Say Ahhh!

Last week, Cindy Mann blogged about the importance of kids' coverage on healthcare.gov. "As back-to-school time approaches, families are thinking about making sure their children have every opportunity to learn. Now is also the time to make sure that kids have the coverage they need to be healthy - the first step to a successful school year."

Luckily, many kids already have an affordable coverage option through Medicaid and CHIP. As part of the challenge to get all eligible kids signed up, CMS has launched Get Covered. Get in the Game. to bring coaches, schools, families, and communities together to raise awareness. (Maryland's Suzanne Schlattman blogged about the campaign for us earlier this month.)

Check it out to see how you or your organization can help get children covered and in the game.

Under the Affordable Care Act, states will have considerable flexibility, within federal guidelines, to design Medicaid benefit packages and cost-sharing rules that are appropriate for newly-eligible adult beneficiaries. The often-extensive health care needs and very low incomes of the newly-eligible adults are important considerations for states as they put the new law into effect, according to a new issue brief written by CCF and the Kaiser Commission on Medicaid and the Uninsured. 

Half of all uninsured adults below 133 percent FPL have income below 50 percent FPL. When it comes to their health status, about one-third have a diagnosed chronic condition, such as hypertension or depression, and about 1 in 6 are in fair or poor health.  Given the limited income and often-extensive health care needs of newly-eligible adult Medicaid beneficiaries, it will be critical that they be provided with benefits designed to reflect their unique needs if health reform is to work as intended.

Both the federal and state governments will play important roles in making sure the new law works for newly-eligible adult Medicaid beneficiaries. The issue brief identified two key areas for policyakers to consider as they move forward on implementing the new law:

• Benefit Packages: The content of the coverage provided to the millions of low-income adults slated to secure Medicaid coverage under the health reform law will depend, in part, on how the federal government addresses key issues, such as the definition of "essential health benefits." In addition to covering these essential benefits, the coverage for the newly eligible must be equal to coverage provided under one of three "benchmarks." Importantly, states can also provide additional benefits on top of the benchmark.
• Continuity of Care: Given that changes in income, health status, and other factors are common, coordination and consistency of coverage between Medicaid groups and over time are key aims. Because individuals may also shift between eligibility for Medicaid and Exchange coverage, identifying ways in which states can promote continuity of care between the two systems is a priority.

The responsibility of creating a coherent program that provides the full range of groups served by the Medicaid program with the benefits that they need when they need them falls mainly to the states. Thankfully, the federal government has helped make it easier on the states by making a commitment to finance the full cost of care for the newly-eligible Medicaid adults for the first three years of reform and at least 90 percent of the cost thereafter.

Hope for uninsured low-income adults is on the horizon.  Let's hope policymakers finish the job by making wise choices in how they design the benefit packages and address the need for continuity of care for newly eligible Medicaid beneficiaries.  

We've been following for some time the inconsistent progress of legislation that would extend increased federal Medicaid payments to states.  While versions of the legislation have previously passed both houses of Congress, the two chambers had not succeeded in making the extension law by agreeing to the same bill.  Today, they have, with the House interrupting its August recess to pass a bill approved by the Senate last week that includes both the Medicaid funding and more support for public schools.  The act will continue for six months a portion of the increased Medicaid funding that states have been receiving under the economic recovery legislation.  The funds had been scheduled to expire in December of this year, but instead will phase out through June of 2011. 

States have been receiving an extra 6.2 percentage points in federal matching funds for their Medicaid programs, plus an additional amount based on the state's unemployment rate.  Under the extension, this will drop to 3.2 percentage points in January 2011 and 1.2 percentage points in April, again with an additional increase based on unemployment figures.  See this Center on Budget and Policy Priorities report for an estimate of the amount each state will receive over the first six months of 2011.

This extension will give states a bit more breathing room in their 2011 budgets.  The Medicaid and education funds will help protect not only health coverage and kids' schooling, but should reduce pressure across states' budgets.  Many states had already counted on the extension in the budgets they approved earlier this year, so Congress's action is an important contribution to keeping those budgets intact.  State budgets remain challenged but it's good to see Congress take action to protect important services that are helping kids and families today.

With the Senate's approval today to extend the enhanced Medicaid matching rate (aka FMAP) until June 30, 2011, cash-strapped states and their most vulnerable residents can rest a bit easier.  This measure will now return to the House of Representatives where it is expected to be approved next week. 

As the bipartisan National Governors' Association (NGA) recently noted:

"Funding for FMAP is a particularly effective tool because it immediately allows Governors to eliminate planned budget cuts required to meet balanced budget requirements and continue services for those with the greatest need." 

My colleagues at CCF, Liz Arjun, Joe Touschner and Jocelyn Guyer have blogged extensively on this topic and articulated well why approval of fiscal relief to the states is so crucial.  Families USA and many others have been on the frontlines making sure Congress realized the severe consequences of failing to extend the increased Medicaid matching rate during these tough economic times. 

The legislation also provides $10 billion to local governments to help them avert layoffs of teachers and other public-sector workers like firemen and police officers.

By Suzanne Schlattman, Maryland Citizens' Health Initiative Education Fund, Inc.

This week, the U.S. Department of Health and Human Services (HHS) announced the Get Covered. Get in the Game  initiative which will be launched in seven pilot states across the country including: Colorado, Florida, Maryland, New York, Oregon, Ohio and Wisconsin. The initiative brings together coaches, schools, and communities to educate families with children who are eligible for Medicaid or CHIP about the immediate availability of free and low-cost health care programs for children.

What a great idea! In public health, we stress prevention and leading an active lifestyle is one health behavior that pays the greatest dividends for preventing poor health. However, uninsured kids often miss out on organized youth sporting activities because they cannot afford the necessary physical or because their families are afraid that they won't be able to pay the medical bills if their child gets hurt. Providing coaches with information about affordable health insurance options for children is a great way to promote coverage among eligible families and promote the adoption of healthy behaviors.

In Maryland, we played around with this theme when we launched our "Got healthcare?" campaign after the state expanded Medicaid eligibility for adults in 2007. Local sports heroes from the Baltimore Ravens and Washington Redskins volunteered to help promote the program. We ran radio ads, partnered with local hotlines and put up posters in every hospital to alert people.  Having sports celebs promote enrollment in Medicaid helped raise awareness about the program, break down the stereotype that Medicaid was only for pregnant women and children, and again repeated the theme of leading an active lifestyle.  Over 200,000 Marylanders have gained access to free and low cost health care services since this campaign began.

Check out one of the great radio ads that was part of this campaign:

Chris Samuels of the Washington Redskins with Maryland Governor Martin O'Malley

And the poster with Ed Reed of the Baltimore Ravens:

It makes a lot of sense to involve youth sports leaders with our enrollment efforts as an estimated 44 million children participate in organized youth sports.  Coaches for youth sporting leagues are local celebs in their communities too -- and to have these folks promote enrollment in children's health insurance programs across the country is great news.  

In announcing the initiative, HHS Secretary Kathleen Sebelius reminded us of why we all work so hard to connect children with coverage:  

"Healthy kids do better in school and in life because they are able to participate fully in activities that develop their bodies and their minds," Secretary Sebelius said. "Kids should not have to miss out on their favorite sports and other activities that get them moving because they lack health insurance coverage."

All states can use the materials developed for the pilot states to get coaches involved in outreach efforts to enroll eligible children.  More information about the Get Covered: Get in the Game initiative is available at www.InsureKidsNow.gov.

The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.