1. Many children in working families, including many families whose family income ranges between $40,000 and $80,000, are uninsured.

2. Numerous studies, including the Institute of Medicine’s report, “Health Insurance Matters,” demonstrate that lack of insurance negatively affects health status.

3. Access to health care is a key component for children’s healthy development and successful education.

4. It is, therefore, the intent of this legislation to provide access to affordable health insurance to all uninsured children in the state.

1. “Application agent” means an organization or individual, such as a licensed healthcare provider, school, youth service agency, employer, labor union, local chamber of commerce, community-based organization, or other organization, approved by the Department to assist in enrolling children in the Program.

2. “Child” means a person under the age of 19.

3. “Department” means the Department of [Health].

4. “Program” means the Covering All Kids Health Insurance Program.

5. “Resident” means an individual who is in the state for other than a temporary or transitory purpose during the taxable year, or who is domiciled in this state but is absent from the state for a temporary or transitory purpose during the taxable year.

6. “State medical assistance” means healthcare benefits provided under [the state Medicaid or the SCHIP programs], or under another government program.

1. There is established a Covering All Kids Health Insurance Program. The Program shall be administered by the Department of [Health]. The Department shall have the same powers and authority to administer the Program as are provided to the Department in connection with the Department’s administration of [the state Medicaid program] and the [SCHIP program]. The Department shall coordinate the Program with the existing health programs operated by the Department and other State agencies.

2. To be eligible for the Program, a person must be a child who is a resident of the state, and who is ineligible for state medical assistance, and:

3. An entity that provides health insurance coverage to state residents shall provide health insurance data to the Department for the purpose of determining eligibility for the Program. The rules for obtaining this information shall be consistent with all laws relating to the confidentiality or privacy of personal information or medical records, including provisions under the federal Health Insurance Portability and Accountability Act (HIPAA).

4. The Department, at its discretion, may take into account the affordability of dependent health insurance when determining whether employer-sponsored dependent health insurance coverage is available upon reemployment of a child’s parent.

5. The Department shall adopt eligibility rules, including, but not limited to rules regarding annual renewals of eligibility for the Program; rules providing for re-enrollment, grace periods, notice requirements, and hearing procedures; and rules regarding what constitutes availability and affordability of private or employer-sponsored health insurance, with consideration of such factors as the percentage of income needed to purchase child or family health insurance, the availability of employer subsidies, and other relevant factors.

6. The Department shall develop procedures to allow application agents to assist in enrolling children in the Program or other children’s health programs operated by the Department. At the Department’s discretion, technical assistance payments may be made available for approved applications facilitated by an application agent.

7. The Department may provide grants to application agents and other community-based organizations to educate the public about the availability of the Program. The Department shall adopt rules regarding performance standards and outcomes measures expected of organizations that are awarded grants under this Section, including penalties for nonperformance of contract standards.

8. The Department shall request any necessary state plan amendments or waivers of federal requirements in order to allow receipt of federal funds for implementing any or all of the provisions of the Program. The failure of the responsible federal agency to approve a waiver or other state plan amendment shall not prevent the implementation of any provision of this Act.

1. The Department shall purchase or provide healthcare benefits for eligible children that are identical to the benefits provided for children under the [SCHIP] program.

2. As an alternative to [SCHIP] program benefits, when cost-effective, the Department may offer families:

3. The content, availability, and terms of eligibility of any alternatives to [SCHIP] program benefits shall be at the Department’s discretion and the Department’s determination of efficacy and cost-effectiveness.

4. Children enrolled in the Program are subject to the following cost-sharing requirements:

1. To the extent of the amount of healthcare benefits provided for a child under the Program, the Department shall be subrogated to any right of recovery such recipient may have under the terms of any private or public healthcare coverage or casualty coverage, without the necessity of assignment of claim or other authorization to secure the right of recovery to the Department.

2. When benefits are provided or will be provided to a beneficiary under the Program because of an injury for which another person is liable, or for which a carrier is liable in accordance with the provisions of any policy of insurance, the Department shall have a right to recover from such person or carrier the reasonable value of benefits so provided. To enforce such right, the Department may institute and prosecute legal proceedings against the third person or carrier who may be liable for the injury in an appropriate court, either in the name of the Department or in the name of the injured person, his guardian, personal representative, estate or survivors.

1. Establishing estimates, broken down by regions of the state, of the number of children with and without health insurance coverage; the number of children who are eligible for Medicaid or the state Children’s Health Insurance Program, and, of that number, the number who are enrolled in Medicaid or the state Children’s Health Insurance Program; and the number of children with access to dependent coverage through an employer, and, of that number, the number who are enrolled in dependent coverage through an employer.

2. Surveying those families whose children have access to employer-sponsored dependent coverage but who decline such coverage as to the reasons for declining coverage.

3. Ascertaining, for the population of children accessing employer-sponsored dependent coverage or who have access to such coverage, the comprehensiveness of dependent coverage available, the amount of cost-sharing currently paid by the employees, and the cost-sharing associated with such coverage.

4. Measuring the health outcomes or other benefits for children enrolled in the Covering All Kids Health Insurance Program and analyzing the effects on utilization of healthcare services for children after enrollment in the Program compared to the preceding period of uninsured status.

5. These studies shall be conducted in a manner that compares a time period preceding or at the initiation of the program with a later period.

6. The Department shall submit the preliminary results of the study to the governor and the legislature no later than July 1, 2009 and shall submit the final results to the governor and the legislature no later than July 1, 2011.