PRESS BRIEFING BY TELEPHONE
WITH CHRIS JENNINGS, SENIOR HEALTH CARE POLICY ADVISOR,
AND A SENIOR ADMINISTRATION OFFICIAL
ON THE PRESIDENT'S RADIO ADDRESS
2:10 P.M. EST
MR. JENNINGS: I'm not sure this is going to be my last time doing this. I think, just because we work every day until the end, we'll probably have some others. But this is one of the last ones, and it's a very good news story the President is quite pleased with. He will be announcing tomorrow in his radio address, -- and as we have indicated, this is all embargoed for tomorrow morning at the time of delivery -- that we have new state reporting data documenting that at least 3.3 million children are now enrolled in the Children's Health Insurance Program -- S-CHIP. That represents a 70-percent increase over the 1999 level, which was 1.3 million.
This is resulting from significant new efforts in outreach, ongoing activities in implementation and expansion of the program, and a better understanding of its availability. As many of you know, we have spent a lot of time in the last two or three years in being very aggressive in this area.
I would point out before I go on that this number does not include hundreds of thousands of kids that also are increasing enrollment in the Medicaid program. The Medicaid program we don't have good numbers on just yet, so we can't give an explicit number. But there's absolutely no doubt the number is at least 3.3 million.
In addition, the President will be announcing a number of new regulations and initiatives that he will be unveiling as early as -- well, one is coming out today, a reg, late this afternoon or early Monday; and another, an agriculture reg, as well. And they will remove additional barriers for enrollment.
Specifically, there is legislation that we worked with in a bipartisan fashion with the Congress to enable us to share information through the school lunch program, the special milk programs for children, and other food programs that are available for children in school, with Medicaid programs to help enroll Medicaid-eligible populations.
A recent study by the Urban Institute found that approximately 60 percent of the uninsured children nationwide are currently enrolled in these school lunch programs, so there's a very significant overlay of these populations. And as we give this information to the states and their Medicaid programs, we anticipate significant enrollment increases if they choose this option, by making it easier to enroll these people, because it will have the information about their income eligibility and their current status.
Secondly, we are going to be implementing the presumptive eligibility provisions that were included both in the 1997 BBA, as well as the most recent 2000 HCFA legislation that will enable children to be presumptively enrolled in a wide range of areas, such as schools, child care centers, homeless shelters, other entities determined eligible for Medicaid --
This is a very significant development because it makes it much easier to target the kids where they are and enroll them there, and enroll them immediately without any delay. This was a provision that many people have been advocating on the Hill and obviously this administration has been pushing for it for a number of years. And it was one of the last things we won in the BBRA negotiations, as many of you will recall.
And then there's other provisions, as well. But I think those are the highlights that I would indicate right now. I would say this -- that my colleague -- would you add or supplement anything that I've stated, or do you want to just take Q&As?
Q Chris, what was the 3 million? Is that how many more kids you expect to enroll now?
MR. JENNINGS: The 3.3 million now enrolled.
Q Now enrolled in CHIPS, right?
MR. JENNINGS: In 2000.
SENIOR ADMINISTRATION OFFICIAL: This is -- the number I wanted to clarify is it was compared to 1.9 million in fiscal year '99, a year ago.
MR. JENNINGS: Oh, I'm sorry -- 1.9 million. And that is still 70 percent increase?
SENIOR ADMINISTRATION OFFICIAL: That's right.
Q At some point, the government was using the number of 2 million, 2.1 million. What did that refer to?
MR. JENNINGS: We were getting additional state reports earlier in the year that gave us the ability to add on to those numbers. This represents the end-of-the-year enrollment numbers that were submitted by the states.
Q So then you picked up 1.4 million during this past year?
MR. JENNINGS: Well, it's going from '99 to 2000, yes.
Q And then, what's the potential audience, if that's the right word, potential number of kids that could be enrolled?
MR. JENNINGS: There are millions of children, both in Medicaid and in S-CHIP who are eligible and not yet enrolled. As you may recall, the President had a goal of 5 million children when we enacted the CHIP program, S-CHIP program in '97.
Q What's the source of the numbers? Is it the Census Bureau? Is it the United States government? Is it a private organization?
MR. JENNINGS: No, it's state reporting data, Robert. It's all the states are reporting in their children's health enrollment numbers to HCFA.
