1 Texas Medicaid and CHIP Enrollment Update for

1 Texas Medicaid and CHIP Enrollment Update for Hobby Policy Conference October 10, 2006 Anne Dunkelberg, Associate Director 900 Lydia Street - Austin, Texas 78702 Phone (512) 320 -0222 – fax (512) 320 -0227 - www. cppp. org Center for Public Policy Priorities www. cppp. org

2 Texans and Health Insurance US Census Bureau Statistics (March 2006 CPS): • Approximately 5. 5 million Texans uninsured in 2005 – 24. 6% of Texans of all ages were uninsured (versus 15. 7% U. S. ) – 26. 9% of Texans under age of 65 were uninsured • Another three million Texans covered by Medicaid or CHIP (i. e. , generally not insured through private coverage) • Why are so many Texans uninsured? Low percentage of employer-sponsored insurance (ESI) – 8% below national average for < age 65 (54. 5%, vs. 62. 8%) – 10. 4% below national average for < age 18 –Only 12. 0% of Texans below poverty have ESI • Approximately 83% of Texas Medicaid recipients are below poverty (i. e. , most are unlikely to be insured w/o Medicaid) Center for Public Policy Priorities www. cppp. org

Texas’ Uninsured by Income, 2005 Income, % of Poverty Uninsured (millions) As % of Group All 5. 5 24. 6% <100% 1. 55 42. 2% $20, 000 100 -200% 1. 92 37. 5% $40, 000 200 -300% 1. 04 26. 5% $60, 000 300 -400% 0. 446 14. 8% $80, 000 400 -500% 0. 172 9. 4% $100, 000 Above 500% 0. 368 7. 1% More than $100 K Center for Public Policy Priorities Max income, Family of 4 www. cppp. org

4 How Does Immigration Factor In? • Immigrants are NOT the primary cause of Texas’ last-place ranking – Census Bureau reported 2. 4 million non-citizens (includes both legal residents and undocumented persons); 1. 3 million of them are uninsured (54. 5% of non-citizens) – BUT! If you removed non-citizens from the equation, Texas would still be tied with New Mexico for the worst uninsured rate at 20. 6% uninsured (4. 2 million), even if you left the non-citizens in the other state’s counts • Without immigrants, New Mexico’s rate would drop to 18. 9% Center for Public Policy Priorities www. cppp. org

5 Texas Health Insurance Stats: What They Tell Us About the Need for Outreach? Texas Children who are Uninsured, 2005 – U. S. Census All incomes, under age 19 (0 -18*; 2 -year average 2004 -05 Census CPS) 20. 4% 1. 367 million < 200% FPL; under age 19 (0 -18; 2 -year average 2004 -05 Census CPS) 28% of <200%; 13. 4% of all kids 919, 000 • In other words, 2/3 of uninsured Texas children are below 200% of the federal poverty line, despite Medicaid and CHIP. • Texas is home to an estimated 230, 000 undocumented kids, and another 160, 000 legal immigrant (LPR) children under age 18 (Pew Hispanic Center). • But, the LPR kids can participate in CHIP. • Clearly, undocumented children are just a small part of our uninsured problem • At least half of our uninsured kids (~689, 000) could enroll in Medicaid or CHIP! Center for Public Policy Priorities www. cppp. org

6 Texas Medicaid: Who it Helps August 2006, HHSC data. Total enrolled 6/1/2006: 2, 644, 167 Center for Public Policy Priorities www. cppp. org

7 Texas Child Medicaid and CHIP Enrollment (Jan. 2002 -September 2006) 9/03: 2, 150, 543 9/06: 2, 040, 225 Source: Enrollment from Texas Health and Human Services Commission; Texas State Demographer's 0 -17 Population Estimates Center for Public Policy Priorities www. cppp. org

8 Texas Child Medicaid Enrollment (February 2001 -September 2006) Simplified Enrollment begins High: 1, 838, 239 Source: Texas Health and Human Services Commission Center for Public Policy Priorities www. cppp. org

9 Texas CHIP Enrollment (May 2000 -Oct. 2006) Highest, 5/02: 529, 271 9/03: 507, 259 10/06: 300, 685 Source: All figures from Texas Health and Human Services Commission; Compares most recent month with September 2003 Center for Public Policy Priorities www. cppp. org

