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Children’s Health Coverage Shifted: Facilitated Enrollers Take A Hit

October 1, 2004

As part of the state budget package adopted in mid-August, the Legislature eliminated Medicaid coverage for children at least six years of age but less than 19 who live in households with net incomes above 100% of poverty but less than 133% of poverty. As of October 1, 2004, children between 100% and 133% of poverty will only be eligible for Child Health Plus (CHP-B). Disabled children are not exempt. Children currently participating in Medicaid will remain in the program until their next recertification. The bill directs the Commissioner of Health to ensure a smooth transition of children from one program to the other, but advocates fear that these children will suffer a loss of coverage due to inevitable drop off from churning.

According to the Children’s Defense Fund, “reducing eligibility from 133 to 100 percent of the federal poverty level will impact a minimum of 77,000 children.” CDF further notes that “when children are required to change or transfer their health insurance coverage they become increasingly vulnerable –indeed, even with simplified main-in renewal, more than 40% of children lose health insurance coverage at the time they re-certify.”

The legislation directs the Commissioner of Health to create a simplified transfer process which “shall include but not be limited to “the automatic transfer of any child who is currently enrolled in a Medicaid Managed Care Organization that is also a Child Health Plus provider” and the Commissioner “shall assure” that families are “fully informed” of their right to enroll in CHP-B. For the targeted age and income group, if a complete application for recertification for Medicaid (or CHP-A) is denied, it “shall be deemed an automatic application for coverage” under CHP-B and the process “shall not require additional documentation to establish eligibility.”

The bill further requires that “medical assistance coverage shall not be terminated (for these children) until a successful transfer of eligible persons to a child health insurance plan is complete.” The CHP plans will have two months from the time of application to certify eligibility.

In addition, the local department of social services will be directed to screen these children for SSI-related coverage and for home and community-based waiver programs. Again, current assistance “shall not be terminated until the disability review is complete”. The bill specifically notes that all Fair Hearing rights for these children and families are maintained.

While the legislation’s procedural specifications are clearly intended to ease the transition process for low-income children, their effectiveness will be limited by severely strained county budgets and the Governor’s decision to reduce funding for facilitated enrollers, who might have helped families navigate the process. As part of the state budget fight, on August 20, Governor Pataki vetoed $1 million in funding for facilitated enrollment for children. When federal matching funds are figured in, this hit is likely to amount to a $3 million cut to the $10 million in funding for child enrollment. Families seeking assistance will be confused enough understanding why and how their children will be moved from or enrolled in CHP-A or B; many will now face the process without the assistance of a community-based facilitated enroller.  

 





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