
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The Last Step to Coverage for All Kids
PA Has Completed All Other Expansions
Covers Children up the income scale with Medicaid, CHIP and buy in programs
Covers lawfully residing children and removes five year waiting period with CHIPRA S. 214 option
Uses emergency Medicaid for children who are not citizens or lawfully present
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Return PA to the Top Quartile of Lowest Uninsurance Rates
All Kids Hispanic Kids
Source: CCF calculations are based on ACS data, 2009-2014 15
Uninsured Rate for All Children
16
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
2009 2010 2011 2012 2013 2014
Pennsylvania
California
Illinois
Massachusetts
New York
Washington
United States
Source: CCF calculations are based on ACS data, 2009-2014
Uninsured Rate for Hispanic Children
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0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
2009 2010 2011 2012 2013 2014
Pennsylvania
California
Illinois
Massachusetts
New York
Washington
United States
Source: CCF calculations are based on ACS data, 2009-2014
Sonya Schwartz
Research Fellow
Georgetown University Center for Children and Families
ss3361@georgetown.edu
202-784-4077
Twitter: @SonyaSchwartz
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