The JBA Special Needs of Children Committee member Sarah Sullivan
In the wake of the Affordable Care Act (ACA) and the state overhaul of Medicaid and other health delivery systems, our first inclination is to consider how these changes will affect our bottom lines and whether or not the government is dipping into our pockets more than we want.
More than half of all Medicaid recipients in the state of Florida are children.
However, children account for only 19 percent of the Medicaid budget. Children do not vote, they do not lobby the Legislature, and they do not contact the press.
How can we ensure that Florida’s children receive the health care they need? This article, in an effort to give a voice to those children affected by health care reform, will provide a brief explanation of the existing programs pre-reform, followed by a discussion of how state and federal reforms affect children in Florida.
There are several programs that combine to create a complicated health care delivery system for children. Prior to health care reform, there was family Medicaid (FAMMEDS), the Florida Children’s Health Insurance Program (KidCare and CMS), and private employer-sponsored health care.
A child’s eligibility for these programs depends on family income and whether or not an affordable employer-sponsored health insurance plan exists.
Medicaid. For children living in homes within 100 percent of the federal poverty level, the traditional family Medicaid program provides health insurance coverage. Children on Medicaid cost the state and federal government around $1,600 per child per year compared to the adult cost of about $2,800 per adult per year.
The Medicaid program is a combined state and federal program. The federal government’s contribution to the state Medicaid budget depends on the per capita income of Florida residents compared to the national per capita income. In 2011 the federal government will pay Florida for about 55 percent of the total Medicaid budget.
CHIP. The Florida Children’s Health Insurance Program (CHIP) was created in 1997 and was the largest taxpayer-funded expansion to children’s health insurance since the Medicaid program began in the 1960s. Fortunately, Congress reauthorized the CHIP program in 2009 and also increased federal dollars flowing to the states as an incentive to increase children’s health insurance coverage.
The CHIP program in Florida has many components. The generic name for the Florida’s CHIP program is KidCare. However, other programs under the CHIP umbrella include Healthy Kids, MediKids and Children’s Medical Services. All of these different programs are funded through Title XXI of the Social Security Act.
The different programs cover different age groups and have different income eligibility standards. However, they all provide a safety-net health insurance plan for those children who do not qualify for Medicaid because the family income is too high, but the family is incapable of affording private health insurance through individual and/or employer-sponsored health insurance coverage.
Children’s Medical Services operates through the Department of Health and provides early screening for developmental deficits as well as primary care for children with chronic health needs.
Now, more than a decade since implementation of the CHIP programs, enrollments are up and more children are being covered through the different programs funded by the legislation.
Reform is taking place today both on the federal and state levels.
Florida, desirous of trailblazing Medicaid reform, began the Medicaid Reform Demonstration Waiver in 2006. The reform concept included enrollment of certain Medicaid recipients into privately managed Health Maintenance Organizations (HMO) or Provider Service Networks (PSN). A PSN is a network established or organized and operated by a health care provider or group of affiliated providers.
In 2006, Broward and Duval counties implemented Medicaid reform. The goal of the Legislature was to curb the rapidly expanding Medicaid budget while cutting down on fraud and jump-starting innovation in health care through patient choice.
Medicaid reform expanded to Clay, Nassau and Baker counties in 2007.
Based on information available today, improvements to the Medicaid system through reform are negligible, and cost-savings are inconclusive.
Although the achievements of the Medicaid reform pilot are inconclusive, the Florida Legislature voted, in 2011, to spread this privatized model of Medicaid delivery to all Florida counties.
The Agency for Health Care Administration (AHCA) is required to draft and submit the waiver application to the federal government for approval prior to implementation.
Still, an important question surrounding state reform remains unanswered. Does privatization save money through cutting unnecessary waste, or do savings occur because privatization makes access to health care so tenuous that Medicaid beneficiaries give up and don’t seek medical attention when it is needed?
In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA). The highlights of the ACA include expansion of Medicaid, an individual mandate for health coverage, mandatory coverage of pre-existing conditions, continuation of private coverage for children until age 26, and creation of insurance exchanges and health co-ops intended to expand choice for consumers.
The ACA expands Medicaid to all citizens who fall within 133 percent of the federal poverty guidelines. More than 20 million Americans who were uninsured will now be eligible for Medicaid enrollment. With the individual mandate, and the expansion of Medicaid, Florida’s children can only benefit from expanded coverage.
Those children that were either uninsured or underinsured will have the opportunity for adequate health coverage if/when the provisions of the ACA are implemented.
Rather than having a beginning and an end, health care reform should be interpreted as a constantly evolving process.
Health care coverage for children has evolved and continues to evolve during these times of economic hardship. Although health reform embodies competing theories of choice versus expansion of access, both state and federal governments recognize the benefit of health care for children.
Without a crystal ball, it is impossible to determine whether reforms of our public and private health care system will yield benefits for future generations.