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Children's Health Coverage Expansion Complicated

By Rebecca Adams, CQ HealthBeat Associate Editor

The expansion of health coverage for families that is envisioned in the health care overhaul faces a number of barriers, researchers at an Urban Institute briefing said.

The health care law (PL 111-148, PL 111-152) expands family coverage through Medicaid, new tax credits and other programs.

Among the challenges are problems at the state level that could make Medicaid expansion difficult. Those include outdated computer systems, complex enrollment procedures, a political culture and workforce that may lead some state employees to make it difficult for new applicants, and financial obstacles.

For example, the health care law provides a high federal match, initially 100 percent, of the costs for people who became eligible for Medicaid through changes in the law. But if people who had previously been eligible for Medicaid but who were unaware of their eligibility start signing up for coverage, the higher federal matching rate does not apply. Instead, state officials would get the same matching rate as before— an average of 57 percent.

Senior fellow Stan Dorn said that states are "rightly" worried that they will face financial concerns if an influx of people seeks to enroll for Medicaid and not all are eligible for the higher matching rate.

Just the mechanics of administering the coverage for families also could get complicated. Urban Institute researchers have found that 28 million children live in a household that does not include at least one parent, so eligibility for families could be complex. And 20 million children are in families in which the parents and children are eligible for different types of coverage under the law. About 6.5 million children face both types of situations.

Those problems, coupled with barriers some Medicaid patients face in being able to get appointments with some types of physicians, demonstrate some of the difficulties in implementing the program.

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