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    "title": "Binder No. 12 DPC [Domestic Policy Council] Documents: Children's Health Issues 07/24/97",
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    "ocrText": "CHILDREN'S\nHEALTH 158110\nTOBACCO TAX\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nSupport $8 billion over five years in tobacco tax revenue for children's health and\nthe remaining $6 billion child care deduction\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known.\nPOSSIBLE FALLBACK OPTIONS\nSupport any additional revenue from tobacco tax for children's health. This has\nbecome a cornerstone issue for the children's advocates and our leadership on\nthis will be watched closely.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nBENEFITS\nCONFERENCE PROVISION\nREPORTEDLY: Benefits equal to or \"substantially actuarially equivalent\" to one of the\nfollowing:\nFEHBP Blue Cross / Blue Shield PPO plan\nState employee health plan (1 of 5 with highest enrollment)\nHMO plan with the largest coverage in the state\nKids-only plan (in any state) that, on enactment, meets the benefits mandate\n(covers 4 categories: inpatient / outpatient; physician; lab & x-ray; prevention)\nADMINISTRATION POSITION\nSupport benefits on par with the FEHBP Blue Cross / Blue Shield option.\nOppose actuarial equivalence (must be benefits standard).\nPROBLEMS WITH CONFERENCE PROVISIONS\nPotentially excludes needed services. States could substitute or exclude less\ncostly but critical services to give more of one service. Children may not receive\nimportant health services like prescription drugs, vision, and mental health care.\nVague standard Interpretation of \"substantially actuarially equivalent\" will result\nin questions, reviews, disallowances, and possible law suits. States could hire\ntheir own actuaries\nPOSSIBLE FALLBACK OPTIONS\n1.\nAdd choices. FEHBP Blue Cross / Blue Shield, plus State employee health\nplan and Secretarial approved plan plus vision, hearing and mental health.\n2.\nAdd another choice: Largest HMO in the state, approved by the Secretary, plus\nvision, hearing and mental health.\n3.\nONLY IF NEEDED: Actuarial value equal to FEHBP Blue Cross Blue Shield\nwithin classes of services (inpatient, outpatient (including therapy), physicians,\nlab & x-ray, drugs, preventive, vision, hearing, dental, mental health).\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nMENTAL HEALTH\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nSupport mental health parity provision in the Senate.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known.\nPOSSIBLE FALLBACK OPTIONS\n1.\nLink to managed mental health benefit in an FEHBP plan\n2.\nRequire that a plan cover mental health as approved by the Secretary.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nCOST SHARING\nCONFERENCE PROVISION\nNot known. Senate has no cost sharing for children below 150% of poverty.\nHouse has no protections.\nADMINISTRATION POSITION\nCost sharing protections for children below 150% of poverty.\nPROBLEMS WITH CONFERENCE PROVISIONS\nExcessive cost sharing reduces access. The investment in children's health\nis intended to make insurance more affordable for working families. High\npremiums could prevent families from insuring their children. High coinsurance\ncould cause families to postpone seeking care or not to get care at all.\nPOSSIBLE FALLBACK OPTIONS\n1.\nConference agreement's Medicaid cost sharing: Nominal co-payments for\nbelow 150 percent of poverty; cost sharing up to 3 percent for 150-200% of\npoverty; up to 5 percent for 200% of poverty and above.\n2.\nConference agreement's Medicaid cost sharing: Nominal cost sharing\n(including premiums) for below 150 percent of poverty; up to 3 percent for 150-\n200% of poverty; up to 5 percent for 200% of poverty and above.\n3.\nSecretarial approved cost sharing. Allows review of cost sharing by Secretary\nto assure that it is not excessive and assures access.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nDIRECT SERVICES\nCONFERENCE PROVISION\nDirect Services (reported): Allow up to 15% of a state's allotment to be used\nfor direct services.\nADMINISTRATION POSITION\nOppose direct services. Contrary to the spirit of the budget agreement, which\ncalled for health insurance for as many uninsured children as possible.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot used for coverage. CBO assumes that a significant proportion of the\n\"direct services\" funds in the House-passed bill will be used to reduce the\nMedicaid DSH cuts.\nCould crowd out administrative & outreach spending. Since all are within\nthe same cap, states will likely prefer to use the cuts for other purposes.\nPOSSIBLE FALLBACK OPTIONS\n1.\nNo compromise.\n2.\nIf compromise:\n-\nReduce percent (amount of reduction depends on the size of the\ninvestment).\n-\nUse of funds. As drafted, the direct services funds may be use for many\ndifferent items. It could be restricted to certain types of services (e.g.,\nclinic services without DSH hospitals).\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nACCOUNTABILITY\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nEligibility: States must:\n-\nMaintain Medicaid income & resource standards & methodologies (6/97)\n-\nEnroll children eligible for Medicaid in Medicaid.\n-\nCover lower income children before higher income children\n-\nNot use funds to cover families of state employees or children committed\nto penal institutions.