St@teside

Colorado

An $18.4 billion operating and capital budget, referred to as the annual “Long Bill” by lawmakers, was signed by Governor Bill Ritter, Jr. on April 28, 2008, expanding the state’s children’s health insurance program (SCHIP)—Child Health Plan Plus (CHP+) —to pregnant women and children living in families earning less than 225 percent of the federal poverty level. This expansion will provide benefits for an additional 9,040 children and 686 pregnant women when fully implemented.

This bill was passed in conjunction with legislation (S.B. 160) that adds a CHP+ mental health benefit, which will provide the same type of benefits offered through Medicaid. The budget also provides $1.4 million to double the amount of the current CHP+ outreach budget and an additional $9.6 million to provide health care for 5,358 eligible children who are not enrolled in CHP+.

The CHP+ expansion was one of several proposals in Governor Ritter’s “Building Blocks to Health Care Reform” package, introduced February 13. All of the governor’s proposals have been approved by the 2008 state General Assembly, which adjourned May 6. Highlights of Ritter’s proposals and other health care bills that passed during this legislative session include:

Expanded Access to Care

• Provides a medical home to every child enrolled in Medicaid and CHP+
• Increases reimbursement for primary and oral health care providers

Improved Efficiencies in Private Health Insurance & Public Programs

• Standardizes health plan ID cards and require the use of magnetic strips on all cards to allow for electronic data exchange
• Invests in health information technology through the Colorado Regional Health Information Organization, which will improve quality of care by helping to decrease duplication of services, medical errors, and negative health effects
• Increases transparency in health insurance by creating a Web-based report card on health insurance companies and by requiring disclosure of insurance companies’ compensation structure

Improved Public Health Programs

• Funds the Colorado Immunization Information System
• Supports LiveWell Colorado, the major anti-obesity initiative at the Colorado Department of Public Health and Environment launched this fall with a $16 million grant from Kaiser.
• Directs the Department of Public Health and Environment to develop a statewide comprehensive public health improvement plan and requires local public health agencies to create a plan based on community needs.

The budget also included the following measures in the state’s Medicaid program:

• An additional $28.1 million ($13.2 million from the state General fund) for provider rate increases covering greater reimbursement for Medicaid services
• An increase of $5.5 million ($2.6 million General Fund) devoted to centralizing eligibility determinations, in effort to make the Medicaid and CHP+ application process more efficient
• An increase of $ 4.3 million from the General Fund for additional community mental health services
• An increase of $986,386 from the General Fund for nurse compression pay at mental health institutes in order to recruit and retain nurses.

Florida

Governor Charlie Crist recently signed into law the Cover Florida Plan (S.B. 2534).  Described as a “comprehensive market-based strategy to address the uninsured in Florida,” the legislation aims to have a new program available to 3.8 million uninsured residents starting January 2009.

The bill outlines a plan to allow private insurers to develop ‘Consumer Choice Benefit Insurance Plans.’ Insurers would competitively negotiate with the state to provide the benefit plans which will cost consumers approximately $150 or less per month. The plans must focus on primary care and preventive care in order to discourage people from using emergency rooms as their source of primary care. At minimum, all benefits plans will include:

• Coverage for preventive services
• Screenings
• Office visits
• Urgent care
• Prescription drugs
• Durable medical equipment
• Diabetic supplies

Health plans will also compete with each other to provide supplemental coverage, such as vision, dental, and cancer care.

Individuals that are uninsured for more than six months will be eligible for the program. The legislation also creates the Florida Health Choices Corporation, described as a clearinghouse with elements that appear to be similar to Massachusetts Connector.  Through the Corporation, small employers with 50 or fewer employees will be able to access coverage for their employees. Employees will have the ability to choose from several health plans, flexible savings accounts and traditional insurance products. Employers will be required to establish Section 125 plans.

The program will be administered by a 15-member board made up of appointees chosen by the governor, the Senate president and the House speaker.

