Medicaid, SCHIP, and Federal Authority⁴

Section 1115 Waiver - In 2005, California received approval for its Medi-Cal Hospital Uninsured Care 1115 Waiver. This new five-year comprehensive waiver derives from an existing waiver.  The California 's 1915(b) Selective Provider Contracting Program (SPCP) has allowed the state to selectively contract with a limited number of hospitals at a prospective per diem rate which is lower than the standard rate paid in the absence of the waiver.  In return, the selected hospitals receive preferential or exclusive referrals of Medicaid patients in their geographic area. The most significant real expansion of enrollment will occur in the last several years (2007-2010) of the demonstration when $180 million of the $766 million annual Safety Net Pool allocation is diverted to expand coverage to individuals still uninsured at that time.

HIFA Waiver - In 2002, California received approval from CMS to use its SCHIP allotment to cover parents, relative caretakers, and legal guardians with net incomes at or below 200 percent FPL, who are not eligible for no-cost Medi-Cal. The waiver has not yet been implemented. The waiver also includes a coverage bridge for children after annual re-certification for SCHIP. The waiver allows California to provide a 2-month coverage "bridge" for children after their application is forwarded to Medi-Cal. California received an extension for implementing this waiver program until June of 2007.

High-Risk Pool  

The California Major Risk Medical Insurance Program (MRMIP) was a program developed to provide health insurance for Californians who are unable to obtain coverage in the individual insurance market. This program became operational in 1991. Subscribers in the MRMIP are charged a monthly premium ranging from 125 to 137.5 percent of each participating plan's average standard individual rate. As of December 2006, just under 8,000 persons were enrolled in MRMIP.

After 36 months, MRMIP subscribers are disenrolled and given access to guaranteed issue individual market products (GIP). GIP losses are shared jointly by the insurance industry via assessments and the state via annual appropriations. Premiums for GIP are approximately 10 percent higher than MRMIP products. GIP products have similar benefits to MRMIP but a higher annual benefit maximum ($200,000). As of June 2005, over 6,700 persons were enrolled in a GIP product.

Group Purchasing Arrangements    

PacAdvantage Health Plan was a purchasing alliance, which allowed small businesses and self-employed individuals to buy insurance in California. PacAdvantage offered affordable combinations of health insurance plans for businesses based in California with 2-50 employees. PacAdvantage ceased all coverage December 31, 2006.

Other

Access for Infants and Mothers (AIM) program - This state-funded program was established in 1992. AIM offers low-cost health coverage for pregnant women and their newborns. It has been designed for middle-income families who don't have health insurance and whose income is too high to qualify for no-cost Medi-Cal. AIM is also available to those who have health insurance if their deductible or co-payment for maternity services is more than $500. This program provides coverage for those between 200 and 300 percent FPL. In 2004, the state began enrolling infants born of AIM enrollees into the Healthy Families Program, California 's SCHIP program. California now draws Title XXI (SCHIP) funds to cover pregnant women between 200 and 300 percent FPL.

Children's Health Initiatives - Over twenty counties operate Children's Health Initiative programs. These county-level programs have been quite successful in enrolling children and families into the Medi-Cal and Healthy Families Program. In 2003, the state expanded health insurance coverage levels to 300 percent FPL for children residing in selected counties - Alameda , San Francisco , San Mateo , and Santa Clara. These counties now have authority to draw federal matching funds for uninsured children to 300 percent FPL via the County Children's Health Insurance Program (C-CHIP). Currently, San Mateo County serves uninsured children up to 400 percent FPL using county funds. Alameda County has not implemented coverage above 250 percent FPL.

County Medical Services Program - The County Medical Services Program (CMSP) was established in January 1983, when California law transferred responsibility for providing health care services to indigent adults from the State of California to California counties. Thirty-four counties participate. CMSP provides medical assistance to adults (age 21-64) below 200 percent FPL who do not qualify for Medi-Cal. Other resource limits apply.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

² Children (19 and younger) whose income is up to 300 percent FPL are covered in three counties: San Francisco , San Mateo , and Santa Clara. These three counties draw federal matching funds via the C-CHIP program. San Mateo covers children from 300 to 400 percent FPL using county funds. Alameda County has authority to draw federal matching for uninsured children under 300 percent FPL but has not implemented.

³ Medi-Cal covers pregnant women up to 200 percent FPL. The AIM program now draws Title XXI federal matching funds for uninsured pregnant women from 200 to 300 percent FPL.

⁴ The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

⁵ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.