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A Proposal to Secure Quality, Affordable Health Care for Ohio’s Children

02-20-2007

An estimated 156,000, or 5.4%, Ohio children are uninsured.¹ The majority of these children live in families with one or more working parent and with family incomes under 200% of the Federal Poverty Level ($33,200 annually for a family of three).

Access to quality health care is especially important for children because they are growing and developing. Preventive care and early detection and treatment of child health and developmental needs are some of the most cost-effective investments we can make.

Ohio does many things right. The state’s relatively good ranking in terms of the rate of uninsured Ohio children is due to its continuing investment in Healthy Start Healthy Families Medicaid. Medicaid eligibility for children is at 200% of the FPL ($33,200 annually for a family of three, 2006) and covers nearly one million Ohio children annually.

However, it is time to close the gap and make sure every Ohio child has access to quality affordable health care. We can do this by:

Finding, enrolling, and retaining more of the uninsured children who are eligible for but not yet enrolled in Healthy Start Healthy Families Medicaid
Further streamlining the enrollment and renewal processes, and
Expanding coverage

Taken together, these three strategies will assure quality, affordable health care for nearly all Ohio’s children.

Finding, enrolling, and retaining more of the uninsured children who are eligible for but not yet enrolled in Healthy Start Healthy Families Medicaid:

106,000 or 68% of Ohio’s uninsured children (ages 0 – 17) currently are eligible for, but not yet enrolled in Medicaid. Ohio should increase strategic efforts to find, enroll, and retain more of these children by:

Investing public dollars in community-based outreach, enrollment and renewal strategies. Medicaid and SCHIP administrative dollars can be used to fund outreach, enrollment and renewal activities. The respective matching rates are 50:50 and 71:29 respectively. At least 14 other states invest in outreach, enrollment and/or renewal efforts; many states are increasing their investment.
Setting target retention and/or enrollment rates for each county, monitoring progress and publishing results.
Supporting outreach workers at federally qualified health centers and other large-volume Medicaid providers.

Further streamlining the enrollment and renewal processes by:

Adopting presumptive eligibility for children so that selected health providers and community agencies could place children who appear to be eligible on Medicaid for a period not to exceed two months while the family submits necessary documentation to support an application and confirm eligibility.
Establishing 12-month redetermination for parents: Change the redetermination period from 6 months to 12 months for parents enrolled in Medicaid. Children already have 12-month redetermination so this would make timeframes within the family consistent and reduce “churning” for parents.
Electronic verification of income: Instead of clients’ producing paper documentation of income, the JFS can “match” employment and earnings data through electronic records and verify income for most clients. Those for whom an electronic match cannot be established would be asked to provide paper documentation.
Strengthen ex parte review: the process whereby caseworkers search for and review client data from other programs that can determine a client’s eligibility for Medicaid

Expanding Medicaid/SCHIP eligibility to 300% of FPL

According to the 2004 Ohio Family Health Survey, 106,000² of Ohio’s 156,000 uninsured children live in families with incomes under 200% of the FPL, the eligibility level for Healthy Start Healthy Families Medicaid.

An estimated 32,000 of Ohio’s uninsured children under age 19 live in families with incomes between 201 – 300% of FPL.³ Therefore, expanding Medicaid eligibility to 300% of FPL ($49,800 annually for a family of three, 2006) would assure that most of Ohio’s children have access to health coverage.

Estimated annual costs are⁴:

Regular Medicaid/per child	SCHIP Expansion/per child
(60:40 federal:state match)	(71:29 federal:state match)
$1968 annual total	$1968 annual total
$1181 federal share	$1397 federal share
$787 state share	$571 state share

32,000 children under age 19 live in families between 200 – 300% FPL.

Estimated 70% take-up rate = 22,400 children enrolled

Total funds: (annual)	$44 million	Total funds: (annual)	$44 million
Federal share:	$26.4 million	Federal share:	$31.2 million
State share:	$17.6 million	State share:	$12.8 million

Estimated 65% take-up rate = 20,800 children enrolled

Total funds: (annual)	$41 million	Total funds: (annual)	$41 million
Federal share:	$24.6million	Federal share:	$29.1million
State share:	$16.4 million	State share:	$11.9 million

Estimates are provided for financing the expansion through regular Medicaid match and through a SCHIP expansion.

¹The 2004 Ohio Family Health Survey reports that 5.4% or 156,000 Ohio children (AGES 0 – 17) were uninsured in 2004. (source: ) National figures estimate the number to be as high as 245,000. For example, analysis by Mark Merlis for Families USA, based on the Census Bureau’s most recent Current Population Survey (average of years 2003-2005) reports that 245,404 or 8.3% of Ohio’s children are uninsured. (source: No Shelter from the Storm: America’s Uninsured Children, Families USA, September 28, 2006). Each source relies on different methodologies and sample sizes. This paper relies upon 2004 Ohio Family Health Survey data.
²Childhood Statistics for Voices for Children, 2004 Ohio Family Health Survey, special data run by Health Policy Institute of Ohio, October 2006.
³Ibid, with additional estimate of 18-year olds provided by ODFJS, January 2007
⁴Annual costs are based upon blended per member/per month for children cost of $164 provided by ODJFS/Office of Ohio Health Plans, January 2007. Additional calculations by Voices for Ohio’s Children.

Mary Wachtel
Director of Public Policy

614.648.1450