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Binder No. 12 DPC [Domestic Policy Council] Documents: Children's Health Issues 07/24/97
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Binder No. 12 DPC [Domestic Policy Council] Documents: Children's Health Issues 07/24/97
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CHILDREN'S
HEALTH 158110
TOBACCO TAX
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Support $8 billion over five years in tobacco tax revenue for children's health and
the remaining $6 billion child care deduction
PROBLEMS WITH CONFERENCE PROVISIONS
Not known.
POSSIBLE FALLBACK OPTIONS
Support any additional revenue from tobacco tax for children's health. This has
become a cornerstone issue for the children's advocates and our leadership on
this will be watched closely.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
BENEFITS
CONFERENCE PROVISION
REPORTEDLY: Benefits equal to or "substantially actuarially equivalent" to one of the
following:
FEHBP Blue Cross / Blue Shield PPO plan
State employee health plan (1 of 5 with highest enrollment)
HMO plan with the largest coverage in the state
Kids-only plan (in any state) that, on enactment, meets the benefits mandate
(covers 4 categories: inpatient / outpatient; physician; lab & x-ray; prevention)
ADMINISTRATION POSITION
Support benefits on par with the FEHBP Blue Cross / Blue Shield option.
Oppose actuarial equivalence (must be benefits standard).
PROBLEMS WITH CONFERENCE PROVISIONS
Potentially excludes needed services. States could substitute or exclude less
costly but critical services to give more of one service. Children may not receive
important health services like prescription drugs, vision, and mental health care.
Vague standard Interpretation of "substantially actuarially equivalent" will result
in questions, reviews, disallowances, and possible law suits. States could hire
their own actuaries
POSSIBLE FALLBACK OPTIONS
1.
Add choices. FEHBP Blue Cross / Blue Shield, plus State employee health
plan and Secretarial approved plan plus vision, hearing and mental health.
2.
Add another choice: Largest HMO in the state, approved by the Secretary, plus
vision, hearing and mental health.
3.
ONLY IF NEEDED: Actuarial value equal to FEHBP Blue Cross Blue Shield
within classes of services (inpatient, outpatient (including therapy), physicians,
lab & x-ray, drugs, preventive, vision, hearing, dental, mental health).
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
MENTAL HEALTH
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Support mental health parity provision in the Senate.
PROBLEMS WITH CONFERENCE PROVISIONS
Not known.
POSSIBLE FALLBACK OPTIONS
1.
Link to managed mental health benefit in an FEHBP plan
2.
Require that a plan cover mental health as approved by the Secretary.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
COST SHARING
CONFERENCE PROVISION
Not known. Senate has no cost sharing for children below 150% of poverty.
House has no protections.
ADMINISTRATION POSITION
Cost sharing protections for children below 150% of poverty.
PROBLEMS WITH CONFERENCE PROVISIONS
Excessive cost sharing reduces access. The investment in children's health
is intended to make insurance more affordable for working families. High
premiums could prevent families from insuring their children. High coinsurance
could cause families to postpone seeking care or not to get care at all.
POSSIBLE FALLBACK OPTIONS
1.
Conference agreement's Medicaid cost sharing: Nominal co-payments for
below 150 percent of poverty; cost sharing up to 3 percent for 150-200% of
poverty; up to 5 percent for 200% of poverty and above.
2.
Conference agreement's Medicaid cost sharing: Nominal cost sharing
(including premiums) for below 150 percent of poverty; up to 3 percent for 150-
200% of poverty; up to 5 percent for 200% of poverty and above.
3.
Secretarial approved cost sharing. Allows review of cost sharing by Secretary
to assure that it is not excessive and assures access.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
DIRECT SERVICES
CONFERENCE PROVISION
Direct Services (reported): Allow up to 15% of a state's allotment to be used
for direct services.
ADMINISTRATION POSITION
Oppose direct services. Contrary to the spirit of the budget agreement, which
called for health insurance for as many uninsured children as possible.
PROBLEMS WITH CONFERENCE PROVISIONS
Not used for coverage. CBO assumes that a significant proportion of the
"direct services" funds in the House-passed bill will be used to reduce the
Medicaid DSH cuts.
Could crowd out administrative & outreach spending. Since all are within
the same cap, states will likely prefer to use the cuts for other purposes.
POSSIBLE FALLBACK OPTIONS
1.
No compromise.
2.
If compromise:
-
Reduce percent (amount of reduction depends on the size of the
investment).
-
Use of funds. As drafted, the direct services funds may be use for many
different items. It could be restricted to certain types of services (e.g.,
clinic services without DSH hospitals).
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
ACCOUNTABILITY
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Eligibility: States must:
-
Maintain Medicaid income & resource standards & methodologies (6/97)
-
Enroll children eligible for Medicaid in Medicaid.
