The Medicaid program, which serves poor families, will again be the target for budget cuts. The White House will likely offer the proposal to reduce reimbursement to the states for administrative costs. This reduction is an indirect cut in funds available to serve the health care needs of poor children and families. In addition, Medicaid managed care regulations will be refined during the upcoming months. These regulations should ensure access and protection for Medicaid recipients. As noted in the Welfare Backgrounder, the decline in Medicaid case rolls related to the decline in Welfare rolls needs to be carefully monitored to ensure that eligible families and children are not denied access to health care.
This year the President proposed restoring Medicaid and Supplemental Security Income eligibility to legal immigrants who enter the country after 8/22/96 if they have been in the U.S. for five years and become disabled after entering the U.S.
State Children's Health Insurance Program
Currently only Wyoming and Washington have not submitted state plans to the federal government in order to draw down their state allotments for the SCHIP program. Forty-eight states and three jurisdictions have submitted plans. Forty eight plans have been approved. States were given until September 1999 to submit their plans for approval. So far, outreach efforts to identify eligible children have proven difficult. The states and the federal government are designing outreach efforts to enroll more children.
The SCHIP program will again be the target of efforts to change the criteria for using the allocated funds. Unsuccessful efforts were made last year by some states who have greatly expanded their existing Medicaid programs to use some of the SCHIP funds to pay for Medicaid children. This year these efforts will resume as well as other efforts to expand coverage for pregnant women and families. In fact, Wisconsin was recently granted a waiver by Health and Human Services to include the parents of SCHIP eligible children in their Medicaid program.
Congress and the Administration agreed last year to assemble a commission to examine options for changing the Medicare system to stabilize its finances as more Americans live longer and the pool of workers contributing to the Medicare system grows smaller. The Commission, whose members were named in December, will be important in shaping how Congress addresses these issues. The results of the commission's work are expected to be released in March 1999.
The Administration has offered a proposal to open Medicare to retirees between 62 and 64 who do not have health insurance and to early retirees [55 years] whose companies drop retiree health benefits. Under last years proposal, these new enrollees would have to pay premiums of $300 and $400 per month. Given the cost, if this were enacted, it would only benefit about 10% of the 3 million early retirees.
The bishops' 1981 pastoral Health and Health Care calls for a universal national health insurance program. As a bridge to that goal, the bishops have supported expansion of Medicaid for all low-income persons who could not otherwise afford health insurance. Following the "option for the poor," the USCCB has given first priority to the most vulnerable: pregnant women, children, frail elderly, and persons with disabilities.
In the past, concern was expressed about the use of managed care for Medicaid recipients without safeguards and oversight necessary to ensure that plans do not try to save money by limiting patient services inappropriately or by providing substandard services.
In The State Children's Health Insurance Program: Guidelines for State Advocates, which was developed jointly by USCCB, CHA, and CCUSA, the guidelines called for coverage of as many insured children as possible with comprehensive benefits as well as more effective outreach efforts. Once the states have implemented their plans, consideration might be given to changes in the structure of the program to allow coverage of other vulnerable populations, e.g. pregnant women and families.
USCCB has been supportive of the Medicare program with special attention to poor elderly who depend on both Medicare and Medicaid for their health care. When the commission's recommendations are released, it will be necessary to evaluate their potential impact on vulnerable populations who depend on Medicare and its guaranteed benefits for their health care.
- Continue to insist that universal coverage is our goal.
Currently more than forty-three million individuals lack health insurance and that number continues to grow. The costs of health care which had been growing at a slower rate in the last five years have begun to increase more dramatically making it more difficult for both individuals and businesses to buy health insurance. Although legislation to achieve universal coverage is not politically viable this year, the issue should still be raised with members in order to push it higher on their agenda.
- Medicaid recipients should be protected as they are moved into managed care settings.
Health and Human Services is still revising the regulations which will shape the protections which Medicaid recipients will have as their states move them into managed health care. Continue to support efforts to ensure that Medicaid recipients will have adequate access to quality health care providers and institutions without undue burdens.
- Medicaid and SCHIP outreach efforts need to be strengthened.
The President is developing an expanded outreach effort and a couple bills are being introduced to promote effective outreach. Rep. Diana DeGette [D-CO] will be introducing a bill [no number available] which would simplify outreach and enrollment by giving states some greater flexibility in their use of administrative funds and extending the availability of the $500 million available through the welfare reform legislation for outreach for Medicaid and SCHIP. The bill would also expand coverage options to include pregnant women and legal immigrants. Sen. Moynihan has introduced S. 206 which would strengthen the data collection sections of the SCHIP law. Support efforts to strengthen and expand both outreach and enrollment efforts for both Medicaid and SCHIP.
- Medicare, as the guarantee of health care for the elderly, needs to be preserved.
Medicare currently covers nearly 39 million elderly or disabled people. In 1995, nearly 40% of Medicare beneficiaries had family incomes below 200% of poverty. More than 10% of beneficiaries have incomes below 100% of poverty.
Some of the poorest elderly are eligible for enrollment in Medicaid as well as Medicare. The poorest of these "dual eligibles" have their Medicare premium, deductible and cost sharing requirements paid by Medicaid. Nearly 6 million Medicare beneficiaries [16%] qualified for this added assistance. Support efforts to protect the guaranteed benefits of Medicare and the protections for the poor elderly.
For further information, contact:
Patricia A. King, USCCB at firstname.lastname@example.org