Managed Care

 

Kids’ health coverage a continuing bright spot

MANAGED CARE August 2010. © MediMedia USA
Managed Care Outlook

Kids’ health coverage a continuing bright spot

MANAGED CARE August 2010. ©MediMedia USA

If it weren’t for the recent passage of the Patient Protection and Affordable Care Act (PPACA), there would have been very little progress made toward reducing the overall number and the percentage of uninsured adults in the United States.

Efforts to expand children’s coverage is another matter.

Census Bureau statistics bear this out: The portion of children who lack coverage declined from 12.5 percent in 1999 to 9.9 percent in 2008. What caused this? Gains in Medicaid and the Children’s Health Insurance Program, with 1.7 million more children covered than a year earlier. Also, the number of uninsured children below the federal poverty level decreased in 2008 to 2.2 million — a 5.7 percentage point drop.

PPACA will affect children’s coverage in a number of ways. For example, beginning in 2014, the law makes Medicaid coverage mandatory for kids ages 6–19 in families between 100 percent and 133 percent of the federal poverty level. The Children’s Health Insurance Program (CHIP) will continue through 2019. States can expect a significant increase in the CHIP match rate, up to 100 percent of costs, in 2015. Current match rates range from 65 to 85 percent.

2010 federal poverty level guidelines
Percent poverty guidelines
Family size 100% 133% 200%
2 $14,570 $19,378 $29,140
3 $18,310 $24,352 $36,620
4 $22,050 $29,326 $44,100
Source: 2010 Federal Poverty Guidelines, U.S. Department of Health and Human Services

Private insurer coverage of children under PPACA

Plans will have to cover pre-existing conditions for currently insured children and not exclude children with pre-existing conditions from future coverage. The requirement becomes effective with the insurance plan years that begin after Sept. 23, 2010 (the year starts Jan. 1, 2011 for most people).

After September 23, 2010

  • Young adults can remain on their parents’ health plan until they turn 26.
  • Children under 19 with private insurance can no longer be denied coverage for pre-existing conditions.
  • Insurers may no longer impose lifetime caps or restrictive annual limits on coverage, and may not rescind coverage when a person becomes ill.
  • New plans must provide free preventive services to enrollees.

Source: Center for Children and Families, Georgetown University

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015