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?

2

WHY HAVE OTHER STATES DECIDED TO COVER ALL KIDS?

3

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)

5

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

9

WHAT HAS THE IMPACT BEEN?

10

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?

13

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

14

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

17

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

18