California's Bridge to the Affordable Low Income Health Insurance Care
California's new 1115 Medicaid Waiver allows counties to receive federal reimbursement funds for programs that serve low-income childless adults who are not eligible for public health benefit programs like Medi-Cal or Medicare. These programs are called Low Income Health Programs (LIHPs). In 2014 under the Affordable Care Act most of these childless adults will become eligible for Medi-Cal, or for subsidies in the Health Insurance Exchange.
Right now, counties already have a legal duty to provide subsistence health care services to this population under state law (Welfare & Institutions Code ¡± 17000 et seq.). The counties pay for these programs with some limited funds from the state and their county general funds. As budgets are shrinking, counties are under pressure to cut their programs that serve low-income childless adults. Under California's previous 1115 Medicaid Waiver, ten California counties were selected in 2007 to receive Federal funds to expand care to low-income childless adults. Those programs are called ¡§Coverage Initiatives. Starting this year, all counties will be eligible to receive federal funds for programs that serve low-income childless adults if they meet certain requirements. This new source of funding will help counties maintain, improve and expand their health care services for low-income childless adults.
What counties will implement LIHPs (California's New Low Income Health Insurance Programs)?
We expect that all counties will implement LIHPs at some point between now and 2014! As of March 14, 2011, twenty-four counties have applied to implement LIHPs. The remaining thirty-four counties currently join together to offer health care to low-income adults as a collaborative called the County Medical Services Program(CMSP). They are expected to submit a joint application later this month.
What are counties required to do to get Federal money for their LIHPs?
Counties must serve lower income people before serving those with higher incomes.
The counties can receive unlimited funds for programs that serve childless adults with income up to 133% of the Federal Poverty Line ¡V these programs will be known as Medicaid Coverage Expansions (MCEs). The counties can receive a certain amount of additional funds to serve those with income between 134 and 200% of the Federal Poverty Line based on an allocation set by the state and Federal governments ¡V these programs will be known as Health Care Coverage Initiatives (HCCIs). Counties can set income eligibility for their LIHPs anywhere up to 200% of the Federal Poverty Line, but they can¡¦t serve higher income people unless they first serve lower income people.
Counties must provide certain services.
The counties must offer people who enroll in their LIHPs a broad range of services, including emergency services, prescription medications, and mental health services.
Countries programs must meet certain requirements.
To be eligible for federal funds, counties must show that people who enroll in their LIHPs will be able to access care in a timely manner. The counties also must show that they have enough medical providers to get the people who enroll the care they need.
Counties cannot charge unaffordable premiums or co-payments.
The LIHPs cannot charge any premiums or co-payments to people with income below 134% of the Federal Poverty Line except for nominal co-payments like those allowed in Medi-Cal. LIHPs can ask those with income between 134% and 200% of the Federal Poverty Level to pay some premiums or co-payments, but cost sharing cannot exceed 5% of a persons monthly income.
There are other, more technical requirements, too. To read more about the LIHPs, you can go to the Department of Health Care Services’ LIHP
website: http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx.
California's new 1115 Medicaid Waiver allows counties to receive federal reimbursement funds for programs that serve low-income childless adults who are not eligible for public health benefit programs like Medi-Cal or Medicare. These programs are called Low Income Health Programs (LIHPs). In 2014 under the Affordable Care Act most of these childless adults will become eligible for Medi-Cal, or for subsidies in the Health Insurance Exchange.
Right now, counties already have a legal duty to provide subsistence health care services to this population under state law (Welfare & Institutions Code ¡± 17000 et seq.). The counties pay for these programs with some limited funds from the state and their county general funds. As budgets are shrinking, counties are under pressure to cut their programs that serve low-income childless adults. Under California's previous 1115 Medicaid Waiver, ten California counties were selected in 2007 to receive Federal funds to expand care to low-income childless adults. Those programs are called ¡§Coverage Initiatives. Starting this year, all counties will be eligible to receive federal funds for programs that serve low-income childless adults if they meet certain requirements. This new source of funding will help counties maintain, improve and expand their health care services for low-income childless adults.
What counties will implement LIHPs (California's New Low Income Health Insurance Programs)?
We expect that all counties will implement LIHPs at some point between now and 2014! As of March 14, 2011, twenty-four counties have applied to implement LIHPs. The remaining thirty-four counties currently join together to offer health care to low-income adults as a collaborative called the County Medical Services Program(CMSP). They are expected to submit a joint application later this month.
What are counties required to do to get Federal money for their LIHPs?
Counties must serve lower income people before serving those with higher incomes.
The counties can receive unlimited funds for programs that serve childless adults with income up to 133% of the Federal Poverty Line ¡V these programs will be known as Medicaid Coverage Expansions (MCEs). The counties can receive a certain amount of additional funds to serve those with income between 134 and 200% of the Federal Poverty Line based on an allocation set by the state and Federal governments ¡V these programs will be known as Health Care Coverage Initiatives (HCCIs). Counties can set income eligibility for their LIHPs anywhere up to 200% of the Federal Poverty Line, but they can¡¦t serve higher income people unless they first serve lower income people.
Counties must provide certain services.
The counties must offer people who enroll in their LIHPs a broad range of services, including emergency services, prescription medications, and mental health services.
Countries programs must meet certain requirements.
To be eligible for federal funds, counties must show that people who enroll in their LIHPs will be able to access care in a timely manner. The counties also must show that they have enough medical providers to get the people who enroll the care they need.
Counties cannot charge unaffordable premiums or co-payments.
The LIHPs cannot charge any premiums or co-payments to people with income below 134% of the Federal Poverty Line except for nominal co-payments like those allowed in Medi-Cal. LIHPs can ask those with income between 134% and 200% of the Federal Poverty Level to pay some premiums or co-payments, but cost sharing cannot exceed 5% of a persons monthly income.
There are other, more technical requirements, too. To read more about the LIHPs, you can go to the Department of Health Care Services’ LIHP
website: http://www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx.
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