Q What you were talking about, allowing children to enroll in schools, child care centers, homeless shelters, et cetera, is that for Medicaid or for S-CHIP, or for both?
MR. JENNINGS: Well, that actually is going to be for the Medicaid program and S-CHIP, but we already have the ability for S-CHIP. So this is new explicitly -- is that correct, did I say that right?
SENIOR ADMINISTRATION OFFICIAL: It is correct. In Medicaid you needed explicit statutory authority. So it's new for Medicaid. For CHIPS they've had the authority to do presumptive eligibility at a variety of sites and with broad flexibility. But the way the law had been drafted is, there was still some restrictions in how the money was going to be reimbursed to the states, and so the new legislation gave the states some more flexibility to use presumptive eligibility in CHIP, as well as in Medicaid.
Q There's been some concern among groups about how difficult it is to re-enroll kids once they're in the program, because you're not re-enrolling through a workplace, like people with private insurance. Do any of these regulations make the re-enrollment process easier for kids who are already in the program?
SENIOR ADMINISTRATION OFFICIAL: There's really nothing in federal law either on Medicaid or CHIP that makes the re-enrollment necessarily difficult. The law does require states to check in on eligibility at least once a year. And the law also allows states the option to continuously enroll children for at least 12 months. The regs attempt to encourage further simplification of that process by allowing in areas self-declaration, of citizenship, for example, so that verification is not a barrier.
And there's been a lot of work that HCFA has done with states over the last year to really promote what we're now actually calling, and a lot of states are calling, a renewal process, rather than redetermination. So it's sets up the presumption, just like you have with private health insurance, that you continue to be eligible, you just need to check in periodically.
So it's actually an area that states already have a lot of flexibility on and many of them are working now to make that process one that encourages continuous coverage.
Q From the report you received from the states, can you say the numbers of people enrolled in several of the largest -- the states with the largest enrollment?
MR. JENNINGS: Well, we do have reported data and -- are there states you're particularly interested in?
Q No, whichever have the largest ones.
MR. JENNINGS: Oh, the largest increases, you mean?
Q No, just the largest numbers --
MR. JENNINGS: In aggregate?
Q Or, Chris, if you have a state-by-state for all the states?
MR. JENNINGS: And then we'll see if we can get a state-by-state out to you all today.
SENIOR ADMINISTRATION OFFICIAL: California, the number for 2000 is 477,600. The number for New York is 769,450. Those are the two largest. North Carolina is a state that's done a lot of very good enrollment. They have a total CHIP enrollment of 103,560. Georgia, 120,600. Massachusetts, 113,000. Ohio, 111,400. Pennsylvania, 119,700, and let me give you one more. Texas is now at 130,519.
MR. JENNINGS: Okay. And we will have state-by-state and we'll get that out to you.
Q Just to clarify, was it the BBA '97, or the BBRA '99 that was revised to make this easier?
MR. JENNINGS: The presented eligibility provisions? There are provisions in both. The reg was being worked on for the BBA provisions. But when we had the BBA legislation -- or BBRA 3 or whatever you want to call it -- that we signed into law this fall, we amended the regs that were ongoing so we could implement them altogether, and that reflects -- many of you were aware that part of the last negotiations were trying to get more flexibility for states to help enroll kids in various sites. And we were pleased to win that before the conclusion of those negotiations. And they were then integrated into this final reg.
Q Did you get any reaction from members of Congress, especially where the states have had the largest increases in enrollment, or reaction to the making it easier, increasing the flexibility for state to do the enrollment --
MR. JENNINGS: Most state officials are quite pleased to have more flexibility in enrollment. These are state options, clearly, and generally they're pleased to have them. There may be some exceptions to that, but not many that I would anticipate public, and certainly, all -- the CHIP program was a bipartisan achievement. It is a program that got up and running within a year for all 50 states. We have governors of Republican and Democratic persuasion who are doing extremely well in their outreach efforts. It was -- Congress has worked together and achieved what we think was a balanced approach to dealing with an unacceptable situation of having so many uninsured children.
I don't think you will hear anything but very positive news coming from everyone since there was such broad investment in this policy from the beginning.
I would say that there are states who have done extremely well. There are three states that actually tripled their enrollment. Montana, North Dakota and Wisconsin, and there are many others who have doubled their stake. And during this time, enrollment has increased by one-third in 44 of the states. So there really has been a significant increase in enrollment in the CHIP program, for which we're quite pleased with. But I must underscore that we have a ways to go to meet the goals that we all have of enrolling all eligible children both into Medicaid program and in the S-CHIP programs and we believe the regulations that we are releasing today will go a long way to help achieve those goals.
