23 States Recognized for Success – Getting More Eligible Children Enrolled in Health Coverage

by Cindy Mann, CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services  

Families across the country are experiencing hard times. The good news is that, despite the challenges States themselves are facing, many States are moving forward to adopt strategies that help get more eligible children enrolled in Medicaid and CHIP and stay enrolled for as long as they qualify.  We are working hard, together with the states, to keep children’s health coverage a high priority.

We are pleased to be able to recognize and support states that are improving their programs and are enrolling more children in health coverage as a result.  Performance Bonuses, authorized by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), were designed to reward states for making access to health coverage easier for eligible children and signing up more children who qualify.

This year, 23 states qualified for CHIPRA Performance Bonuses totaling nearly $300 million. States were eligible for a bonus if they reached targets for the number of additional children enrolled in Medicaid, and if they took steps to simplify their enrollment and renewal processes, adopting at least five out of eight options.  In addition to providing an incentive for States to make lasting positive changes to their programs, the performance bonuses help offset the added costs of insuring the lowest income children.

Of the states that earned bonuses, seven are new this year: Connecticut, Georgia, Montana, North Carolina, North Dakota, South Carolina, and Virginia. And, many of the states that have received bonuses in the past haven’t stopped improving their programs – five of these states implemented a sixth strategy in an effort to further streamline procedures.

The states awarded performance bonuses for the first time have simplified enrollment and renewal in a variety of ways.  For example:

• Georgia is using information from the WIC program to make Medicaid enrollment simpler, using the “express lane eligibility” option.
• Virginia has simplified the eligibility renewal process so that children have an easier time keeping their coverage when it’s time to renew.
• North Carolina and North Dakota both guarantee eligible children enrollment for a full year, to be sure they get continuous coverage and don’t lose access to care.
• Montana and Connecticut have adopted the “presumptive eligibility” option, which jump-starts enrollment for children who appear eligible and lets them see a doctor or get a prescription while their full eligibility is being determined.

These and other activities to simplify the process and enroll eligible children are paying off:  New data from the CDC’s  National Center for Health Statistics found that an additional 1.2 million children have gained health insurance coverage since CHIPRA was signed into law in 2009. This increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP.

Learn more about CHIPRA – and find out what states and communities are doing to get more eligible children covered.

As Open Enrollment Ends, People with Medicare save $1.5 billion on prescriptions

by Kathleen Sebelius

If you’ve had a Medicare Advantage or Prescription Drug Plan for a few years, you’ll know that December is the end of Medicare Open Enrollment.  This year, the last day for you to choose new Medicare health or prescription drug coverage for 2012 is December 7, earlier than it’s been in previous years.

December 7 is tomorrow.  But you still have until midnight tomorrow if you want to make a change  to your medical or prescription drug coverage.

And as you are reviewing your plan, remember that Medicare is only getting stronger. New data released today shows how millions of seniors have gotten cheaper prescription drugs and free preventive services, all thanks to the President’s health reform law.

Thanks to the Affordable Care Act, the Medicare prescription drug coverage gap known as the donut hole is starting to close. Through the end of October, 2.65 million people with Medicare have received discounts on brand name drugs in the donut hole.  These discounts have saved seniors and people with disabilities a total of $1.5 billion on prescriptions – averaging about $569 per person.  For State-by-State information on the number of people who are benefiting from this discount in 2011, visit this page.

Over the coming years, the Affordable Care Act will help close the coverage gap completely. Each year from now to 2020, you’ll pay less for brand name and generic drugs in the coverage gap.  And in 2020, the coverage gap will be eliminated and the donut hole will be closed for good.

In addition to cheaper prescription drugs, the Affordable Care Act also made preventive services available to people with Medicare for free. Preventive care helps people stay healthy and live longer lives. Through the end of November nearly 24.2 million people with Medicare have received one or more free preventive services, including Medicare’s new free Annual Wellness Visit.  For State-by-State information on the numbers of people who are utilizing preventive services in 2011, visit this page.

These new benefits are just two ways the Affordable Care Act is making Medicare and our health care system stronger and giving hardworking families the security they deserve. It has helped lower your Part B premium in 2012 by $22.  And, on average, Medicare Advantage premiums will be lower in 2012 as enrollment continues to rise.

And if you haven’t reviewed your Medicare coverage, take time now to compare your current coverage with other options to make sure your plan will meet your health care needs for the coming year.  Medicare now offers better choices, more benefits, and lower costs thanks to the Affordable Care Act. Visit www.Medicare.gov/open-enrollment/ for more information.

Better quality of life and improved health care for individuals living with HIV

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services

Today, we celebrate the vast improvements in treatments and the quality of life for individuals living with HIV.  This day serves as a reminder of the many accomplishments in fighting AIDS during the past three decades, but also highlights how much more work we have left in fighting this disease.

Thanks to major advances in science and medicine, people living with HIV face a much different reality today.  In 1981, when AIDS first emerged in the US, the disease was equivalent to a death sentence. Now, thirty years later, people with HIV who receive medication and proper care live longer, healthier lives — just as they could with any other chronic illness.

Despite the powerful arsenal at our disposal, some of our best defenses remain out of reach for a significant proportion of the more than 1.2 million Americans living with HIV. An estimated 30 percent of this group does not have health coverage of any kind. As a result, they have no way to cover the cost of medications and treatment that we know are life-preserving.

We took an important step to remove this barrier this past summer. The Centers for Medicare & Medicaid Services (CMS), in collaboration with, the Health Resources and Services Administration (HRSA), and the Centers for Disease Control (CDC), released new guidance that encourages States to take advantage of important Medicaid options that will help improve care for individuals living with HIV.

These options can make it easier for States to prevent or delay the institutionalization of people living with HIV and can help people living in nursing homes or other institutions transition back home when they are able. States can expand Medicaid access to low-income people living with HIV, enabling them to become eligible for services without having to be considered permanently disabled due to an AIDS diagnosis. States can provide more effective, earlier treatment of HIV by making available a limited or comprehensive package of services, which may include anti-retroviral therapies or case management to ensure adherence to treatment.  Better coordinated care opportunities were also made available to support physical and behavioral health and linkages to long-term supports for individuals with multiple chronic conditions through the state option to establish health homes.

This epidemic has claimed the lives of 600,000 Americans.  We can and are doing more to slow transmission of the disease and to ensure people living with HIV have access to the health care that will help them lead longer and healthier lives. I am confident of the positive quality of life effects that these options will make for Medicaid beneficiaries living with and fighting through HIV/AIDS every day.