-
Cover lower income children before higher income children
-
Not use funds to cover families of state employees or children committed
to penal institutions.
-
Include provisions to ensure that private insurance coverage is not
reduced as a result of this program.
Spending: States must maintain their 1996 spending on non-Medicaid children's
health insurance (similar to President's budget provision and reduced Senate
provision).
State reporting similar to Medicaid:
-
State plan submission and amendment process similar to Medicaid
-
Quarterly financial reports with auditing and disallowance process (could
link to Medicaid's MSIS system)
-
Annual reports on number of children served, type of benefits, etc.
Evaluation by Secretary in 2000.
PROBLEMS WITH CONFERENCE PROVISIONS
Not known.
POSSIBLE FALLBACK OPTIONS
Drop the spending maintenance of effort; not very effective anyway. Very
important to keep the eligibility rules.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
EQUAL MATCHING RATES FOR MEDICAID & GRANT
CONFERENCE PROVISION
Not known but appears to be equal matching rates.
Not known but appears to allow for Medicaid and/or grant options.
ADMINISTRATION POSITION
Equal matching rates for Medicaid and grant options
State option to use both Medicaid and grant approaches.
PROBLEMS WITH CONFERENCE PROVISIONS
Not known.
POSSIBLE FALLBACK POSITIONS
No compromise. Given our position on the Senate's Chafee-Rockefeller
amendment, it is important for us to maintain our strong support of Medicaid as a
viable choice in the initiative.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
PERFORMANCE-BASED MATCHING
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Support creating financial incentives to improve efficiency of the grant program.
This includes:
-
Higher matching rate for any new child (including OBRA expansion
children, outreach children, and newly eligible children);
-
Higher match (or requirement) that states education children and their
parents about coverage options through schools.
PROBLEMS WITH CONFERENCE PROVISIONS
Not known.
POSSIBLE FALLBACK POSITIONS
Performance-based matching is based on the Senate's desire to help states that
cannot necessarily pass expansions through their state legislatures. It allows
states to access funds from the grant for Medicaid by giving the extra matching
for outreach as well. It may also help the states like Minnesota and Rhode
Island that prefer expanding through Medicaid but have already raised their
eligibility limits as high as they can.
The President has repeatedly stated his support for school-based approaches to
covering children. We could give states higher incentives, but a more effective
approach is to require states to make information about options available in
schools.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
ELIGIBILITY INCOME LIMITS
CONFERENCE PROVISION
Not known. Both House and Senate had upper income limits.
ADMINISTRATION POSITION
Oppose income ceilings on eligibility.
PROBLEMS WITH CONFERENCE PROVISIONS
Restricts expansion for generous states. The limit makes it difficult if not
impossible for states that have already expanded to these levels to access the
new funds.
POSSIBLE FALLBACK POSITIONS
Special rule. Only five states (Hawaii, Rhode Island, Tennessee, Vermont and
Washington) have used Medicaid to expand to at least 200 percent of poverty.
There could be an exception to the general income ceiling for these states.
Amend the "low income children first" rule. To prevent states from
inappropriately expanding to higher income children, this rule could be modified
to say that a state can only expand to higher income children if it first covers
lower income children statewide, regardless of age, first. States that have
already expanded will meet this criteria while states interested in covering middle
class children in particular cities cannot.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
ACCELERATED PHASE-IN OF OBRA CHILDREN
CONFERENCE PROVISION
Not known
ADMINISTRATION POSITION
Support accelerated phase-in.
PROBLEMS WITH CONFERENCE PROVISIONS
Not known
POSSIBLE FALLBACK POSITIONS
Drop the acceleration provision, since OBRA children will be fully phased-in by
2002 anyway.
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
ALLOCATION OF FUNDS
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Allocate funds based on the number of uninsured children in the State, with
exceptions made for those States which have already enrolled a large number of
children.
PROBLEMS WITH CONFERENCE PROVISIONS
An allocation determined by requiring States to enroll children based on income
fails to drive funds to the States that have the highest number of uninsured
children. At the same time, basing the allocation on the number of uninsured
children harms States that have already enrolled a large number of children.
POSSIBLE FALLBACK POSITIONS
???
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am
CAP MEDICAID ENROLLMENT
CONFERENCE PROVISION
Not known.
ADMINISTRATION POSITION
Oppose cap on Medicaid enrollment? [Need policy guidance]
PROBLEMS WITH CONFERENCE PROVISIONS
Capping enrollment would allow States to deny coverage to eligible children
once their block grant allocation has been expended, however, failing to cap
enrollment could cause spending for the program to exceed the $16 billion
appropriation.
POSSIBLE FALLBACK POSITIONS
???
DRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am