Urban Institute Examines Recent Health Policies for Low-Income People in Alabama, Colorado and Texas

The Urban Institute has released three reports describing the status of health care financing in Alabama, Colorado and Texas, focusing on the states' Medicaid and CHIP programs. The reports are part of a series called Assessing the New Federalism (Assessing the New Federalism release, 4/5). The following is a summary of each report's findings:

• Alabama: Enrollment of children in the state's Medicaid and CHIP programs has increased because of "aggressive and effective outreach" efforts, including "streamlined" enrollment and recertification processes and increased provider reimbursement rates. However, the programs are "constrained" by a lack of state funding (Ormond/Wigton, "Recent Changes in Health Policy for Low-Income People in Alabama," March 2002). The report notes that the federal government's decision to gradually eliminate the Medicaid loophole "represent[s] the greatest current threat to health care programs" in Alabama (Assessing the New Federalism release, 4/5). The full report is available online.
• Colorado: The state's health care safety net is "strained" because of a reduction in state revenues, as well as state constitutional provisions that require Colorado to make an annual examination of ways to contain health care costs. In the past, state officials have tried to limit costs by relying on managed care plans to deliver services to Medicaid beneficiaries and by reducing provider fees. The only major health initiative undertaken by the state since 1998 is the implementation of the state's CHIP program, called Children's Basic Health Plan, which covers children through age 18 who are living in families with annual incomes up to 185% of the federal poverty level. The report notes that "major expansions" in public health insurance in the future are "not likely" (Tilly/Chesky, "Recent Changes in Health Policy for Low-Income People in Colorado," March 2002). The full report is available online.
• Texas: A substantial low-income and foreign-born population has led to a high number of uninsured people in the state, according to the report, and the number of children who are eligible for Medicaid but are unenrolled is a "major concern." To address these issues, the state Legislature last year passed a two-year budget that simplified Medicaid eligibility, increased CHIP program funding, boosted nursing home reimbursement rates, established a health insurance system for public school teachers and created a drug-benefit program for seniors and people with disabilities (Wiener/Brennan, "Recent Changes in Health Policy for Low-Income People in Texas," March 2002). While state budget deficits might "curtail further expansions" of state health programs, Texas "has not suffered the extreme fiscal pressures" that other states have experienced, the report notes (Assessing the New Federalism release, 4/5). The full report is available online.