\n-\nInclude provisions to ensure that private insurance coverage is not\nreduced as a result of this program.\nSpending: States must maintain their 1996 spending on non-Medicaid children's\nhealth insurance (similar to President's budget provision and reduced Senate\nprovision).\nState reporting similar to Medicaid:\n-\nState plan submission and amendment process similar to Medicaid\n-\nQuarterly financial reports with auditing and disallowance process (could\nlink to Medicaid's MSIS system)\n-\nAnnual reports on number of children served, type of benefits, etc.\nEvaluation by Secretary in 2000.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known.\nPOSSIBLE FALLBACK OPTIONS\nDrop the spending maintenance of effort; not very effective anyway. Very\nimportant to keep the eligibility rules.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nEQUAL MATCHING RATES FOR MEDICAID & GRANT\nCONFERENCE PROVISION\nNot known but appears to be equal matching rates.\nNot known but appears to allow for Medicaid and/or grant options.\nADMINISTRATION POSITION\nEqual matching rates for Medicaid and grant options\nState option to use both Medicaid and grant approaches.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known.\nPOSSIBLE FALLBACK POSITIONS\nNo compromise. Given our position on the Senate's Chafee-Rockefeller\namendment, it is important for us to maintain our strong support of Medicaid as a\nviable choice in the initiative.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nPERFORMANCE-BASED MATCHING\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nSupport creating financial incentives to improve efficiency of the grant program.\nThis includes:\n-\nHigher matching rate for any new child (including OBRA expansion\nchildren, outreach children, and newly eligible children);\n-\nHigher match (or requirement) that states education children and their\nparents about coverage options through schools.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known.\nPOSSIBLE FALLBACK POSITIONS\nPerformance-based matching is based on the Senate's desire to help states that\ncannot necessarily pass expansions through their state legislatures. It allows\nstates to access funds from the grant for Medicaid by giving the extra matching\nfor outreach as well. It may also help the states like Minnesota and Rhode\nIsland that prefer expanding through Medicaid but have already raised their\neligibility limits as high as they can.\nThe President has repeatedly stated his support for school-based approaches to\ncovering children. We could give states higher incentives, but a more effective\napproach is to require states to make information about options available in\nschools.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nELIGIBILITY INCOME LIMITS\nCONFERENCE PROVISION\nNot known. Both House and Senate had upper income limits.\nADMINISTRATION POSITION\nOppose income ceilings on eligibility.\nPROBLEMS WITH CONFERENCE PROVISIONS\nRestricts expansion for generous states. The limit makes it difficult if not\nimpossible for states that have already expanded to these levels to access the\nnew funds.\nPOSSIBLE FALLBACK POSITIONS\nSpecial rule. Only five states (Hawaii, Rhode Island, Tennessee, Vermont and\nWashington) have used Medicaid to expand to at least 200 percent of poverty.\nThere could be an exception to the general income ceiling for these states.\nAmend the \"low income children first\" rule. To prevent states from\ninappropriately expanding to higher income children, this rule could be modified\nto say that a state can only expand to higher income children if it first covers\nlower income children statewide, regardless of age, first. States that have\nalready expanded will meet this criteria while states interested in covering middle\nclass children in particular cities cannot.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nACCELERATED PHASE-IN OF OBRA CHILDREN\nCONFERENCE PROVISION\nNot known\nADMINISTRATION POSITION\nSupport accelerated phase-in.\nPROBLEMS WITH CONFERENCE PROVISIONS\nNot known\nPOSSIBLE FALLBACK POSITIONS\nDrop the acceleration provision, since OBRA children will be fully phased-in by\n2002 anyway.\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nALLOCATION OF FUNDS\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nAllocate funds based on the number of uninsured children in the State, with\nexceptions made for those States which have already enrolled a large number of\nchildren.\nPROBLEMS WITH CONFERENCE PROVISIONS\nAn allocation determined by requiring States to enroll children based on income\nfails to drive funds to the States that have the highest number of uninsured\nchildren. At the same time, basing the allocation on the number of uninsured\nchildren harms States that have already enrolled a large number of children.\nPOSSIBLE FALLBACK POSITIONS\n???\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am\nCAP MEDICAID ENROLLMENT\nCONFERENCE PROVISION\nNot known.\nADMINISTRATION POSITION\nOppose cap on Medicaid enrollment? [Need policy guidance]\nPROBLEMS WITH CONFERENCE PROVISIONS\nCapping enrollment would allow States to deny coverage to eligible children\nonce their block grant allocation has been expended, however, failing to cap\nenrollment could cause spending for the program to exceed the $16 billion\nappropriation.\nPOSSIBLE FALLBACK POSITIONS\n???\nDRAFT: CHILDREN'S HEALTH; July 24, 1997, 9am"
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