"FamilyCare Act of 2004"

SUMMARY

Beginning October 2004, States will have access to $50 billion of new federal money to provide health insurance coverage to the parents of children enrolled in Medicaid and CHIP.

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) ($31,340 for a family of three in 2004), eliminate any waiting lists or eligibility restrictions for children in their CHIP program, and align application and renewal procedures for children in the Medicaid and CHIP programs.

States will be eligible to receive FamilyCare money in the form of a 100% federal match rate for the coverage of parents for two years and then continue to be eligible for an enhanced match in the following years.

Adoptive parents or relatives who are responsible for the child are also eligible for coverage.

FamilyCare facilitates families in transition from welfare to work and makes it easier for low-income working families never on welfare to obtain health insurance.

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

States may waive or eliminate TMA reporting requirements for families.

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

Gives States the option to allow all low-income working families to receive 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 an additional 12 months of eligibility for TMA.

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 up to 185% FPL through Medicaid 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.

If a pregnant women is covered under Medicaid or CHIP, her newborn will be automatically enrolled at birth, as well.

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.

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 claims for Medicaid-presumptive eligibility costs by allowing States to charge all such costs to Medicaid rather than CHIP allotments.

Makes all children eligible for coverage for 12 full months, and allows States the option to provide 12 months of continuous eligibility for parents as well.

Provides $10 million in grant money to improve coordination of services, outreach, and enrollment of homeless families.

Expands 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.

Provides enhanced matching funds for language services under Medicaid and CHIP to ensure that States have language-appropriate assistance for families.

Encouraging Coverage Expansions and Enhancing Equity in Program Payments

FamilyCare provides an initial allotment of $50 billion of federal money between FY2005 and FY2012 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 FY2006, the classes of individuals eligible for enhanced federal financial participation will change. States will receive an enhanced federal match for children covered above the federal mandatory minimum Medicaid levels (e.g., (1) 100% FPL for children over age 6 and (2) 133% FPL for infants). States will also be able to receive enhanced match for pregnant women covered above 133% of poverty (federal mandatory minimum Medicaid level) so long as they have expanded coverage to 185% of poverty.

CHIP and FamilyCare allotments will be combined into one fund for FamilyCare coverage. Beginning in FY2013 for FamilyCare (and FY2008 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 FY2002 through FY2004 providing States additional resources for coverage expansions.