| TO: | Honorable Patrick M. Rose, Chair, House Committee on Human Services |
| FROM: | John S. O'Brien, Director, Legislative Budget Board |
| IN RE: | HB743 by Dukes (Relating to health benefits coverage for certain persons under the child health plan and other programs.), As Introduced |
| Fiscal Year | Probable Net Positive/(Negative) Impact to General Revenue Related Funds |
|---|---|
| 2010 | ($32,310,834) |
| 2011 | ($64,848,216) |
| 2012 | ($72,717,198) |
| 2013 | ($74,229,186) |
| 2014 | ($73,698,561) |
| Fiscal Year | Probable (Cost) from General Revenue Fund 1 |
Probable (Cost) from GR Match For Medicaid 758 |
Probable (Cost) from GR Match For Title XXI 8010 |
Probable (Cost) from Premium Co-payments 3643 |
|---|---|---|---|---|
| 2010 | ($2,737,497) | ($900,000) | ($28,673,337) | ($3,979,500) |
| 2011 | ($5,630,621) | ($745,536) | ($58,472,059) | ($179,530,680) |
| 2012 | ($6,253,133) | ($1,516,488) | ($64,947,577) | ($360,124,716) |
| 2013 | ($6,386,973) | ($1,535,550) | ($66,306,663) | ($364,803,265) |
| 2014 | ($6,341,841) | ($1,556,730) | ($65,799,990) | ($369,856,640) |
| Fiscal Year | Probable (Cost) from Experience Rebates-CHIP 8054 |
Probable (Cost) from Vendor Drug Rebates-CHIP 8070 |
Probable (Cost) from Federal Funds 555 |
Probable Revenue Gain from Premium Co-payments 3643 |
|---|---|---|---|---|
| 2010 | ($1,650,598) | ($1,773,835) | ($80,059,663) | $3,979,500 |
| 2011 | ($3,394,177) | ($3,633,685) | ($163,150,696) | $179,530,680 |
| 2012 | ($3,769,621) | ($4,034,219) | ($181,989,637) | $360,124,716 |
| 2013 | ($3,850,182) | ($4,120,434) | ($185,793,874) | $364,803,265 |
| 2014 | ($3,823,220) | ($4,091,579) | ($184,419,695) | $369,856,640 |
| Fiscal Year | Probable Revenue Gain from Experience Rebates-CHIP 8054 |
Probable Revenue Gain from Vendor Drug Rebates-CHIP 8070 |
|---|---|---|
| 2010 | $1,650,598 | $1,773,835 |
| 2011 | $3,394,177 | $3,633,685 |
| 2012 | $3,769,621 | $4,034,219 |
| 2013 | $3,850,182 | $4,120,434 |
| 2014 | $3,823,220 | $4,091,579 |
Section 1 requires the Health and Human Services Commission (HHSC) to increase income eligibility for the Children’s Health Insurance Program (CHIP) from at or below 200 percent of the federal poverty level (FPL) to at or below 300 percent of FPL. Section 3 makes the new income eligibility level applicable to determinations of eligibility made on or after the effective date of the bill, regardless of the date of application for coverage.
Section 2 requires HHSC to develop and seek a waiver to implement a demonstration project to provide health benefits plan coverage to parents of children enrolled in Medicaid or CHIP if the family’s net income is at or below 300 percent of FPL and the parents are not currently eligible for Medicaid or covered by a health benefit plan offering adequate benefits (as determined by HHSC). The demonstration project must qualify for federal funding and be administered in a manner that is substantively identical to the CHIP program. Persons covered under the benefit plan would be required to pay 100 percent of the plan premium as well as other cost-sharing. Benefits of the plan are required to be similar to those provided by CHIP. The demonstration project must include provisions designed to discourage crowd-out. Section 4 requires HHSC to apply for and actively pursue the federal waiver as soon as practicable after the effective date of the bill and allows the commission to delay implementation of the demonstration project until the waiver is granted.
Section 5 requires state agencies to request any federal waiver or authorization, other than the waiver required to implement the demonstration project, necessary to implement any other provisions of the bill and authorizes them to delay implementation until the waivers or authorizations are granted.
Section 1: It is assumed that beginning September 1, 2009 clients between 200 and 300 percent of FPL will begin enrolling in CHIP. It is assumed that annual enrollment fees will be established in the amount of $65 for families between 200 and 250 percent of FPL and $85 for families between 250 and 300 percent FPL. All other costs and program policies are maintained at the level assumed for children at or below 200 percent FPL.
