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

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State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage Theresa Sachs Technical Director Centers for Medicare and Medicaid Services

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State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage. Theresa Sachs Technical Director Centers for Medicare and Medicaid Services. Public Programs and the Uninsured. Medicaid State Plan SCHIP Program Health Reform Demonstrations. - PowerPoint PPT Presentation

Transcript of State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Page 1: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

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

Insurance Coverage

Theresa SachsTechnical DirectorCenters for Medicare and Medicaid Services

Page 2: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Public Programs and the Uninsured

• Medicaid State Plan

• SCHIP Program

• Health Reform Demonstrations

Page 3: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Health Insurance Flexibility and Accountability (HIFA)

• Section 1115 approach

• Medicaid/SCHIP

• Coverage expansions

Page 4: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

HIFA Flexibility

• Benefits

• Cost-sharing

• Employer-sponsored insurance

Page 5: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Funding for Expansions

• “Pass-through” expansions

• Re-direct DSH

• Managed care savings

Page 6: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

SCHIP Funding in HIFA

• Parents

• Pregnant women

• Childless adults

• Children protected

Page 7: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

HIFA Employer-Sponsored Insurance Flexibility

• Wrap-around

• Cost sharing

• Cost effectiveness

Page 8: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

HIFA in Present Environment

• Unforeseeable circumstances

• Rising numbers of uninsured

• Great deal of activity

Page 9: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Approved HIFA Demonstrations

• AZ - childless adults and parents

• CA - parents

• SCHIP funding

Page 10: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

Utah Demonstration

• Non-HIFA

• Benefit package modifications

• Enrollment fee

• Expansion - primary care

Page 11: State and Local Efforts to Close the Gaps Between Public and Private Insurance Coverage

HIFA Advantages

• Guidance

• Application template

• Expedited review


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

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