Of how medicaid works.
If a state is willing to put up 40 dollars, the feds give 60
If they put up 40 million, the states give 60 million.
It is up to the state to fund up to the level that they are willing to, and then the feds contribute the rest.
The fact that OHIO, only put up X dollars, does not indicate what they COULD have done under medicaid, but what they were willing to.
A subsection 1115 waivers, allows a state to use FEDERAL funds that it has not spent in other areas, to use it to provide medicaid services to people ABOVE a the Federal Poverty levels up to a certain percentage. IF the STATE will take on the task of providing medicaid services for children iin families between 185 percent and 300 percent of those above poverty level, the FEDS then pick up a higher percentage of those BELOW 185 percent.
96 percent coverage is only a good record if you know that before Dena it was much leower. It was not. Over 90 percent of all individuals were covered in Vermont. This largely was responsible for more than 90 percent of the subset of this group, children, being covered in Vermont before Dean even acted. Medicaid and Dr Dynasaur, and VHAP existen in Vermont several years before Dean was even in office. Adult Coverage incresed from 90.4 to a maximum of 92 recent while Dean was in office, before finally dropping to 91.3 in 2000.
The additions to Dr Dynasaur were provided by funding through medicaid that this federal grant and waiver provided, not by anything Dean legislated in Vermont, allowed through additional state funding of ANY new or innovative state programs. None other small states did as well, or even more than Dean did usiing these waivers and grants, as they were willing to proportionally increase the states expenditures. Hawaii was one of these. THey managed to pass universal health insurance legislation while Dean was threatening to veto the Vermont legislatures version(which did not give big windfalls to large Health Care Provider businesses, which was Deans desired bill)
DEAN didnt do ANYTHING except have the state apply for the waiver.
It was applied for through the HRSA:
This section discusses Dr. Dynasaur:
Buy in to VHAP: Individuals without access to employer
coverage living below 300 percent FPL could be permitted to
purchase coverage under the VHAP program by paying a
premium. Small employers could also be given the option of
purchasing coverage for their employees and dependants
through VHAP. While the premium would be equal to the
full cost of coverage, this would still likely be lower than
purchasing comparable coverage in the private sector.
Incrementally expand VHAP up to 300 percent FPL: This
would affect primarily adults between the current VHAP
eligibility level and 300 percent FPL. Vermont has the option
under section 1931(b) of the federal Medicaid law to increase
the income level for parents under Medicaid to match the
maximum income level at which children are eligible for Dr.
Dynasaur (300 percent FPL);
This is a large section of the rest of the grant proposal:
HRSA State Planning Grantee: Vermont
Project Goals
Vermont’s stated goals for this SPG were to:
1. design and conduct in-depth quantitative and qualitative
research of Vermont’s population at both statewide and local
levels to better understand demographics and characteristics of
the uninsured;
2. design and conduct in-depth qualitative research of
Vermont’s employer, health-insurer, and provider
communities to improve understanding of their perceptions
of public and private health coverage in the state and to gauge
reactions to likely responses to coverage strategies;
3. perform actuarial analyses to assist in pricing coverage options
and for evaluating financing issues;
4. facilitate collaboration across various state agencies and private
organizations participating in the development and/or
regulation of coverage options within Vermont.
Project
Components
Planned components of the project included:
Conduct a general population survey addressing the health insurance
coverage status of Vermont residents, with an oversample of
specific subpopulations;
Convene a series of focus groups and structured one-on-one
interviews with employers and associations to explore perceptions
of the current health care market and delivery system, in terms of
accessibility and affordability;
Convene a Work Group of public- and private-sector representatives to
help identify barriers to coverage from the insurer/health plan
perspective, and to help market-test and refine proposals;
Convene a Work Group of clinical representatives to provide quality,
access, and outcomes perspectives for proposed health coverage
and program design options;
Conduct an actuarial analysis of different strategies to increase
insurance coverage;
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Evaluate alternative coverage options and programs that might be
responsive to the needs of Vermont’s uninsured;
Market-test each coverage option and program design selected by the
Steering Committee through the use of consumer focus groups,
employer interviews, and sessions with insurer/provider/public
health Work Groups;
Prepare an implementation estimate that includes high-level analysis
of expected utilization charges within the delivery system;
estimates of administrative and service delivery costs, premiums,
funding sources; and the anticipated number of participants.
Grant Amount and
Time Frame
$1,288,892; 10/1/00–9/30/01, with an extension through
9/30/02.
