OVERVIEW OF KENTUCKY Outreach MEDICAID AND KCHIP
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1 OVERVIEW OF KENTUCKY Outreach MEDICAID AND KCHIP Lisa Lee Director, Medicaid Division of Provider Operations Program Director, Kentucky Children s Health Insurance Program (KCHIP) September 2011
2 Background Medicaid was signed into law July 30, 1965 by President LBJ Created to provide medical benefits to low income people who did not have adequate health insurance coverage: Low income children deprived of parental support and their caretaker relatives Elderly (age 65 and older) Blind Disabled Federal-state program. States administer within Federal guidelines. Costs shared between federal and state governments KY program approx. 70% federally funded
3 Moving Forward Recognized need to provide health care to additional populations which resulted in changes to system: 1986 Pregnant women and infants (under age 1) at or below 100% of FPL was established as a state plan option under Medicaid; 1989 Pregnant women and children under age 6 and at 133% of FPL federally mandated under Medicaid (KY covers pregnant women at or below 185% of FPL); 1997 Balanced Budget Act of 1997 created the State Children s Health Insurance Program (SCHIP)
4 Why SCHIP? Estimated 10 million children lacked health insurance nationwide in 1997 SCHIP was created for uninsured children who are not eligible for Medicaid because their families incomes are too high, but they also do not make enough money to pay for private health insurance
5 Medicaid vs. SCHIP Medicaid: Entitlement program Individuals of all ages Can be covered by other insurance SCHIP: Capped grant program Children under age 19 Uninsured Both Programs tied to FPL
6 What is Poverty? 2011 Federal Poverty Levels Monthly Income FAMILY SIZE 100% FPL 101>133% FPL 185% FPL 151>200% FPL 1 $908 $1,207 $1,679 $1,815 2 $1,226 $1,631 $2,268 $2,452 3 $1,545 $2,054 $2,857 $3,089 4 $1,863 $2,478 $3,446 $3,725 5 $2,181 $2,901 $4,035 $4,362 6 $2,500 $3,324 $4,624 $4,999 7 $2,818 $3,748 $5,213 $5,635 8 $3,136 $4,171 $5,802 $6,272
7 2011 Average Kentucky Insurance Premiums Single $4,683 $886 employee contribution $3,797 employer contribution Family $ $3,060 employee contribution $10,292 employer contribution Plus Once $9,079 $2,076 employee contribution $7,003 employer contribution Source:
8 Key Stats Kentucky Median Income Annual Insurance Premiums Percent of Annual Income 2 person families $44, $3, % 3 person families $53, $3, % 4 person families $63, $3, % 5 person families $60, $3, % 6 person families $57, $3, % 7 or more person families $53, $3, % Median Income amount obtained from U.S. Census Bureau:
9 Insurance Premiums for Individuals Living in Poverty Family of 2 FPL Income Limit Annual Premiums Percent of Annual Income 100% $14, $3, % 133% $19, $3, % 200% $29, $3, %
10 Insurance Premiums for Individuals Living in Poverty Family of 4 FPL Income Limit Annual Premiums Percent of Annual Income 100% $22, $3, % 133% $29, $3, % 200% $44,70000 $3, %
11 Kentucky Children s Health Insurance Program (KCHIP) Program established in 1998 Capped Grant SCHIP, Title XXI of Social Security Act 80% Federal match rate in Kentucky Only Children are Eligible: Under age 19 Not covered by other health insurance Under 200% of the Federal Poverty Level
12 Benefit Package Inpatient Hospital Outpatient Hospital Emergency Services Outpatient Surgery Physician, Nurse Practitioner and Primary Care Services Early and Periodic Screening, Diagnosis and Treatment (Well Child Care and Special Services) Preventive Services in Health Departments Vision Care Hearing Care Dental Services Family Planning Services Pharmacy Lab and X-ray Home Health Therapies (Physical, Speech and Occupational--limited settings) Medical Equipment and Supplies Transportation (emergency and non-emergency) Renal Dialysis Hospice Nursing Home Care Inpatient Mental Health Services Outpatient Mental Health Services Early intervention for infants and toddlers with disabilities Services provided by school districts for children with disabilities Some additional specialized services for people with disabilities
13 2008 KCHIP Outreach and Enrollment Changes Simplified application process; Trained community partners regarding the new application process Family Resource and Youth Services Center (FRYSC) Local health departments Advocacy organizations Medicaid providers; Developed new outreach materials; Audio news releases; State fair; Back-to-school campaigns
14 Kentucky s Success Since November 1, 2008 Kentucky has increased the net number of children enrolled in Medicaid and KCHIP by 55,000 Average of 2,931 new children per month in CY2009 1,335 per month in CY per month in CY % of newly enrolled children were enrolled in Medicaid
15 Factors that led to Success in KY Leadership; Simplification of enrollment procedures; Grassroots outreach efforts; Training and partnering with community to assist with outreach Providers Health Departments Schools Advocacy organizations Faith based organizations Child care centers Foundations Marketing: Focus on uninsured children rather than poverty level
16 Key Stats Medicaid and KCHIP $6 Billion Budget approximately 24% of overall state budget 38,000 Providers Enrollment Medicaid 757,787 (433,000 children 57%) KCHIP 64,180 Total 821,967 Medicaid covers 1 out of every 3 Kentucky births Medicaid covers approx. 70% of all Nursing Home Care in Kentucky 24,081 PCPs 1 for every 34 recipients 1,307 Dentists 1 for every 629 recipients
17 2010 Key Stats Approximately 57% of children enrolled in Medicaid and KCHIP received a well-child check Approximately 43% of children received dental treatment
18 Issues and Future Direction Managed Care Initiative Health Care Reform Increased enrollment of newly eligible population Beginning in 2014 Affordable Care Act extends Medicaid to all non-medicare individuals under age 65 with income up to 133% of FPL Childless adults Funding Access to Care
19 Dental Stats The following counties have no Medicaid enrolled dentist to serve Medicaid and KCHIP children: Gallatin 1,599 Garrard 2,427 Henry 2,235 Livingston 1,254 Menifee 1,336 Robertson 366 Spencer 1,669 TOTAL Children Enrolled in Counties without dentist 10,886
20 Contact Information Lisa Lee 275 East Main Street, 6W-D Frankfort, KY (502)
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