Copyright 1999 Federal News Service, Inc.
Federal News Service
APRIL 29, 1999, THURSDAY
SECTION: IN THE NEWS
LENGTH:
1066 words
HEADLINE: PREPARED TESTIMONY BY
BARBARA
COULTER EDWARDS
MEDICAID DIRECTOR
OHIO DEPARTMENT OF HUMAN SERVICES
BEFORE THE SENATE FINANCE COMMITTEE
BODY:
Mr. Chairman, members of the committee, I
appreciate the opportunity to testify this morning before the Committee on
Finance to share Ohio's Title XXI children's health plan
experience.
I am Barbara Edwards. I oversee the Office of Medicaid within
the Ohio Department of Human Services. Medicaid in Ohio is a $6.5 billion a year
health care plan that serves over 1.4 million Ohioans,
including more than 600,000 children. I also direct Ohio's Title XXI children's
health insurance plan (CHIP).
The State of Ohio implemented
its Title XXI plan on January 1, 1998. We offer comprehensive
health coverage to all children ages 0 through 18 living in
families with countable incomes at or below 150 percent of the federal poverty
level. Ohio's Governor, Bob Taft, has proposed expanding the title XXI plan to
include all children in families up to 200% of the federal poverty level
beginning January 2000. A fully implemented children's health
plan under Title XXI is seen as a strong support for families seeking to
establish and maintain self- sufficiency in the work force.
Through March,
over 104,000 children have enrolled in our Title XXI children's
health plan. We estimate that this includes 55% of the state's
uninsured children in the targeted expansion group.Ohio expects
to have reached up to 125,000 children by the end of June. With the planned
expansion to 200% of poverty, an additional 27,000 children could be enrolled by
the end of the next biennium.
Ohio was the fourth state in the nation to
receive approval for its CHIP plan. Under the leadership of former Governor, and
now U.S. Senator, George V. Voinovich, Ohio's 1998-99 biennial budget included
an expansion of Ohio's Medicaid program for children, even before enactment of
title XXI. This put Ohio in the enviable position of having both the authority
and the funding to take early advantage of the opportunity offered in the
federal Balanced Budget Act.
Using both a Title XIX and a Title XXI state
plan filing, Ohio expanded income eligibility up to 150% of poverty for
HealthyStart, our Medicaid plan for children. Ohioans supported offering the
full HealthyStart EPSDT benefit package to low-income children. In addition,
since Ohio Medicaid already contracts with licensed private sector managed care
plato in all the major urban areas of the state, most children enrolled under a
HealthyStart expansion receive their benefits through a private
health insurance plan.
The most compelling reason Ohio
selected the Medicaid option was the ability to offer wraparound insurance to
under-insured children under title X, in addition to offering coverage to
uninsured children under Title XXI.
To encourage enrollment
in the children's health plan, Ohio uses a simplified three
page HealthyStart application that can be mailed in; parents do not have to
visit any government office in order to apply. Ohio also offers a very popular
toll-free consumer hotline with evening and weekend hours to make it easy for
families to get information about the children's health plan
and to apply by phone.
Finally, Ohio has engaged local communities in
developing and implementing outreach efforts to low-income working families.
Ohio has allocated to its counties almost all of the $16. l million in enhanced
federal matching funds available to the state under the federal Personal
Responsibility and Work Opportunity Reconciliation Act (PRWORA) to conduct
Medicaid outreach to families who leave cash assistance programs. I have
attached to my testimony a description of the CHIP outreach initiatives
undertaken by the state, in addition to those initiated at the local level.
As a result of state and local efforts, Ohio has experienced a recent net
increase in covered children across all Title XIX and Title XXI programs, even
while cash assistance caseloads continue to decline. This includes a 23%
increase in the percentage of new enrollees in non-CHIP HealthyStart. Even so,
we are not fully satisfied with our expansion efforts. Our enrollment
information shows that we are still mostly reaching children in families who
already have some connection to the Medicaid health plan. The
majority of new enrollees are children who either were previously covered by
non-CHIP HealthyStart themselves or who have younger siblings covered by
non-CHIP HealthyStart. This suggests there may be significant numbers of
children whose families still do not know that coverage is available or who for
some reason are reluctant to enroll their children in a public
health plan.
We also are concerned that we "lose" a
significant number of children from the program at eligibility redetermination.
While over 104,000 children have been enrolled to date, only 54,000 children
were covered in the expansion group in March. We add about 8000 children each
month and lose 7000. Half of the children who leave the expansion program at the
required six-month redetermination move to non-CHIP HealthyStart and so still
have full health coverage. We do not know what is happening to
the rest of the children who lose coverage each month; we are concerned that
these children may be uninsured.
As we look to the future,
Ohio is committed to further simplifying the application and eligibility
processes for both Title XIX and Title XXI health plans. We
will pay particular attention to reapplication requirements to minimize the
number of children who lose coverage because of time lines and paperwork. And we
are committed to working with local communities to clarify the message that
health care is not welfare. Access to quality
health care is critical to healthy development in early
childhood, to having children start school ready to learn, and to supporting
children as they grow to be productive adults.
My sincere thanks to you, Mr.
Chairman, and to the members of your committee, for your interest in states'
efforts to implement Title XXI. Each state faces a unique set of challenges and
opportunities as we seek to provide health care services to
children. I encourage the Committee to continue to seek ways that the states can
work in partnership with the federal government. I encourage you, especially, to
continue to increase flexibility for states administering both Title XIX and
Title XXI health plans, so that together we may achieve our
mutual goal of good health for all our children. Thank you.
END
LOAD-DATE: April 30, 1999
