FAMILYCARE ACT OF 2000

FamilyCare Coverage for Parents. Beginning October of 2000 FamilyCare makes available $50 billion of new federal money for states to provide health insurance coverage to parents of children enrolled in CHIP and Medicaid. In order to be eligible for FamilyCare money:

States must first cover all children whose parents’ income is less than 200% of the Federal poverty level (FPL) (about $28,300 for a family of three) and must eliminate any waiting lists or eligibility restrictions on covering children in their CHIP program.

A parent may include adoptive parents or relatives who are responsible for the child.

States will receive an enhanced match for parents covered beyond the state’s 1/1/00 eligibility level for parents. Parents may be covered up to the same eligibility levels as children in their state.

By 2006 every state must cover parents at least up to 100% FPL.

  Facilitating the Transition from Welfare to Work. FamilyCare facilitates families’ transition from welfare to work and makes it easier for low-income working families never on welfare to access health insurance:

Makes the Transitional Medicaid Assistance (TMA) program permanent. TMA allows individuals leaving welfare to go to work but keep their Medicaid health insurance coverage for up to one year.

Eliminates TMA requirements for families to report to the state during beginning TMA periods.

Eliminates TMA requirement for states that have expanded coverage to low-income working families (parents and children) to 185% FPL.

Allows states to provide TMA for working families above 185% FPL. Gives states the option to allow all low-income working families to get TMA, regardless of whether or not they were enrolled in Medicaid for three of the previous six months (current-law TMA requirement).

Allows states the option to provide 12 months of continuous eligibility for TMA.

Eliminates the "100-hour Rule" and allows all low-income families to qualify for health care coverage regardless of how little they earn.

Encouraging Market Innovation and Alternative Coverage Expansions. FamilyCare provides new options for expanding health insurance coverage through innovative means:

Provides a grant program of $100 million per year over five years to encourage demonstrations in up to 10 states promoting innovative expansions of health insurance coverage to the uninsured, including alternative group purchasing or pooling arrangements; individual or small group market reforms; consumer education and outreach; and subsidies to individuals, employers or both for obtaining health insurance. Allows a portion of the funding to be allocated for any number of states to develop proposals.

Facilitates state option to pool state funding with employer contributions to private insurance, which can be a cost-effective way to expand coverage. Families otherwise eligible for FamilyCare coverage could get assistance in purchasing employers’ health plan if it meets FamilyCare standards and their employer pays at least half of the premium.

Provides grant funds to shore up the safety net through the Community Access Program. Grant funds would be used to create consortiums of safety net providers like Community Health Centers and public hospitals to expand access to direct patient care in areas with high rates of uninsured or under-served families.

  Expanding Coverage For Children and Pregnant Women. FamilyCare provides states additional options to expand coverage to uninsured children and pregnant women:

Provides new state options to cover legal immigrant children, pregnant women, and parents in Medicaid and CHIP.

Provides a new state option to expand coverage under CHIP and Medicaid to children through age 20.

Provides a new state option to expand coverage to first time pregnant women in CHIP. The state must first cover pregnant women to 185% FPL through Medicaid (current Medicaid optional levels) before exercising the CHIP option. To encourage prenatal care and healthy babies, FamilyCare protects against cost-sharing for pregnancy-related services.

Provides for automatic coverage of children born to CHIP-enrolled parents at birth.

  Increasing Enrollment Through New Options for Outreach Activities. The FamilyCare bill gives states new tools to identify and enroll families. The proposal builds on successful programs and convenient access points to maximize the effectiveness of outreach efforts:

Allows additional entities (e.g., homeless shelters, schools, WIC offices) to determine parents and children initially eligible for health insurance coverage.

Provides an explicit option for presumptive eligibility in CHIP; allows cost of presumptive eligibility to be charged against the CHIP allotment.

Allows presumptive eligibility for entire families.

Simplifies state claiming of Medicaid presumptive eligibility costs by allowing states to charge all such costs to Medicaid rather than CHIP allotments.

Provides grant money for improved coordination of services, outreach, and enrollment of homeless families.

Expands outreach contact points by including information on CHIP and Medicaid in school lunch outreach materials.

Prohibits conflict of interest between enrollment broker marketing activities and HMOs serving CHIP families and prohibits affiliation with fraudulent or debarred individuals.

  Simplified Application Requirements. In order to help families enroll in health insurance, FamilyCare simplifies the application process for families and requires states to make the enrollment process the same in Medicaid and CHIP:

For children (and separately for parents) states must make their enrollment procedures the same for CHIP and Medicaid in several key areas: resource standards; simplified eligibility (including application other than in person); initial determinations and redeterminations using the same verifications policies, forms and frequencies; and face to face interview requirements.

States must also use one simplified application for enrollment in either program for children. They may add parents to the simplified application for children to facilitate family enrollment.

Ensures families don’t fall through the cracks and lose coverage by requiring screening and enrollment of families that lose coverage under Medicaid for potential eligibility under CHIP and vice versa.

  Encouraging Coverage Expansions and Enhancing Equity in Program Payments. FamilyCare provides an initial allotment of $50 billion of federal money between 2002 and 2010 for coverage expansions and harmonizes the rules for enhanced matching. Funding will be allotted to states under the same formula as under CHIP:

Beginning in 2006, the classes of individuals eligible for enhanced federal financial participation will change. States will receive enhanced federal financial participation for children covered above the federal mandatory minimum Medicaid levels (e.g., 100% FPL for children over 6 ($17,050 for a family of four), 133% FPL for pregnant women and infants). States will receive an enhanced match for any parents covered above their 1/1/00 levels or, in the case of states that were above 100% FPL on 1/1/00, they will receive enhanced matching for any parents covered above the mandatory minimum level, 100% FPL.

CHIP and FamilyCare allotments will be combined into one fund for FamilyCare coverage. Beginning in 2011 for FamilyCare (and 2008 for CHIP) the aggregate allotments will be increased by the consumer price index for medical services.

Allotment for Puerto Rico and the Territories will now be 1.05% of the total annual allotment (distributed in the same manner as under CHIP).

Evens out the dip in CHIP funding in 2002 to provide a dependable stream of funding for coverage.