10 CHIP Caseloads: Now and Projected 2006 2007 HHSC 2/05 enrollment projection, if 12 month eligibility restored 386, 110 467, 404 SB 1 funded caseload, traditional CHIP (6 month renewal)* 344, 750 351, 132 Additional caseload, perinatal coverage 17, 425 47, 498 Total, SB 1 projected CHIP caseload, traditional & perinatal CHIP 362, 175 398, 630 September 2003 actual caseload 507, 259 October 2006 actual caseload 300, 685 decline, 9/03 to 10/06 (-40. 7%) (-206, 574) *Rider 57 HHSC (SB 1) requires agency to request more $$ for CHIP from LBB if needed for enrollment and benefits. • HHSC Budget Request for 2008 -09 would allow enrollment to grow to 339, 037 in 2009. Center for Public Policy Priorities www. cppp. org

Recent Declines in Texas Children’s Medicaid Enrollment December 2005 September 2006 Decline, December to September 1, 838, 239 1, 748, 695 -89, 544 -4. 9% 139, 682 134, 021 -5, 661 -4. 1% 64, 339 64, 212 -127 -0. 2% 182, 954 172, 030 -10, 924 -6. 0% 98, 319 91, 162 -7, 157 -7. 3% 316, 896 301, 042 -15, 854 -5. 0% 4, 953 5, 178 225 4. 5% Tarrant 97, 908 91, 296 -6, 612 -6. 8% Travis 52, 667 50, 835 -1, 832 -3. 5% Webb 36, 473 33, 347 -3, 126 -8. 6% State total Bexar Cameron Dallas El Paso Harris Hays Center for Public Policy Priorities Source: Texas Health and Human Services Commission www. cppp. org 11

12 Children’s Medicaid declines • Drop of over 99, 000 children statewide from December 2005 to April 2006 caused alarm. • As of April, Travis and Hays showing much greater loss since December than statewide loss (-11. 4% and -16. 8%, vs. -5. 4% statewide). • However, caseloads improved June to September, and Travis and Hays county child enrollment rebounded by much larger margin than the statewide growth. • Then dropped 35, 607 from August to September. • Net decline since December now -89, 544. • Travis and Hays counties now doing BETTER than state average (Due to extra State attention to them? ). • Of concern and unexplained: Webb and El Paso counties drop more than Travis (-8. 9%, -5. 3%) Center for Public Policy Priorities www. cppp. org

Adult Medicaid Trends - Statewide Dec-05 Sept. -06 Dec 05 to Sept. 06 Change Aged and Disabled 687, 177 710, 131 22, 954 3. 3% Cash Assistance 31, 876 25, 527 -6, 349 -19. 9% Maternity 93, 617 98, 614 4, 997 5. 3% Other Parents 64, 656 59, 412 -5, 244 -8. 1% 877, 326 894, 585 17, 259 2. 0% Total • CAVEAT: Travis and Hays County Medicaid enrollment have DECLINED for adults from December 2005 to September 2006. • Points to problems with the IE&E pilot and TIERS Center for Public Policy Priorities www. cppp. org 13

Adult Medicaid Trends – Travis County Dec-05 Sept. -06 Dec 05 to Sept. 06 Change Aged and Disabled 17, 435 16, 846 -589 -3. 4% Cash Assistance 4, 089 4, 352 263 6. 4% Maternity 1828 1, 967 139 7. 6% Other Parents 1, 692 1, 596 -5. 7% 25, 044 24, 761 -283 -1. 1% Total • From December 2005 to July 2006, Statewide Adult Medicaid enrollment grew by 1%, but Travis County enrollment DECLINED for adults, including aged and disabled and maternity (-6. 5% overall) • Enrollment since then shows some recovery; Statewide growth 2% since December, but Travis County enrollment dropped -1. 1% • Points to problems with the IE&E pilot and TIERS. Center for Public Policy Priorities www. cppp. org 14

Adult Medicaid Trends – Hays County Dec-05 Sept. -06 Dec 05 to Sept. 06 Change 1, 956 1, 658 -298 -15. 2% Cash Assistance 348 456 108 31. 0% Maternity 261 273 12 4. 6% Other Parents 119 106 -13 -10. 9% 2, 684 2, 493 -191 -7. 1% Aged and Disabled Total • From Dec. 2005 to Sept. 2006, Statewide Adult Medicaid enrollment grew by 2%, but Hays County enrollment DECLINED for aged and disabled and non. TANF parents (-7. 1% overall) • Hays County decline as of July was -10. 1% (vs. +1. 1% statewide), so some improvement over summer. • Points to problems with the IE&E pilot and TIERS Center for Public Policy Priorities www. cppp. org 15

