The FamilyCare Act of 2005

SUMMARY

FamilyCare Coverage for Parents

If enacted, beginning in October 2005, 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 this funding, States must meet the following criteria:

expand coverage to all children whose parents earn less than 200% of the Federal poverty level (FPL) ($32,180 for a family of three in 2005);
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 that meet these standards will be eligible to receive for two years under the FamilyCare Act funds equaling a 100 percent Federal match rate for the coverage of parents. States continue to be eligible for an enhanced match in the following years after the initial two years.

Adoptive parents or relatives with primary responsibility for a child under Medicaid or CHIP would also be eligible for health care coverage.

Facilitating the Transition from Welfare to Work

The FamilyCare Act would ensure families transitioning from welfare to work do not lose coverage and makes it easier for low-income working families to obtain health insurance.

The bill would make permanent the Transitional Medicaid Assistance (TMA) program. TMA allows individuals leaving welfare for work to keep their Medicaid health insurance coverage for up to one year.
States are permitted to waive or eliminate TMA reporting requirements for families.
Eliminates the TMA requirement for States that have expanded coverage to low-income, working families (parents and children) up to 185 percent of FPL.
Gives States the option to provide TMA to all low-income working families, even if they were not enrolled in Medicaid for three of the previous six months (a current TMA requirement for enrollment).
Allows States the option to provide an additional 12 months of eligibility for TMA.

Expanding Coverage For Children and Pregnant Women

The FamilyCare Act would provide 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 under CHIP. Before utilizing CHIP for this coverage, the State must first provide coverage of pregnant women up to 185 percent FPL through Medicaid. To encourage prenatal care and healthy babies, FamilyCare protects against cost-sharing for pregnancy-related services.
Provides for automatic coverage of children born to parents enrolled in CHIP.
For pregnant women who are covered under Medicaid or CHIP, their newborns would also be automatically enrolled at birth.

Increasing Enrollment Through New Options for Outreach Activities

The FamilyCare Act would give States new tools to identify and enroll eligible families. The proposal builds on other 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 their 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

The FamilyCare Act would provide an initial allocation of $50 billion of Federal money between FY2006 and FY2013 for expanding coverage and would align the rules for enhanced matching funding. Funding would be allocated to States under the same formula as under CHIP.

CHIP and FamilyCare allocations will be combined into a single fund for FamilyCare coverage. Beginning in FY2014 for FamilyCare, and FY2008 for CHIP, the aggregate allocation for medical services will increase based upon the consumer price index.
Allocations for Puerto Rico and the Territories would now be 1.05 percent of the total annual allocation (distributed in the same manner as under CHIP).