Federal law currently caps income eligibility for CHIP at 50 percentage points above the highest limit for children enrolled in Medicaid; in
It is estimated that increasing maximum income eligibility for the CHIP program would result in an additional 70,707 average monthly recipient months in fiscal year 2010; 145,397 in fiscal year 2011; 161,480 in fiscal year 2012; 164,931 in fiscal year 2013; and 163,776 in fiscal year 2014. The average cost per recipient month is estimated to be $129.69 in each fiscal year. The additional cost to the program from higher caseloads would be $110.0 million All Funds, including $36.5 million in General Revenue Funds, in fiscal year 2010; $226.3 million All Funds, including $72.9 million in General Revenue Funds, in fiscal year 2011; $251.3 million All Funds, including $80.8 million in General Revenue Funds, in fiscal year 2012; $256.7 million All Funds, including $82.6 million in General Revenue Funds, in fiscal year 2013; and $254.9 million All Funds, including $82.1 million in General Revenue Funds in fiscal year 2014. These General Revenue Funds amounts include expenditure of additional collections of Vendor Drug Rebates for CHIP, Experience Rebates, and Premium Copayments totaling $7.4 million in fiscal year 2010, $12.4 million in fiscal year 2011, $13.6 million in fiscal year 2012, $14.0 million in fiscal year 2013, and $14.1 million in fiscal year 2014.
There would also be additional administrative expenditures associated with the expanded program estimated to be $7.9 million All Funds, including $2.3 million in General Revenue Funds, in fiscal year 2010; $12.6 million All Funds, including $3.6 million in General Revenue Funds, in fiscal year 2011; $14.0 million All Funds, including $4.0 million in General Revenue Funds, in fiscal year 2012; $14.3 million All Funds, including $4.1 million in General Revenue Funds, in fiscal year 2013; and $14.2 million All Funds, including $4.1 million in General Revenue Funds, in fiscal year 2014. These amounts include one-time costs for system changes and policy implementation and ongoing costs for eligibility and enrollment broker services and postage.
The total cost of Section 1 is estimated to be $118.0 million All Funds, including $38.8 million in General Revenue Funds, in fiscal year 2010 rising to $269.1 million All Funds, including $86.2 million in General Revenue Funds, by fiscal year 2014. It is assumed that CHIP federal matching funds will be available; however, if the state exhausts its capped federal allotment, General Revenue Funds would be required in lieu of assumed Federal Funds.
Section 2: It is assumed that it will take a year for the agency to obtain the necessary waivers and authorizations and to perform required start-up activities. It is assumed that client services will begin September 1, 2010.
It is estimated that the demonstration project would take a year to reach full caseload resulting in 35,200 average monthly recipient months in fiscal year 2011; 71,600 in fiscal year 2012; 72,500 in fiscal year 2013; and 73,500 in fiscal year 2014. The average cost per recipient month is estimated to be $412.34 in each fiscal year. The client services cost of the project is estimated to be $174.2 million in fiscal year 2011, $354.3 million in fiscal year 2012, $358.7 million in fiscal year 2013, and $363.7 million in fiscal year 2014. It is assumed that the client services portion of the project will be funded entirely through collection of Premium Copayments.
There would also be administrative expenditures associated with the demonstration project estimated to be $1.8 million All Funds, including $0.9 million in General Revenue Funds, in fiscal year 2010; $1.5 million All Funds, including $0.7 million in General Revenue Funds, in fiscal year 2011; $3.0 million All Funds, including $1.5 million in General Revenue Funds, in fiscal year 2012; $3.1 million All Funds, including $1.5 million in General Revenue Funds, in fiscal year 2013; and $3.1 million All Funds, including $1.6 million in General Revenue Funds, in fiscal year 2014. These amounts include one-time costs for system changes and policy implementation and ongoing costs for eligibility and enrollment broker services, postage, and collection of premiums. It is assumed that matching federal funds will be available at the Medicaid administrative 50/50 match.
The total cost of Section 2 is estimated to be $1.8 million All Funds, including $0.9 million in General Revenue Funds, in fiscal year 2010 rising to $366.8 million All Funds, including $365.2 million in General Revenue Funds, by fiscal year 2014. These General Revenue amounts include expenditure of collected Premium Copayments.
The total cost of the bill is estimated to be $119.8 million All Funds, including $39.7 million in General Revenue Funds, in fiscal year 2010 increasing to $635.9 million All Funds, including $451.5 million in General Revenue Funds, by fiscal year 2014.
Technology costs included above total $2.0 million All Funds, including $0.8 million in General Revenue Funds, in fiscal year 2010 for one-time costs associated with system changes.
| Source Agencies: | 529 Health and Human Services Commission
|
| LBB Staff: | JOB, CL, PP, LR
|