On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

The Journal of Health Politics, Policy and Law has published a study examining relative affordability of health coverage premiums under the national health care reform law and the expansion of the Children's Health Insurance Program (CHIP).  The authors compare the cost of covering a family in Illinois, Pennsylvania, and Washingon through a combination of CHIP and employer-sponsored coverage to that of a family obtaining coverage through one of the law's health exchanges. 

Gresenz, C., Laugesen, M., Yesus, A. and Escarce J.  (2011).  Relative affordability of health insurance premiums under CHIP expansion programs and the ACA.  The Journal of Health Politics, Policy and Law, 36 (3): 859-877.  doi: 10.1215/03616878-1407658.  http://jhppl.dukejournals.org/content/early/2011/07/22/03616878-1407658.full.pdf+html

Authors: Carole Gresenz, Miriam Laugensen, Ambeshie, Yesus and Jose Escarce.   

The National Academcy for State Health Policy has released a report examining the role of children's health coverage programs in the evolving coverage landscape.  The authors examine the opinions of subject matter experts on working withing programs including Medicaid and the Children's Health Insurance Program (CHIP) to improve children's coverage in the context of the national health care reform law.

From the report:

Medicaid and the Children’s Health Insurance Program (CHIP) served more than 42 million children in federal fiscal year (FFY) 2010.  Together, these two public programs provide the backbone of health care coverage for low and moderate-income children. The passage of national health care reform has ushered in new opportunities for states to work toward continuous and improved coverage for children, not just through Medicaid and CHIP, but also through private health insurance, publicly supported and subsidized insurance Exchanges, and other options provided through the Affordable Care Act (ACA). Medicaid and CHIP programs can exert important leadership roles in promoting access to seamless, quality care for children and in implementing necessary health systems reforms for sustaining continuous coverage and coordination across programs.

Full report: The Role of Children's Coverage Programs in a Changing Health Care Landscape: EPSDT, CHIP, and Health Care Reform (PDF | 135.57 KB)

National Academy for State Health Policy.  (2011).  The role of children's coverage programs in a changing health care landscape: EPSDT, CHIP, and health care reform.  Farrell, K. and Hess, C.

The Kaiser Family Foundation has released a brief, offering strategies for states to streamline eligibility verification systems for Medicaid, the Children’s Health Insurance Program (CHIP), and subsidies through health reform’s exchanges.  Noting that health reform will dramatically expand health coverage through these programs, the authors suggest employing “express lane” principles that use existing data already held by other government agencies.  The brief recommends establishing electronic links between health programs and other public programs, including the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and other federal databases.

From the report:

Under the Affordable Care Act (ACA), beginning in 2014, millions of uninsured adults and children will gain eligibility for and are expected to enroll in Medicaid and coverage through new health insurance Exchanges. Many of these individuals participate in other need-based public programs for which they have already provided income and other information needed to establish eligibility. The ACA calls for states to leverage existing data sources as much as possible to develop simple and streamlined processes for establishing, verifying, and updating eligibility for Medicaid, CHIP, and subsidies for Exchange coverage. To do this, states will be required to create linkages between the health subsidy programs and public programs such as Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), and with databases held by federal agencies like the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service.  States can already use eligibility findings from other programs to enroll children in Medicaid and CHIP under the “Express Lane Eligibility” authority in federal statute.

Full report: Explaining Health Reform: Uses of Express Lane Strategies to Promote Participation in Coverage (PDF | 566.47 KB)

Kaiser Family Foundation.  (2011).  Explaining health reform: uses of express lane strategie to promote particpation in coverage.

On July 28, the Pew Center on the States’ non-partisan non-profit news service Stateline released a primer on Medicaid financing, exploring the changes offered under the Obama Administration’s plan to “blend” rates for Medicaid and the Children’s Health Insurance Program (CHIP).  Offered as an alternative to the GOP budget plan that passed in the U.S. House on April 15, rather than convert Medicaid into a block grant program, President Obama’s proposal would blend the CHIP rate, the existing Federal Medical Assistance Percentage (FMAP) for Medicaid, and the rate set to apply to newly covered Medicaid enrollees under health reform’s 2014 expansion.  Though the Administration has yet to release details of the blending plan, the primer examines the impact of potential rate blending on states as well as initial reactions from state lawmakers.

From the report:

To states, the most significant part of Obama’s plan is a change in a few key funding formulas that determine how many federal dollars states get for Medicaid. Obama’s so-called “blended rate” would simplify the way federal money is divvied among the states. But it also would shift a greater share of Medicaid spending to the states —which has riled numerous governors and nearly everyone in the health care community. How would the blended rate proposal change Medicaid? Here’s a primer on the way Medicaid is currently financed, and the possible impacts of the administration’s plan.

Full report: Medicaid Explained: How a 'Blended Rate' Would Work

Stateline. (2011). Medicaid explained: how a 'blended rate' would work. Vestal, Christine.

The Center on Budget and Policy Priorities has released a brief arguing that the Children's Health Insurance Program's (CHIP) success does not contribute to the argument to make Medicaid a block grant program.  The authors argue that while states receive fixed allotments of funding under CHIP, Congress has ensured adequate funding for programmatic success.  The brief argues that converting Medicaid into a block grant program would result in insufficient funding, negatively affecting health coverage and access.

From the report:

A fundamental feature of proposals to cap Medicaid funding is a reduction in federal funding well below the levels required to meet current service needs. Medicaid under a block grant would operate very differently than CHIP, a program for which Congress has always ended up providing states with adequate funding to sustain (and expand) their CHIP programs. Facing sharply reduced federal Medicaid funding, states would have to cut eligibility, cap enrollment, reduce benefits, and/or further cut provider reimbursement rates, with adverse impacts on low-income beneficiaries.

Full report: CHIP’s Success Not an Argument for Block-Granting Medicaid (PDF | 321.23 KB)

Center on Budget and Policy Priorities.  (2011).  CHIP's success not an argument for block-granting Medicaid.  Broaddus, M.