Lead Agency
Vermont Agency of Human Services
http://www.dsw.state.vt.us/districts/ovha/ovha22.htmProject Partners
Office of the Governor; Vermont State Legislature; Department
of Prevention, Assistance, Transition, and Health Access; Office
of Vermont Health Access; Department of Health; Department
of Banking, Insurance, Securities, and Health Care
Administration; Vermont Coalition of Clinics for the Uninsured;
Vermont Medical Society; Vermont Association of Hospitals and
Health Systems; Chamber of Commerce; Blue Cross Blue Shield
of Vermont; Vermont Commission on Health Care Values and
Priorities; Office of State Health Care Ombudsman; Bi-State
Primary Care Association; The Business Roundtable
Brief History of
State Health
Reform
In 1989, Vermont created the Dr. Dynasaur program, which
provided state-funded health assistance to children six years and
younger, as well as pregnant women who did not qualify for
Medicaid up to 200 percent FPL. By 1992, the program had
expanded to cover children up to age 17, up to 225 percent FPL,
and was integrated into the state Medicaid program. This was
later expanded under the CHIP program to cover children up to
300 percent FPL. In 1991, Vermont passed the Act 160
Legislative Initiatives, which required all insurers with small-
employer products (50 or fewer workers) to guarantee-issue
policies at community rates and committed the state to the goal
of universal health insurance coverage. The Vermont Health
Access Program (VHAP) was designed to operate under a
1115 Medicaid waiver. The waiver was granted in 1995 and
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recently extended to ensure that it would remain operational
until at least 2003. VHAP covers custodial parents and caretaker
relatives up to 185 percent FPL, noncustodial parents and other
adults up to 150 percent FPL, aged and disabled through 105
percent FPL, and pregnant women through 200 percent FPL.
The VHAP Pharmacy Program replaced the V-Script
program, initially started in 1989. The programs were initially
designed to provide pharmaceuticals to low-income elderly
citizens. It has been expanded to cover Medicare beneficiaries up
to 175 percent FPL and other individuals with incomes up to 300
percent FPL.
Existing Major
Access Programs
Dr. Dynasaur, VHAP, Medicaid
SPG FINDINGS
Insurance Data
About 51,390 (8.4 percent) of Vermont’s 608,829 citizens
lack health coverage.
The uninsured include people at all income levels; 21.6
percent of the uninsured had incomes below FPL; 29.6
percent had incomes 100–200 percent FPL; 22.3 percent had
incomes 200–300 percent FPL; and 26.3 percent had incomes
greater than 300 percent FPL.
More than three-quarters of the uninsured population were
employed; 66.5 percent of the uninsured were working full
time and 10.5 percent were working 30 hours or less per
week.
Most Vermonters believe that the government and employers
should be responsible for providing health insurance,
although they were wary of a government-only system, such
as a single-payer model.
Tax credits, subsidies, or other incentives to health insurance
elicited concern about “red tape,” complicated applications,
and inflexible eligibility standards. There was also little
support for a low-cost insurance option.
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Employer Role
In firms with fewer than five employees, 26.6 percent of
workers are offered coverage compared with over 90 percent
of workers in firms with more than 50 employees.
Employers typically offer one plan, and employees typically
pay about 20 percent of the premium.
Employers view insurance as one of the most valuable
benefits they can offer. Reasons for offering insurance include
increasing employee compensation with a tax-free benefit,
keeping employees healthy and productive, and having access
to group health insurance for themselves.
Those who do not offer insurance cite cost—including
premium levels, unpredictability of costs in the future, and
the time required to research and administer plans—as the
primary reason for not doing so.
Employers view reducing costs as the key to expanding
insurance coverage and show interest in employer tax
incentives, more competition in the market, an affordable
plan that is free of state-mandated benefits, and pools to
negotiate lower rates.
State Policy
Recommendations A Steering Committee consisting of representatives from the various interest groups met regularly and participated in planning and advising on the different policy recommendations. Based on the evaluation of the different policy options, their specific
recommendations are the following:
Increase participation among Medicaid/VHAP/Dr.
Dynasaur–eligible people: The state could substantially reduce
the number of uninsured by increasing enrollment in existing
programs. Outreach programs for Dr. Dynasaur in schools
and through employers could be expanded, while the
premiums for children above 225 percent FPL could be
eliminated.
http://216.239.39.104/search?q=cache:_ZhH5F8rGPsJ:207.189.207.4/programs/insurance/sacks_20hrsagrants_vt_577.pdf+%22Vermont%22+%22Act+160%22+HRSA&hl=en&ie=UTF-8This is the beginning of the ENTIRE Grant proposal from the atate of Vermont for the ss1115 waiver...
All of the programs in Vermont were offered under changes that were instituted to medicaid under Bill CLinton, and the CHIP program, as well as KidCare, the childrens section of Clinton Care, written by Kerry, Presented first as the Kennedy/Kerry bill, and then when it went bi-partisan, turned into Kennedy/Hatch, with Kerry as promary sponsor(as happens with senate protocol between Senior and Junior Senators)
Dean didnt do 'nary a thing. except apply for programs as soon as they were made available.