SB 364 - This act would require the Department of Health to develop a program to assure basic health care to all children in this state 18 years or younger. The Director of the Department of Health will define a minimum health benefit plan that is at least equal to benefits currently available to children on Medicaid.

Children who are not eligible for Medicaid, are not insured for health care by any private or public plan or who are living in a household with an income of less than 250% of the federal poverty level will be assigned to a health assurance entity serving the community where the child resides. If the parent of a child is a client of a health assurance entity, the child will be assigned to the same entity as the parent.

The Director shall seek assistance from public, private and parochial schools and all licensed hospitals and health professionals in identifying and enrolling uninsured children.

Children enrolled in a health assurance entity plan will be enrolled at a premium rate of not more than 30% of the average premium rate for insured children based on a sliding scale in relation to family income. The Department may provide for a waiver of premium payment when it is in the best interest of the child.

The Director of the Department of Health in consultation with the Division of Medical Services shall develop model cooperative arrangements between health assurance entities and schools participating in Medicaid programs. The goal of this cooperative will be to provide delivery of health care to children and to provide health access to all children without identifying the source of payment.

Health assurance entities may discount payments to health providers for services in behalf of all clients by a percentage set by regulation by the Director of the Department of Health. The discount rate will be an amount which will produce approximately 50% of the overall cost of providing benefits to uninsured children less premiums received. The discount rate shall not exceed 1% of the payment to the provider.

Any health assurance entity which does not comply with this act will be suspended from doing business in the state by the Department of Insurance.
CHERYL GRAZIER