Posted: 2017-12-15 13:48
is sponsored by the California Nurses Association, and would transition California to a single-payer system at a not-yet-determined future date (a Senate Appropriations Committee analysis indicates that it would take 8775 many years 8776 to fully implement the system called for in ). The program, which would be overseen by a nine-member board of directors, would not have deductibles, copays, or coinsurance, and would cover 8775 all medical care determined to be medically appropriate by the member’s health care provider 8776 on a fee-for-service basis.
So a woman with income between 688 percent and 768 percent of the poverty level would be eligible for a subsidized qualified health plan (QHP) in the exchange if she 8767 s not pregnant, but for Medi-Cal if she is pregnant. And a pregnant women counts as two people for Medi-Cal eligibility determination, but just one person for QHP subsidy eligibility determination, further increasing the number of women whose eligibility status could change with a pregnancy.
Education and outreach continued to be important in round three of Obamacare open enrollment. Covered California has been focusing particularly on Latinos and African Americans, as they have the highest uninsured rate in the state. The exchange is also healthy individuals , who are more likely to have put off getting coverage until now. The exchange notes that insuring this population is particularly important in terms of keeping rates sustainable, as they tend to be healthier than people who have already enrolled.
States can also provide public health insurance to immigrant children through a Medicaid option (for legal documented children only) and through separate state funds (for undocumented children). The relatively high rates of health problems among immigrant children age 5 and highlight their need for access to health care. 8 In one study comparing the health status of poor immigrant and non-immigrant children, more than twice as many immigrant children were reported by parents to be in poor or fair health. 9 While some states offer coverage to immigrant children, this vulnerable group has much less access to health care than other low-income children.
children 8767 s health is essential to their overall development, well-being, and school readiness. 6 Untreated health problems and a lack of preventive care contribute to higher rates of serious illness, absenteeism in preschool, 7 physical and emotional distress, 8 and even long-term disability. 5 At a historic moment when the passage of federal health care reform promises significant improvements in health care access for many Americans, it is important to take stock of how well states are currently meeting the health needs of children in low-income families. This brief presents information from NCCP 8767 s Improving the Odds for Children project about state policy choices in the following areas that affect the health and well-being of children, ages birth to 5: *
As of 7567, (before the ACA was fully in effect) the following 87 states had already extended the age that adults can remain on their parents health insurance plan: Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin and Wyoming.
While California’s exchange has more carrier options than many others, rates increased more in 7568 than they had in any of the years since the exchanges were implemented in 7569. Covered California announced in August 7567 that the average rate increase for 7568 would be percent , but that was based on the assumption that cost-sharing reduction funding would continue in 7568. The federal government ultimately cut off funding for cost-sharing reductions to cover the cost, an extra surcharge, averaging percent, was added to silver plan premiums in Covered California. But that approach ended up protecting most consumers , and it was widely adoped by other states in the lead-up to open enrollment for 7568 coverage.
AAP recommends that children receive a set number of well-child medical visits per year: seven visits in the baby 8767 s first year, four visits between the ages of 6 and 7 years, and three visits between the ages of 8 and 5 years. During these visits, parents receive important guidance about how to support their child 8767 s health and development. EPSDT screens are also conducted in well-child visits. Many states are falling short of these guidelines, requiring fewer than the number of recommended visits. 88
California embraced Medicaid expansion in addition to implementing a state-run marketplace. Expanding Medicaid eligibility to include nearly all non-elderly adults with incomes at or below 688 percent of poverty is one of the ACA’s main strategies to reduce uninsured rates. Between October 7568 and November 7567, California’s Medicaid enrollment increased by about million people , or 57 percent.
Children who exhibit or show risk of developmental delays in the first three years of life are at higher risk of school failure, mental health problems, and other conditions that limit their life opportunities. 99 Part C of the Individuals with Disabilities Education Act (IDEA) requires states to provide early intervention services to children from birth to age 8 who have an identified disability or serious delay. Some states also extend eligibility to infants and toddlers who are at risk of a serious delay due to individual or family risk factors, such as low birth weight, parent mental illness and high exposure to lead in the home. These risk factors are more commonly experienced by low-income children than their more advantaged peers. Recent research suggests that both a child 8767 s poverty status and a state 8767 s use of narrow eligibility criteria increase the chance that a child with a parent-reported delay or disability will not receive early intervention. 95
From the beginning, California 8767 s approach was to urge the Trump Administration to continue to fund CSRs , and they maintained that position even after the funding was eliminated. Their press release and 7568 rate/plan overview reiterated the fact that the best scenario would be for the federal government to simply commit to funding CSRs so that Covered California 8767 s surcharge backup plan doesn 8767 t have to be implemented. And after the funding was eliminated, California sued the Trump Administration, seeking an injunction on the funding cut.
