Health care reform and its implications for children, nationally and in California

Together, Medicaid and CHIP cover more than 25 million children; California accounts for almost one in five of these children. The health care reform bills passed by the House of Representatives and Senate share many features affecting these children's coverage, including an individual mandate to obtain coverage, expanded Medicaid coverage, subsidies for insurance purchase, and creation of a Health Care Exchange to help families purchase affordable coverage. Important differences include: the Senate bill extends Medicaid to 133% FPL while the House expands to 150%; the House bill eliminates CHIP after 2013 while the Senate retains CHIP through 2019; and the House bill increases Medicaid reimbursement rates. At this time, it remains uncertain whether health care reform will pass. But this paper will analyze the status and outcomes of reform efforts and assess the implications for children. In California, reform may determine the fate of Healthy Families, a program popular among policymakers, providers, and families relative to Medi-Cal, but vulnerable to cuts in a state facing budget deficits exceeding $20 billion. If final legislation increases Medicaid reimbursement for evaluation and management, as the House proposes, children could experience increased access to care. As written, neither the House nor Senate bill represents the “complete package” of optimal policies to maximize eligible children's enrollment and receipt of care. In analyzing the final outcome of the reform process, this paper will assess whether public insurance systems remain in the position to effectively cover low-income children and ensure they receive good access to necessary care.