This article first appeared in the December 2008/January 2009 issue of the newsletter "States in Action."
In November, Montana residents overwhelmingly passed Initiative 155, which establishes the Healthy Montana Kids plan to expand and coordinate coverage for uninsured children under Medicaid and SCHIP. The plan calls for: 1) raising income eligibility levels for children under SCHIP and Medicaid; 2) simplifying transitions between the public coverage programs; and 3) enhancing the use of community-based organizations to enroll eligible children. The initiative is estimated to cost the state $20 to $22 million for the first year, which would bring in additional federal matching funds. The state portion would come from a share of Montana's insurance premium tax.
The Healthy Montana Kids plan is expected to extend Medicaid and SCHIP to about 30,000 Montana children through age 18. This could expand Medicaid/SCHIP for children by nearly 50 percent and cover the vast majority of uninsured children in the state. [1] Medicaid coverage would expand from current family income limits of 100 to 133 percent of the FPL to about 185 percent of the federal poverty level (FPL). [2] Income eligibility for the state's SCHIP would expand from 175 percent to 250 percent of the FPL. [3]
The plan also calls for a single point of access for members of both Medicaid and SCHIP, promoting easier movement between the programs. It provides presumptive eligibility, meaning that children would be covered while awaiting final eligibility determination. Further, the state will enhance use of 'enrollment partners' such as health care providers, schools, and community-based organizations to help identify and enroll eligible children in Medicaid and SCHIP.
According to CHIP Bureau Chief Jackie Forba and Mary Dalton, health resources division administrator for Montana's Department of Public Health and Human Services, the following steps must be taken before the Act can take effect in October 2009:
- Congress must reauthorize SCHIP to ensure federal matching funds.
- The Montana state legislature must vote to appropriate the state funds (already collected from a health insurance premium tax) needed for the first year.
- Montana must submit state plan amendments for Medicaid and SCHIP programs delineating the program changes to the federal government.
- Administrative rules and operational changes must be developed and communicated.
- The economic crisis did not dampen and may have enhanced Montana voters' willingness to expand public coverage. 'Perhaps because we're starting with minimal eligibility levels for Medicaid and SCHIP, the people of Montana have said they want to move ahead.' Dalton says.
References
[1] Montana SCHIP enrollment was 17,240 and Medicaid enrollment for children was 46,645 in November 2008. Approximately 31,000 (14%) of all Montana children are uninsured according the 2008 U.S. Census Bureau Current Population Survey, based on the three-year average (collected 2006-2008).
[2] The eligibility cut-off between Medicaid and SCHIP will depend in part on the details of the SCHIP reauthorization by the U.S. Congress, expected in early 2009.
[3] The SCHIP expansion applies only to children not covered by private insurance for at least three months, ineligible for Medicaid, and who are U.S. citizens or qualified aliens and state residents. The plan stipulates that eligibility may be reduced if funding is insufficient.back to top> |