The Cover Florida Health Access Act also includes additional provisions:

• Coverage for children is also expanded in the Cover Florida plan, allowing families, regardless of income level, to pay premiums in order to “buy in” their children into the KidCare Program.
• Carriers participating in the Corporation will be required to allow dependents up to the age of 30 to remain on their parents’ policy.
• The Florida Health Flex Plans, a basic coverage model established by the Florida Legislature in 2002 in an effort to offer basic affordable health care services to low income uninsured residents, had its sunset provision removed, allowing the plans to continue as well as increasing eligibility in the program from 200–300 percent FPL.

Kansas

On May 18, Governor Kathleen Sebelius signed into law a health care reform bill (S.B. 81) that will expand access to health care. The bill expands eligibility for the State Children’s Health Insurance program for children in households that have incomes up to 250 percent FPL—once federal funding becomes available. Additionally, the bill ensures $460,000 for expanding eligibility for pregnant Medicaid enrollees; $2.5 million to increase Safety Net Clinics; and $1.5 million for the Wichita Center for Graduate Medical Education to fund rural rotations by physicians who get specialized training in Wichita. The bill goes into effect once the statute book has been published.

The legislation includes nine of the 21 policy reforms from the original health reform package sent to the legislature in November 2007. Those nine policies included:

• Defining medical homes;
• Adding the Commissioner of Education to the Kansas Health Policy Authority Board;
• Moving the Small Business Grant Program from the Department of Commerce to the Kansas Health Policy Authority;
• Standardizing insurance cards for Medicaid enrollees;
• Expanding the Community Health Record pilot project, which incorporates administrative claims data into patient electronic records;
• Expanding HealthWave (Kansas SCHIP program) outreach to eligible children;
• Continuing the Coordinated School Health Program, including $500,000 in funding, in order to continue bringing together educational and community resources into schools to help with health education; and
• Providing for dental coverage and tobacco cessation counseling for pregnant Medicaid enrollees.

Illinois

On April 15, a judge in the Cook County circuit court issued a preliminary injunction prohibiting Governor Rod Blagojevich and the Illinois Department of Health and Family Services from continuing an expansion of Illinois’ FamilyCare program. The program, implemented in November 2007, expanded eligibility for Medicaid benefits to families earning up to 400 percent FPL. The injunction was ordered as a result of Governor Blagojevich’s lack of authority to cover recipients with incomes from 133 percent to 400 percent FPL under Medicaid.

Governor Blagojevich initially tried to expand the program through the state legislature, but when they did not approve the legislation, he enacted an emergency rule to expand the program.

At least 3,300 individuals have enrolled in FamilyCare since November 2007 and are now uncertain whether they will continue to receive those benefits. In order to maintain the program, the state will need a minimum of $14 million this year, which was not included in the budget.

The court upheld one part of the governor’s expansion, allowing the Free Breast & Cervical Cancer screening program and its eligibility standards. The program provides uninsured women access to mammograms and other cancer screenings. This program was allowed because lawmakers had allotted $6 million toward the screening program but had not set any income restrictions.

New York

On April 23, Governor David Paterson signed a comprehensive budget bill that is the “first step toward reforming the state’s health care system.” The bill (S. 6808) expands New York’s Child Health Plus program, provides prescription drug discounts for low-income individuals and the disabled, and begins the process of updating the state’s Medicaid reimbursement formula.

The budget expands the Child Health Plus Program to cover children in families up to 400 percent FPL—expanding coverage up to an additional 400,000 children. The prescription drug discount program, based on the state’s Elderly Pharmaceutical Insurance Coverage program, will provide discounts of 30–50 percent on prescription drugs for the disabled and low-income New Yorkers aged 50–64. New York’s Medicaid reimbursement rates will be updated so that the base year in the reimbursement formula is more current—based on the year 2005 instead of 1981. Additionally, the emphasis for Medicaid funding is shifted to a more preventive approach, focusing funds on primary and preventive care rather than inpatient care.