The House will now merge this bill with the versions passed by the other House Committees, and it will be brought to the floor for a vote in September. Here are some highlights on where we are in the House bill in regard to children and families:
- The Medicaid expansion up to 133% FPL is still in place but the Committee scaled back the federal government’s financing of the cost of covering newly-eligible beneficiaries. States will receive 100% federal funding for the first two years (2013-2014), but this will decrease to 90% beginning in 2015, leaving states to pick up 10% of the cost of covering these people. States that have expanded Medicaid above 133% FPL must still maintain that coverage at the regular federal matching rate.
- Maintains the creation of a national Exchange with a public plan option. In deference to Blue Dog concerns, reimbursement rates under the public plan will be negotiated with providers instead of tying them to Medicare. Other Blue Dog changes include allowing nonprofit member-driven cooperatives to offer coverage through the Exchange and exempting more small businesses from the employer mandate.
- Continues to provide subsidies to people up to 400% FPL. The new bill modestly trims the subsidies available to help people purchase coverage (e.g., families at 400% FPL would contribute up to 12% or their income, rather than 11%) and links the share of income caps to premium growth over time. Under the agreement made with the Committee’s progressive members, the subsidies may be readjusted in later years if savings are realized from a series of reforms, including allowing Medicare to negotiate drug prices and establishing Accountability Care Organization pilot programs in Medicaid. In addition, the Exchange must approve any substantial premium increases by insurers.
- Continues to require coverage of pediatric services in Exchange and employer plans, including oral, mental health, and equipment for children. An amendment approved in the Education and Labor Committee also requires coverage of EPSDT; it is unclear what will happen to this amendment given that it was not included in the Energy and Commerce version.
- Still allows CHIP to expire in 2013. An amendment by Rep. DeGette (D-CO) passed in Committee now precludes the movement of children from CHIP to Exchange plans if the coverage provided by plans participating in Exchange is not comparable to that provided by the average CHIP plan.
- Maintains phase-in of higher Medicaid reimbursement rates for primary care services (states will be required to increase to 100% of Medicare rates by 2012). The new costs associated with the rate increases will initially be borne by the federal government, but under a change in the Committee, in 2015 the federal funding for the increases will decrease to 90%.
Need a scorecard? To help you keep track on what is in the bills we have developed a side-by-side of the key provisions affecting children and families in the House Tri-Committee and Senate HELP Committee proposals. We will update the chart as things progress.