The Family Opportunity Act and Children

1
The Family Opportunity Act and Children Youth
with Special Health Care Needs

• Meg Comeau, MHA
• Sally Bachman, PhD
• The Catalyst Center
• Boston University

2
State-at-a-Glance Chartbook The Catalyst Center

• Educational and advocacy tool for all state
  policymakers
• Key indicators of health care coverage for
  children and youth with special health care needs
• State innovations of ways to expand coverage

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FOA Overview In the Deficit Reduction Act 2005

• State option allows families of children with
  disabilities to buy in to Medicaid coverage
• Home And Community-Based Waivers for children
  with psychiatric disorders
• Family-To-Family Health Information Centers

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Focus on Medicaid Buy-in option

• Builds on Ticket to Work, designed to help adults
  with disabilities go to work without losing
  Medicaid
• Allows states to use Medicaid buy-in to offer
  coverage to children with severe disabilities
  living in middle income families
• Can be phased-in by age group over four years

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Some Facts about FOA

• Targets families of children with severe
  disabilities
• Family income under 300 of the Federal Poverty
  Level (FPL)
• Privately insured families whose employers pay at
  least 50 of their premium may buy-in for wrap
  benefits
• Uninsured families may buy-in for full benefits
• Premiums may not exceed 5 7.5 of income

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Advantages to Families

• No institutional level of care requirement no
  cap
• May alleviate effects of underinsurance -more
  robust coverage under Medicaid
• Better access to health care can result in
  improved health status
• Family income
• Opportunity to take raises, promotions, overtime,
  other employment

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Advantages to States

• Allows for expansion of coverage to CYSHCN with
  federal match dollars
• More robust coverage can result in better access
  and better health outcomes potential savings in
  other areas of state spending (education,
  uncompensated care, etc.)

8
Advantages to States, Continued

• Raising income eligibility may incentivize
  obtaining or keeping private coverage
• Increased family earnings may serve as a stimulus
  to local economy, increased tax revenues
• Personal responsibility

9
Development of Economic Model

• Developed methodology as result of requests for
  technical assistance
• Catalyst Center team with consultation by a
  health care economist
• Data Sources
• Numbers National Survey of Children with Special
  Health Care Needs (2001) and Social Security
  Administration
• Cost Congressional Budget Office (CBO) per
  child estimate

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Development of Economic Model, Continued

• National data used
• Built in assumptions
• Result 2nd round estimate with state-specific
  cost estimate advised

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Basic Assumptions

• Fraction of CSHCN between 100-300 of FPL who are
  functionally eligible for FOA will be roughly
  similar to fraction under 100 who are
  functionally eligible for SSI
• SCHIP income ceiling is 200 FPL
• Medicaid and SCHIP benefit packages are roughly
  equivalent

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Walk-through of Sample State Estimate
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Proportion of CSHCN, 0-17, receiving SSI, by
family income and private insurance status, 2001
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Proportion of CSHCN, 0-18 receiving SSI, by
family income and private insurance status,
estimates for 2005
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Estimated nationwide effect of FOA on enrollment
in Medicaid, 2005
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Estimated FOA effect on enrollment and Medicaid
expenditures, state, 2005
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Supplementary Data
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States are working to adopt the Family
Opportunity Act
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States that have expressed interest in our FOA
work

• Arizona
• California
• Colorado
• Connecticut
• Iowa
• Maine
• Montana
• Nevada
• North Carolina
• North Dakota

• New York
• Ohio
• Oregon
• Rhode Island
• South Dakota
• Texas
• Utah
• Virginia
• Wisconsin

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States that have received an estimate release

• Arizona
• Connecticut
• Colorado
• North Dakota
• Oregon
• South Dakota
• Texas

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States that have filed FOA legislation

• Connecticut
• North Dakota
• Oregon
• South Dakota

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2nd Round Refinement

• Adjustment to basic assumptions specific to state
  (costs, numbers of eligible CYSHCN, other
  pathways to Medicaid, etc.)
• Further refinement to take-up estimate
• Further refinement to target population estimates

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Implementation Questions to Date

• Crowd out
• Premium schedule
• Age phase-in
• Connection to federal policy

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For more information, contact

• Meg Comeau, MHA
• Director
• The Catalyst Center
• Health and Disability Working Group
• Boston University School of Public Health
• 617-426-4447, ext. 27
• mcomeau_at_bu.edu
• www.hdwg.org/catalyst