16 Recent Declines in Texas CHIP Enrollment December 2005 September 2006 322, 898 291, 530 -31, 368 -9. 7% 20, 915 18, 443 -2, 472 -11. 8% 7, 814 7, 770 -44 -0. 6% Dallas 33, 325 30, 470 -2, 855 -8. 6% El Paso 13, 628 11, 571 -2, 057 -15. 1% Harris 65, 465 56, 211 -9, 254 -14. 1% Hays 1, 489 1, 342 -147 -9. 9% Tarrant 19, 754 19, 039 -715 -3. 6% Travis 8, 550 8, 847 297 3. 5% Webb 5, 279 5, 153 -126 -2. 4% State total Bexar Cameron Center for Public Policy Priorities Decline, December to September Source: Texas Health and Human Services Commission www. cppp. org

17 CHIP Declines • September ’ 06 county numbers show slight improvement in SOME counties, while most remain well below December ’ 05 enrollment. • Renewal rates ARE improved: back above 70% for June-Sept. -- compared to 50%-57% from January through May. • However, thru September statewide enrollment continues to drop, new enrollment is low. Thus, too early to claim recovery trend for CHIP. Center for Public Policy Priorities www. cppp. org

18 Texas Unspent CHIP Funds Lost to Other States • • • FFY 1998 Federal SCHIP Funds Lost - $170 million FFY 1999 Federal SCHIP Funds Lost - $324. 5 million FFY 2000 Federal SCHIP Funds Lost - $123. 7 million FFY 2001 Federal SCHIP Funds Lost - $85. 3 million FFY 2002 Federal SCHIP Funds Lost - $104. 6 million FFY 2003 Federal SCHIP Funds Lost - $23. 8 million • Total lapsed to date (2000 -2005): $831. 9 million • For perspective, TOTAL Texas CHIP spending in FY 2005 was $401. 6 million, of which $110 million was state dollars • Expected to soon lapse another $26. 5 million from the 2004 allocation, based on state estimates as of 8/2006. Source: Center on Budget and Policy Priorities, analysis of CMS data. Center for Public Policy Priorities www. cppp. org

19 History/Context of Texas CHIP and our Federal CHIP Funding Allocation • BEFORE 2003 CHIP cuts, Texas was projecting a CHIP federal funding shortfall by late 2006. • Had spending held flat at Texas’ fiscal year 2002 high (i. e. , no inflation and no enrollment growth) we’d still have had a federal shortfall at least by 2008. • Now, state is assuming (in current state budget and in official reports to CMS) that CHIP enrollment will rebound, PLUS a perinatal option is scheduled to begin in January 2007. • The latest (unofficial) state projection for federal CHIP shortfall in Texas is 2010. • Texas projects 24% growth in CHIP spending from 2006 to 2007; based on this projected (but as yet non-existent) enrollment rebound PLUS new perinatal program • Additional Texas CHIP spending planned (pending approval), but not included in current state projections: – SCHIP premium assistance waiver; Galveston regional “ 3 -share” waiver which will include SCHIP Center for Public Policy Priorities www. cppp. org

20 Federal SCHIP Reauthorization, 2007 • Other states want Texas’ lapsed funds (Other states have used all their and need more…) • Texas’ CHIP allocation (share of the pie) will be targeted to be reduced based on our lower enrollment • WILL Congress add money to CHIP to allow for population growth, inflation, or expansion? • This is a cautionary example of the problems with block grants Center for Public Policy Priorities www. cppp. org

21 Federal SCHIP Reauthorization, 2007 Priorities: • No loss of SCHIP ground in enrollment or benefits (Need $12 -$14 b/5 yrs new $$ to sustain) • Enough growth to cover all eligible/not enrolled @ current eligibility thresholds • Room to cover more uninsured kids • NO cuts to Medicaid to offset SCHIP Other issues: • Fair treatment of states that did more prior to CHIP Center for Public Policy Priorities www. cppp. org

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