Q Is it possible to say whether the 3.3. million number is the number of people who are enrolled at any time during the year, or the number enrolled at the end of the year or the calendar year or the fiscal year or --
SENIOR ADMINISTRATION OFFICIAL: That's the number ever enrolled, that's the number that's been requested of states in their annual CHIP enrollment reports that cover to the end of September. So it's the number of children that have been enrolled throughout the fiscal year. And that's comparable to the number that we have put out in the past. We are now collecting data that should be available in the future for point and time, but up until now this has been the data that states have reported to HCFA.
And let me also just make clear, so that everybody understands, is that these are CHIPS-funded children and some of them are in Medicaid expansion programs and some of them are in separate child health programs, depending upon the option that a state has selected. So out of the 3.3 million, 2.3 million of them are in separate child health programs and a little over 1 million are in Medicaid expansion programs.
MR. JENNINGS: Now, we do have some press paper that we will give to Lisa and others and fax and e-mail to everyone. All my usual folks will get it and she will make sure everyone else gets it later today.
I think that the one request I might make is that every time we try to do an announcement with any updated numbers or any outreach activities that we have been pursuing, we really ask you to and encourage you to use the 800 number -- which is not really an 800 number, it's an 877 number, but you need to emphasize it is toll-free. In our paper we say what it is, it's 1-877-KIDS-NOW. We have logged over -- we're almost 500,000 calls through November of this year. And every time that we have the opportunity to get that out, we get a big surge and that results in more kids, currently uninsured kids being enrolled. So we would certainly welcome you and encourage you to make people aware of that number, as well.
Q Chris, what was the key to finally agreeing on BBA?
MR. JENNINGS: Well, I believe that when we got an agreement that we could expand options for coverage, both in terms of the presumptive eligibility provisions and some of the Medicare provisions -- for example, the ALS, and the welfare-to-work transition grants. That was a very -- those were all very important to the President himself, but they needed to be included as a final package, and he had hoped also to do some enhancements on provider -- certain targeted provider payments. And I think that all came together when both sides felt strongly that this was a piece of legislation that had to be passed and enacted this year.
Q Have the final CHIP program rules been cleared by the administration? Can we expect them before January 21st?
MR. JENNINGS: Yes, you can. In fact, they're part of -- the CHIP regs are being released, and will be out either today or tomorrow -- I mean, Monday.
SENIOR ADMINISTRATION OFFICIAL: They are on display today.
Q Federal Register?
SENIOR ADMINISTRATION OFFICIAL: Yes, on display at 3:30 p.m. later today.
Q And the rules that you mentioned, they're on display as well, at the register?
MR. JENNINGS: Those are the rules that -- the only two rules are the CHIP rules, and then, of course, the agriculture rule on the school lunch program, which will be put on display next week. And these are -- the CHIP rules and regs that we're highlighting today are going to be -- they will become effective 90 days after publication. And the nutrition program provisions, the school lunch programs are going to be effective as an option retroactive to -- I think it was October 2000, October 1, 2000. So anyway, these will be important steps toward supplementing the good news we have today.
Q Are you talking on the record or on background?
MR. JENNINGS: I am talking on the record.
Q Okay.
MR. JENNINGS: But my colleague is background.
Q Okay, that's cool. That's all I needed to know right now.
MR. JENNINGS: I can't wait to hear the transcript of the first five minutes of this call.
Q What is the Medicaid managed care role? Are we going to see that before January 21st?
MR. JENNINGS: Well, that's under review as we speak, and I think that there's many rules that we hope to get out prior to getting this done, excuse me, prior to the President leaving. That one is a possible one. And because the President wants -- continues to be President, until he no longer is, it's always a possibility. But we are working night and day on trying to do as much positive work as we can prior to departure. But I just can't confirm one way or another. I think, obviously, our desire would be able to do that before we leave, yes.
If there's no other questions, we will get paper out to you shortly, and I thank you for your interest. It's nice to begin the new year with very good information and numbers on children's -- uninsureds. And again, if you have any way to highlight the toll-free number, all of us who work to try to enroll these kids would greatly appreciate it. Thank you all. Bye-bye.
END 2:33 P.M. EST