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

Insurance Coverage

Theresa SachsTechnical DirectorCenters for Medicare and Medicaid Services

Public Programs and the Uninsured

• Medicaid State Plan

• SCHIP Program

• Health Reform Demonstrations

Health Insurance Flexibility and Accountability (HIFA)

• Section 1115 approach

• Medicaid/SCHIP

• Coverage expansions

HIFA Flexibility

• Benefits

• Cost-sharing

• Employer-sponsored insurance

Funding for Expansions

• “Pass-through” expansions

• Re-direct DSH

• Managed care savings

SCHIP Funding in HIFA

• Parents

• Pregnant women

• Childless adults

• Children protected

HIFA Employer-Sponsored Insurance Flexibility

• Wrap-around

• Cost sharing

• Cost effectiveness

HIFA in Present Environment

• Unforeseeable circumstances

• Rising numbers of uninsured

• Great deal of activity

Approved HIFA Demonstrations

• AZ - childless adults and parents

• CA - parents

• SCHIP funding

Utah Demonstration

• Non-HIFA

• Benefit package modifications

• Enrollment fee

• Expansion - primary care

HIFA Advantages

• Guidance

• Application template

• Expedited review