And fourth, the state must establish a minimum of a one-year period of uninsurance for individuals before they receive public coverage if they want to make eligible kids with family incomes 250 percent of the FPL or higher.On the first, no state has 95 percent of eligible kids enrolled. I believe Vermont has 90 or 92 percent and is the highest in the nation.
In Maryland, enrollment targets were not met because “[d]ue to fiscal constraints state centralized outreach activities requiring expenditure of funds did not occur in FY2006. The Department continued to provide program brochures and application forms on request, to maintain current program information, including application forms in English and Spanish, on the Department website, and to speak to various groups about the program. Local health departments maintained existing grassroots relationship with community partners, such as local area schools.”
So, no outreach beyond speaking invitations and the web. I don’t have stats on hand, but I’m guessing that poor, near-poor, and working poor families aren’t spending a lot of time cruising the net. Many don’t have service, many don’t have time, there are language barriers. Of the 622,710 people who speak something other than English in MD, 230,830 speak Spanish. The other biggies are French (40k+), Korean (30k+), Chinese (30k+), Tagalog (18k+) and “African Languages” (36k+).
That and Maryland felt the burden of the citizenship requirements imposed by the Deficit Reduction Act: “The implementation of the new regulations regarding Citizenship/Identity. Maryland [has] a mail-in application program. This new federal requirement will require all MCHP customers to make a visit to the local Department of Social Services or local health departments to hand deliver their Citizenship/Identity documents. Local health departments are not set up for this type of interviewing process and customer direct contact. Space is limited in most all local health departments. Staffing is an issue with the level funding for the past three years for our Local Health Departments. The hiring freeze for permanent state employees continued throughout FY 2006 and 2007.” (This information is from the MD FY2006 Annual Enrollment Report to the CMS. It is available here after unzipping the file).
Think about it: If you were an undocumented parent, would you want to produce citizenship documents for your kid – even if s/he had them – in front of government employee?
On the second, MD already charges families about 2 percent of their income in co-insurance ($44 p/month above 200 of the FPL, $55 p/month 250-300 of the FPL).
On the third, MD already says that any person who voluntary drops employer-sponsored coverage within 6 months of application will be denied SCHIP coverage. The exceptions to rule include: involuntary job loss or loss of coverage; job change; moving out of employer-sponsored coverage area; and expiration of COBRA benefits.
On the fourth, MD already has a 6 month waiting period. This is done to prevent “crowd out.” Crowd out is simply a way to say that some families with access to private insurance will elect to drop that coverage to get government-sponsored coverage because it cheaper. To me, crowd out screams that there is a problem with the health care market. To others it says “over reliance on government.”
Why do I mention all of this? To illustrate that states, even high cost states with existing expansion programs (sometimes called Section 1115 waivers) ARE ALREADY MAKING THESE EFFORTS. The letter acts like high-costs aren’t trying to control costs, aren’t interested in cost-sharing, aren’t making every effort to enroll eligible kids. Essentially, it supposes that high-cost states are just content to throw money at a problem and call it a day.
The White House is mad that the CBO said their proposal would lower the number of enrollees (see pp 22-23). And so this letter is nothing more than an “!@%(*& YOU” to Congress for passing bills (HR 3162 and HR 976) that would expand the program to kids with higher family incomes.
If you want to let Dennis know: write him at
Dennis Smith
7500 Security Blvd.
Baltimore, MD 21244-1850
Dennis.Smith@cms.hhs.gov
