The ACA and State-specific Health Care Reform
The recently passed national health reform legislation holds promise for ensuring comprehensive health care coverage of all children. Although provisions within the Affordable Care Act (ACA) will promote structures and incentives for states to expand coverage, the specific implications for children and youth with special health care needs (CYSHCN) will unfold as federal regulations are determined and state actions in the context of federal guidance are developed.
Even prior to the passage of the ACA, several states implemented state-wide financing systems that are designed to cover all uninsured children (and in some cases like Maine and Massachusetts, all adults as well).
Maine’s program, known as Dirigo Choice, is operated by Maine Medicaid and Anthem Blue Cross and Blue Shield. Benefits are similar to those under Medicaid, and coverage is available to uninsured individuals, businesses and municipalities with 50 or fewer employees, and the self-employed. Discounts on premiums are offered to individuals below 300% of the FPL. Dirigo Choice was originally financed in 2005 through employer and enrollee payments, Medicaid dollars, and state funds. In subsequent years, additional funding will come from an assessment on insurers’ gross premium revenues.
Illinois implemented the All Kids program to provide health care coverage for all uninsured children, including uninsured immigrant children, on July 1, 2006. All Kids offers benefits that are similar to Medicaid benefits, including coverage for doctor visits, hospital stays, prescription drugs, vision care, dental care, and medical devices like eyeglasses and asthma inhalers. There are no copays for preventive services. Parents pay monthly premiums for the coverage, but rates for middle-income families are significantly lower than they would be on the private market. As of July 1, 2011, Illinois intends to restrict eligibility for new enrollments to children whose families make 300% of the Federal Poverty Level (FPL) or less. Currently enrolled children whose family income is over 300% of the FPL will be able to stay on the program until June 30, 2012.
The Massachusetts health care reform law was enacted in 2006. It requires nearly every resident of Massachusetts to obtain health insurance coverage. Through the law, Massachusetts provides subsidized health care for residents earning up to 100% of the Federal Poverty Level (FPL), and partially subsidized health care for those earning up to 300% of the FPL on an income-based sliding scale. The law established the Commonwealth Health Insurance Connector, an authority operated by the state, which connects individuals and businesses with high value and quality health insurance products. Failure to obtain health insurance coverage results in tax penalties. As of August 2010 this reform resulted in 410,000 newly insured Massachusetts residents.[1]
For more information and a complete roundup on Catalyst Center activities and products related to the ACA, please see our Health Care Reform section of our website.
[1] Health Care in Massachusetts: Key Indicators, August 2010. Massachusetts Executive Office of Health and Human Services, Division of Health Care Finance and Policy. Retrieved January 26, 2011 from http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/10/key-indicators-august-2010.pdf
