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Keeping kids enrolled in Medicaid – Support for LB 220


Today, Voices for Children testified in strong support for LB 220, a bill that would reinstate 12-month continuous eligibility for Medicaid for low-income children.  Here’s what we said to the committee:

Voices for Children in Nebraska would like to express our support for LB 220 and thank Senator Avery for bringing this bill forward. In 2002, Nebraska took a step backwards in ensuring low-income children have ongoing access to health care.  Prior to this time, children enrolled in state health insurance programs were considered continually eligible for a period of 12 months after enrollment and in 2002, this time period was shortened to 6 months.  This change increased the administrative burden for both families and Health and Human Services staff and decreased the likelihood that low-income children would maintain consistent health insurance coverage.

As this committee is acutely aware, our health care system in Nebraska and nationally will undergo significant changes in the coming years.  Our state’s Medicaid program provides health insurance coverage for almost a third of our state’s children, making up almost 70 percent of enrollees.  Ensuring the stability of Medicaid coverage for this population will help ensure greater continuity of care for our state’s children as broad system changes move forward.  This is why now is time to restore 12 month continuous eligibility for children’s Medicaid.  Twenty-three other states, including Iowa and Kansas, currently guarantee this type of ongoing eligibility.

To date, there has been limited public information on how our state’s Medicaid program will interact with the new health care marketplaces that will be in place in 2014.  Nebraska can help to minimize coverage disruptions for children by restoring 12 month continuous eligibility.

We appreciate that this fiscal note on this bill is significant and would like to draw the committee’s attention to a couple of factors which could reduce it.  Studies from other states have found that children moved off the program often re-enroll in a few months.  In a three-year period, California spent an estimated $120 million to re-enroll 600,000 children who left Medicaid and then returned; most of them returned to the program within four months of leaving.[1]   Another analysis found that the longer children were enrolled in Medicaid, the lower their average monthly expenditures were, partly because they had more regular preventive care and partly because new enrollees may have pent-up demand for services that are more expensive than regular care.[2]  Early analysis of 12-month continuous eligibility has found reduced administrative costs, increased average months of coverage for enrolled children, reduced average monthly costs per enrollee, and delayed disenrollment.[3]

In addition, the fiscal note appears to assume that we would have nearly every eligible child in the state enrolled by 2014.  There are currently about 18,000 eligible but enrolled children and about 7,500 eligible children are born each year.  While we would love for every eligible child to be enrolled, we are not sure that universal enrollment is a realistic assumption.

Health care access for children plays a critical role in healthy development.  Children need continuous health care coverage to ensure that they receive timely immunizations, developmental screenings, and preventative services.  It is also important that children establish a health home so that their doctor has an ongoing relationship with the child that makes it easier to identify and address developmental issues and treat chronic conditions.

Voices for Children believes that every child in the state should have ongoing access to quality affordable health care.  Health care access is critical to healthy development, educational performance, and long-term success.  We urge the committee to advance LB 220 and take an additional step toward meeting the health needs of all children in our state.  Thank you.

[1] Fairbrother, G. “How Much Does Churning in Medi-Cal Cost?” Woodland Hills, CA: The California Endowment, April 2005.

[2] Ku, L., P. MacTaggart, F. Pervez, and S. Rosenbaum. “Improving Medicaid’s Continuity of Coverage and Quality of Care.” Washington, DC: Association for Community Affiliated Plans, 2009.

[3] Merrill, A., and M. Rosenbach. “SCHIP and Medicaid: Working Together to Keep Low-Income Children Insured.” Final Report Submitted to the Centers for Medicare & Medicaid Services. Cambridge, MA: Mathematica Policy Research, 2006.

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