Summary of Child Health Expansions in Amended Substitute House Bill 119

Main Operating Appropriations Bill SFY 2008-2009

Specific sections of the bill related to each expansion are noted below.

Ohio’s FY 2008-2009 budget, signed by Governor Strickland on June 30, 2007, includes several provisions that will extend access to health care to more children, including:

• Raise the Medicaid eligibility for pregnant women from 150% of the federal poverty level (FPL) to 200% FPL.
• Raise the Medicaid/SCHIP eligibility for Ohio children from 200% FPL to 300% FPL.
• Allow Ohio children aging out of the foster care system to keep Medicaid coverage until age 21.
• Create a new program that allows uninsured children living in families with incomes over 300% FPL to buy public health coverage on a sliding fee scale.

Below is a brief summary of each proposal.

Raise the Medicaid eligibility for pregnant women from 150% FPL to 200% FPL.

Existing Law:  Currently, pregnant women with incomes up to 150% FPL qualify for Medicaid coverage during their pregnancy and delivery and 60-days postpartum.

New Law:  Am Sub House Bill 119 expands Medicaid eligibility for pregnant women through delivery and 60-days postpartum to 200% of FPL.

Number Eligible/Cost:  The Administration estimates that an additional 3800 Ohio women could be eligible and that 2850 will enroll under the expansion.  The Administration estimates that this expansion will cost $5.6 million (all funds) in FY 2008 and $19.3 million (all funds) in FY 2009.

Implementation Date:  January 2008 (targeted)

Ohio Revised Code: 5111.014, Section 309.30.90

Raise the Medicaid/SCHIP eligibility for children from 200% FPL to 300% FPL.

Existing Law:  Currently, children under age 19 with family incomes up to 200% FPL are eligible for Medicaid/SCHIP coverage.

New Law:  Am Sub House Bill 119 authorizes expansion of Medicaid/SCHIP eligibility from 200% to 300% FPL for children under age 19.  Cost-sharing in the forms of monthly premiums are required for participation in the program; there are no co-payments for medical services.  The law sets premiums at $40/month for one child, $80/month for two children, and $120/month for three or more children in each family.  Initial plans are for a statewide vendor to manage the premiums for this program.

Number Eligible/Cost:  Approximately 32,000 uninsured Ohio children could benefit from this expansion; the Administration estimates that 19,695 children will enroll during the biennium.  Estimated cost is $5.6 million (all funds) in FY 2008 and $38.6 million (all funds) in FY 2009.  These estimates may be reduced for two reasons:  1) These cost estimates are based upon a regular Medicaid match rate of 60:40 (federal:state).  If Ohio receives federal approval to provide the expanded coverage as an SCHIP expansion, the state could draw down federal reimbursement at the enhanced SCHIP match rate of 71:29.  2) These estimates do not reflect the premiums collected which will reduce the overall cost.  Dollars collected through premiums will be shared with the federal government at the match rate established.

Implementation Date:  January 2008 (targeted)

Ohio Revised Code:  5101.52

Allow Ohio youth aging out of the foster care system to keep Medicaid coverage until age 21.

Existing Law:  Currently, when children age out of foster care, they lose Medicaid coverage.

New Law: Am Sub House Bill 119 “requires the ODJFS Director to amend the state Medicaid plan to implement a federal option under which an individual under age 21 qualifies for Medicaid if the individual 1) was in foster care under the responsibility of the state on the individual’s 18th birthday, 2) received Title IV-E foster care maintenance payments or independent living services before turning age 18, and 3) meets all other applicable requirements.”

Number Eligible/Cost:  The Administration estimates that 800 individuals will enroll annually in this Medicaid expansion resulting in an ongoing enrollment level of 1600 youth.  Estimated costs are $5.1 million (all funds) in FY 2008 and $10.4 million (all funds) in FY 2009.

Implementation Date:  January 2008 (targeted)

Ohio Revised Code:  5111.0111

Create a children’s buy-in program that allows uninsured children living in families with incomes over 300% FPL to buy public health coverage.

Existing Law: Currently, no program exists.

New Law:  Am Sub House bill 119 establishes the “Children’s Buy-In Program” for uninsured children under age 19 who live in families with income over 300% FPL.  The Director of ODJFS is required to seek federal matching funds for this program; however, it is not likely such funds will be approved because of the defined eligibility requirements of the program.  If federal funds are not available, the program will be funded through state funds and cost-sharing by families and technically will not be Medicaid/SCHIP.  However, children will be served through Ohio’s current Medicaid system.

This program is targeted to children with special health needs or a pre-existing condition for whom private health coverage can be unavailable or extremely expensive.  In order to meet program eligibility requirements, the child must:

• Be under age 19, and
• Have countable family income of over 300% FPL, and
• Have been uninsured for at least six months prior to enrolling.

In addition, the child must meet ONE or more of the following:

• Have been denied coverage due to a pre-existing condition, or
• Lost coverage available because the child has exhausted a lifetime benefit limitation, or
• Cannot obtain coverage for less than two hundred percent of the premium s/he would pay under the buy-in program, or
• Participates in the Bureau for Children with Medical Handicaps program (BCMH).

The law sets monthly premiums for the program as follows:

If premiums are not paid for two consecutive months, the child shall lose eligibility for the program.  The child may not resume participation in the program until the unpaid premiums that accrued before s/he lost eligibility are paid.  Initial plans are for a statewide vendor to manage the premiums for this program.

In addition to monthly premiums, co-payments for medical services may be charged to the extent required by rules (to be determined).

The Director of ODJFS shall prepare a report on the children’s buy-in program that examines the program’s effectiveness and includes the number of children participating in the program and the costs.  The Director shall submit the report to the Governor and the General Assembly no later than December 31, 2008.

Number Eligible/Cost: An estimated 20,000 of Ohio’s uninsured children live in families with incomes over 300% FPL.  The Administration estimates that approximately 4000 will enroll through the biennium.   If no federal participation is allowed, initial cost estimates are $0.8 million (GRF) in FY 2008 and $5.3 million (GRF) in FY 2009.

Implementation Date:  January 2008 (targeted)

Ohio Revised Code:  5101.52

For more information, contact Voices for Ohio’s Children, 877.881.7860, or check back for periodic updates.

View the links below for relevant events and additional resources.

	Download Text of entire bill
	Download Senator Brown and Governor Strickland Support SCHIP
	Download Congress Approves SCHIP Reauthorization

For more legislation details, visit CapWiz.com