Proposed Program Improvements

States are continuing to work to improve health care coverage for children and families. Activity as of March 26, 2009, is listed below. This movement continues five years of progress, despite the budget deficits most states are facing (the size of the state fiscal year 2009 budget gap, as a percentage of the state’s general fund, is listed in parentheses1).

This information is based upon legislative analyses, communication with state advocates, and news accounts. Please note that many legislative sessions are still active and that the updates presented below are subject to change.

Keep us posted on what you hear in your state and send any comments or questions to Martha at [email protected].

Proposed Program Improvements: Alaska (6.8%): There are a few proposals on the table that would expand to 200%. They differ primarily on the level of cost sharing and inclusion of a possible buy-in. There is also a possibility that the 12- month waiting period will be eliminated. California (13.6%): The state is expected to repeal the semi-annual renewal requirement instituted last year in order to comply with Recovery Act’s maintenance of effort requirement. The General Assembly passed the measure on March 26th and the Governor is expected to sign. Colorado (7.7%): The Governor proposed an expansion to 250% funded through a provider fee. This expansion would replace the expansion the state passed last year to 225%. The proposal has received initial approval in the House. There is also a proposal for telephone and online renewals. Iowa (2.1%): A bill includes presumptive eligibility, measures to simplify income verification, passive renewals, and a “soft” mandate on coverage. It would also extend coverage to legally residing immigrant children within the five-year bar up to 300%. Coverage for undocumented children was originally included in the legislation, but was removed prior to passage by the Senate. Maryland (4.6%): A buy-in program, for children with income above 300% has been proposed. The legislation also includes a “soft” mandate in 2010, with a penalty imposed in 2012. Minnesota (3.8%): The state has a “cover all kids” proposal, which includes administrative renewal. The proposal would eliminate premiums for children with income below 275% and the 4-month waiting period for children with income below 200%. Mississippi (3.4%): There was a proposal to eliminate the face-to-face interview at renewal for children ages 1-16 in CHIP in the Medicaid financing bill. However, it is unclear as to whether the provision will be retained in the conference bill. Missouri (3.8%): The Governor has proposed to increase eligibility for parents from 20% to 50% of the FPL. He would also eliminate premiums for children between 150% and 225% and institute a standard $50 premium between 225% and 300%. His proposal to reach more eligible, but unenrolled children includes 12-month continuous eligibility and increased outreach efforts. Nebraska (n/a): There is a proposed expansion from 185% of the FPL to 200%, as well as 12-month continuous eligibility. New Hampshire (1.6%): A bill that would allow young adults up to age 26, with income up to 400% to buy into the state’s CHIP program has passed the Senate. New York (3.0%): The Governor’s budget included a number of simplification measures, including the elimination of the face-to-face interview requirement in Medicaid (for children and parents). It would also eliminate finger printing and the asset test for parents. North Dakota (n/a): The Governor’s budget proposed an expansion to 200%, up from 185% FPL.

1 Source: I. Lav & E. McNichol, “State Budget Troubles Worsen,” Center on Budget and Policy Priorities (March 2009). Oregon (6.6%): The state has a proposed expansion up to 300% FPL, with a buy-in program for children with income above that limit. Rhode Island (11.4%): The Governor’s budget would reinstate coverage to legally residing children and pregnant women. Texas (n/a): The state has a buy-in proposal for children with income between 200% and 300%. There is also a proposal for 12-month continuous eligibility in the state’s Medicaid program. Washington (3.4%): The legislature is attempting to address potential issues with a buy-in program that was authorized in prior legislation. The proposed also includes the Express Lane option and language focused on improving program retention.

Enacted/Plan to Implement: Alaska (6.8%): A regulation to implement 12-month continuous eligibility goes into effect April 1, 2009. Arkansas (n/a): An expansion of ARKids to 250% was signed by the Governor on March 18, 2009. The expansion will be funded by a tobacco tax. Indiana (8.0%): The state continues its negotiations with CMS for approval of its enacted expansion to 300%. Iowa (2.1%): The state plans to implement its expansion to 300% on July 1, 2009. Kansas (2.9%): Funding for the state’s planned expansion to 250% FPL has been secured in both chambers of the state legislature. An implementation date has yet to be established. Louisiana (3.7%): The state plans to implement its approved expansion to 300%, but the date remains undetermined. Montana (n/a): A ballot initiative to expand coverage to 250% passed in November. The Governor included funding in his budget that is currently being debated in legislature. The state has proposed an October 1, 2009 implementation date. North Carolina (9.3%): The state plans to implement its approved expansion to 250%. An implementation date has not been set. Ohio (4.2%): The state plans on implementing its expansion to 300% on July 1, 2009. Oklahoma (n/a): The state continues its negotiations with CMS for approval of its enacted expansion to 300%.

Implemented: Oregon (6.6%): The state implemented 12-month continuous eligibility in Medicaid and CHIP on January 1, 2009. Washington (3.4%): The state implemented its expansion to 300% on February 23, 2009, with retroactive coverage for those applying after November 24, 2008. West Virginia (n/a): The state implemented an expansion to 250% on January 1, 2009. The state has legislative authority to expand coverage up to 300%.