State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

1
State and Local Efforts to Close the Gaps Between
Public and Private Insurance Coverage

• Theresa Sachs
• Technical Director
• Centers for Medicare and Medicaid Services

2
Public Programs and the Uninsured

• Medicaid State Plan
• SCHIP Program
• Health Reform Demonstrations

3
Health Insurance Flexibility and Accountability
(HIFA)

• Section 1115 approach
• Medicaid/SCHIP
• Coverage expansions

4
HIFA Flexibility

• Benefits
• Cost-sharing
• Employer-sponsored insurance

5
Funding for Expansions

• Pass-through expansions
• Re-direct DSH
• Managed care savings

6
SCHIP Funding in HIFA

• Parents
• Pregnant women
• Childless adults
• Children protected

7
HIFA Employer-Sponsored Insurance Flexibility

• Wrap-around
• Cost sharing
• Cost effectiveness

8
HIFA in Present Environment

• Unforeseeable circumstances
• Rising numbers of uninsured
• Great deal of activity

9
Approved HIFA Demonstrations

• AZ - childless adults and parents
• CA - parents
• SCHIP funding

10
Utah Demonstration

• Non-HIFA
• Benefit package modifications
• Enrollment fee
• Expansion - primary care

11
HIFA Advantages

• Guidance
• Application template
• Expedited review