AcademyHealth Stateside - 07/26/2006 (Plain Text Version)In this issue: New State Coverage Reforms Enacted
Cover Kids: The Cover Kids Act creates a separate, stand-alone health care program for all children age 18 and under in Tennessee. This will be a State Children’s Health Insurance Program (SCHIP). Due to its prior TennCare expansion, Tennessee did not operate a separate SCHIP program. The program uses $7 million in state funds for Fiscal Year 2007 (six months) and Title XXI funds (SCHIP) from the federal government to cover children and pregnant women up to 250 percent of the federal poverty level (FPL). Eligibility is layered over current TennCare levels. For children who do not qualify for the subsidized product, the state offers a buy-in program. Cover Tennessee: This program aims to provide a new, portable, and affordable product for the working uninsured in Tennessee who earn less than 250 percent FPL, as well as for small firms who do not currently offer insurance. Under the Cover Tennessee program, workers would be able to take this product with them when they change jobs. During the first three years of the program, premium amounts charged to employers, employees, and individuals may not increase more than 10 percent per year to maintain affordability. Cover Tennessee is based on the three share concept where participating employers pay $50 per member per month (pmpm), the State of Tennessee pays $50 pmpm, and the individual contributes the final portion of the premium. The state will contract with at least two statewide carriers to offer a product ($150 pmpm medical loss) with low or zero dollar deductibles for preventative health services. Currently, the procurement process to contract with those health plans is under development. Access Tennessee: The new legislation also creates a high-risk pool called Access Tennessee. Tennessee, prior to TennCare, operated a high-risk pool but chose to insure medically uninsurable individuals under its TennCare waiver, which was ultimately disbanded as a result of TennCare reform efforts. Eligibility for the new pool includes:
The legislation also allows board leadership to elect to enroll:
The legislation authorizes the administrators of the pool to develop two benefit packages: one modeled after the state employees PPO product, and a second option that is a high-deductible health plan coupled with a health savings account. Access Tennessee will be funded by a combination of premiums, assessments on carriers and third party administrators, state appropriations, and possible federal funds pending grant release from the Centers for Medicare and Medicaid Services (CMS). Premiums charged to pool enrollees will be capped between 150 percent and 200 percent of a commercial benchmark plan after moderate medical underwriting. The state also authorized a premium assistance program to assist those who cannot afford the premiums. Other Programs: The appropriation bill associated with the program also continues funding for Tennessee’s safety net program for affordable prescription drugs, with a focus on high priority populations who have chronic diseases that require medication for daily functioning. The drug program will be available for adults who earn less than 250 percent FPL. In addition, the bill includes the Project Diabetes program, which funds endowment grants to high schools and health care entities to combat the epidemic of diabetes and obesity in the state.
The coverage expansions are part of a larger health care reform package that also includes:
Virginia: On July 1, 2006, small businesses that employ 50 or fewer will be able to join together to form purchasing cooperatives. These cooperatives will be able to purchase or facilitate providing insurance to employees (and dependents of employees) who work more than 30 hours per week. The legislation authorizes the cooperatives to negotiate premiums for their members. Regulatory guidance will be issued by the state Insurance Commission. Full text of the legislation is available online for H.B. 761.
|