Medicaid, SCHIP, & Federal Authority
In September 2006, Kansas received approval from the Centers for Medicare and Medicaid Services (CMS) to establish a benchmark benefit for its Working Healthy Ticket to Work Medicaid Buy-In program. The benchmark benefit was approved as a state plan amendment under DRA authority. Working Healthy provides working individuals with disabilities who have incomes below 300 percent of the federal poverty level (FPL) the State Plan Medicaid coverage, in addition to the following benefits: personal assistance services, which can be self-directed or agency directed, including a “Cash and Counseling” model; assessment to determine personal assistance and related service needs; independent living counseling; and assistive services.In May, 2008 Governor Sebelius signed legislation that will expand SCHIP coverage to children in households up to 250 percent of FPL once federal funding becomes available. Eligibility for pregnant women will also be expanded to 200 percent of FPL.
The Kansas Health Insurance Association (KHIA) offers health benefits for residents who are unable to purchase coverage in the private market for a pre-existing condition, who qualify for HIPAA protections or COBRA rights, who have been quoted a rate higher than the KHIA rate, or who have exhausted health coverage.KHIA premium rates are set to be self-sustaining, but the insurance industry may be assessed to cover pool losses. As of the end June 2006, approximately 1,700 individuals were enrolled in the program.
Group Purchasing Arrangements
In 2001, Kansas implemented a small employer pooling mechanism called the Kansas Business Health Partnership. The pool, a non-profit organization, purchases coverage via the private market with the goals of employee choice, minimized administrative costs, and benefits that meet standards of federal and state law. The original legislation would have made subsidies available for low-income workers to purchase health insurance through the partnership, but budget difficulties delayed the subsidy. In 2005, the Kansas Legislature authorized $500,000 for subsidies.
The original partnership has been dissolved and will be reorganized under the leadership of the Kansas Business Health Policy Committee (BHPC). The BHPC has issued an RFP for carrier participation. Two carriers bid for the pilot program through a bid process that closed April 28, 2006. Efforts are now being weighed to pursue alternative sources of additional funding.
State Specific Strategies
In April 2007, the Kansas Legislature passed Senate Bill 11. Section four of the bill would create a phased-in premium assistance program that would provide premium subsidies for Kansans who earn less than 100 percent FPL to purchase private insurance actuarially equivalent to the state employee health plan. By 2009, Kansans who earn below 50 percent FPL would receive the assistance and each year afterwards the upper income limit would increase by 25 percent until the maximum of 100 percent FPL. The Kansas Health Policy Authority is authorized to seek federal financial participation.
In addition to the premium assistance program, Senate Bill 11 authorizes:
Senate Bill 11 begins to reform the health system incrementally by increasing health insurance coverage and outlining a roadmap to develop health reform options for consideration by the 2008 Kansas Legislature. Premium assistance is part of the short-term plan. In November 2007, the Authority and Health for All Kansans Steering Committee presented data-driven health reform options to the Governor and Legislature. The Authority and Steering Committee is working with four Advisory Councils, comprised of stakeholders, who will provide input and recommendations to form a plan that impacts the health of Kansans.MediKan - MediKan is health program that covers adults with disabilities who do not qualify for Medicaid, but are eligible for services under the State’s General Assistance program. MediKan provides limited benefits to adults whose applications for federal disability are being reviewed by the Social Security Administration. Health benefits include the provision of medical care in acute situations and during catastrophic illness.Overall, the scope of services covered by MediKan is similar to that covered by Medicaid, but a number of restrictions and limitations apply. A majority of the individuals who qualify for MediKan are in the process of applying to the federal Supplemental Security Income (SSI) program. After these individuals qualify for SSI, they will transfer to the Medicaid program.
- Loan guarantees for eligible primary care safety net clinics
- The creation of the Small Employer Cafeteria Plan Development program to encourage small employers to take advantage of the federal pre-tax premium rules.
- The authorization of grants or loans for the purpose of forming associations to increase access to health care.