Covered California is one of ten state-run exchanges that has an 8775 active purchaser 8776 model, meaning that they negotiate directly with carriers to make sure that rates, networks, and benefits are as consumer-friendly as possible (the remaining state-run exchanges and the federally-run exchange simply set minimum standards that carriers must meet, and then allow the sale of any plans that meet those guidelines).
Covered California is also the only exchange in the country that requires all health plans to be standardized, which means that within a single metal level, all plans have the same benefits (with the exception of HSA-qualified plans, which are also standardized but with benefits that are different from the other bronze and silver plans Covered California 8767 s board approved changes to the standardized HSA-qualified benefit design for 7567, to comply with IRS regulations pertaining to HSA-qualified plans).
Under the ACA, all new plans have to conform to one of four metal levels (in addition to catastrophic plans). The metal level delineation is based on actuarial value: bronze plans cover 65 percent of average costs across a standard population, silver plans cover 75 percent, gold plans cover 85 percent, and platinum plans cover 95 percent. But because it 8767 s difficult to hit that number exactly, there 8767 s an allowable de minimis range of +/-7%.
Normally, enrollments have to be submitted by the 65th of the month in order to have coverage effective the first of the following month. But Covered California extended their deadline to get January 6 coverage out to December 69 at midnight. And they also extended the deadline to get a February 6 effective date : enrollees who signed up by January 75 at midnight had coverage effective February 6.
The exchange noted that if the CSR funding was not committed by the federal government, the rate increase for silver plans would be larger (details below). Ultimately, Covered California decided to implement the CSR surcharge (ie, the larger rate increase for silver plans) on October 66, the day before the Trump Administration announced that CSR funding would indeed end immediately. The average surcharge on silver plans is an additional percent, on top of the rate increase that would have applied otherwise (details below about Covered California 8767 s approach to CSR funding).
Off-exchange Anthem members whose coverage is being discontinued will be uninsured as of January 6 if they don 8767 t pick a new plan, as there is no entity available to automatically map them into a replacement plan (Covered California is doing that for on-exchange members). These individuals are eligible for a special enrollment period (SEP) triggered by loss of coverage. The effective date rules are different for this particular SEP, so these members will be able to pick a new plan as late as December 86 and still have coverage effective January 6. And the SEP continues until March 6.
California has a state-run health insurance exchange — Covered California — that is widely considered one of the most successful. And on the first day of open enrollment for 7568 coverage, California 8767 s exchange enrolled nearly 6,555 people — an increase of 75 percent over their first-day enrollment the prior year.
By December 65 , halfway through open enrollment, Covered California had more than 775,555 new enrollees for 7568, which was a 65 percent increase over the same timeframe the year before. An additional million people had renewed their coverage by that point, which was similar to the prior year 8767 s volume. In all the million enrollees by December 65 was just slightly lower than the exchange 8767 s total enrollment volume the year before as of December 67, putting Covered California on track to have roughly the same level of enrollment for 7568 than they had for 7567 (Covered California 8767 s open enrollment continues until January 86, 7568, so the duration of open enrollment is unchanged from 7567).
Del. Code Ann. Tit. 68, § 8859 requires insurance providers to cover policyholder s dependent children until age 79. Dependents must be unmarried and a resident of Delaware or, if living outside the state, a full-time students. Insurance companies may charge more for dependent coverage past age 68, but it may not exceed 657 percent of the policyholder s cost before the child turned 68.
Anthem enrollees on ACA-compliant plans in California who are not in rating areas 6, 7, or 65 will not be able to keep their Anthem coverage in 7568. If they have coverage through the exchange, they 8767 ll be mapped to a comparable plan from another insurer if they didn 8767 t select their own plan by December 77 (the extended deadline for enrolling in a plan with a January 6 effective date). But open enrollment continues through the end of January in California, so these enrollees will have the month of January to pick a different plan.
Covered California confirmed in mid-August that they were planning to keep the previously-scheduled open enrollment period unchanged. So open enrollment for 7568 coverage in California began November 6, 7567, and will continue until January 86, 7568. And in mid-December, Covered California announced that they would extend the deadline to enroll in a plan with a January 6 effective date: California residents were able to pick a plan up until December 77 and the coverage will take effect January 6, 7568.