Child Health Insurance Program

Child Health Insurance Program

Berenice Olivas, Jennifer Medrano, Luz Lopez & Shalon Smith-Hughes

Implementation Continued...

• Outline of the program established a partnership between federal and state government.
• Expanded their programs as well as Medicaid/Insurance Programs.
• States were able to create their own criteria and regarding geographic.
• Income, resources, and age.
• The federal role ensured state met the requirements to ensure coverage under CHIP.
• Each state meets their own individual needs.

(DeParle, 1999)

Implementation of CHIP

Implementation Continued...

• The program provided states a standard application format.
• Provided required information , included policy issues, outreach, fixed cost, and sharing.
• Guidance for each state was provided instructions for development to:
• Strategic planning
• Evaluation and report
• Benefits/protection

(DeParle, 1999)

• Created through the Biapartism Balanced Budget Act of 1977.
• Addressed that over 11 million American children were uninsured.
• Increased health problems/children health.
• The implementations would help families who couldn’t afford coverage.
• Congress of Administration set aside of 24 billion dollars to create Children's Health Insurance Program(CHIP) in 1998.
• Largest investment in Children.
• Cover cost of insurance was at a reasonable price.

(DeParle, 1999)

Approvals

• 52 CHIP plans were created and approved by Congress.
• Alabama was the first state.
• The estimated coverage for this program is about $2.5 million.
• Expansion of the plan moved rapidly.
• 15 amendments approved
• Existed Medicare programs
• Expansion of states will expand and eligibility for the plans of CHIP.

(DeParle, 1999)

Challenges

What services does it cover?

• Outreach efforts are used to enroll eligible children for CHIP and Medicaid
• Due to limited funding from states have lowered rates for coverage on children
• A national campaign was called “Insure Kids Now” was used to increase coverage for children
• Hotline was developed as well as on networks
• Goal was to improve outreach and efforts consistency and reliable

(DeParle, 1999)

• Routine check-ups

• Immunizations

• Doctor Visits

• Prescriptions

• Dental and vision services

• Inpatient and outpatient hospital services

• Laboratory & X-ray services

• Emergency services

NOTE: All benefits vary depending on state.

Federal Formulation

("The Children's Health Insurance Program", n.d.)

Modifications Continued...

• CHIP was created in 1997 as part of the Balanced Budget Act of 1997.
• Bipartisan support for the measure.
• Formulated by a Democratic President & Republican Congress.
• They wanted balance & equilibrium between the states & federal government.
• It contains elements of both an entitlement program and a block-grant.

(Lambrew, 2007)

What is CHIP?

Health services

• Pediatric, visual, and dental care
• Mental health and substance abuse services
• Emergency
• Maternity and newborn care
• Etc.

("Obamacare Facts", n.d.)

Formulation of CHIP

Modifications to CHIP

What is the Cost of CHIP?

Funding

Modificatons Continued...

• Routinely doctor and dental visits are free.

• Other services may require co-payments.

• Monthly premiums are required in some states.

• Patients and families will not be paying more than 5% of family income (yearly).

There have been a myriad of modifications with the implementation of the Affordable Care Act.

Entitlement Programs:

• Program where public funds are given to people because they meet some kind of requirement.
• Ex. Medicare, Medicaid, Food Stamps.

Block-Grants:

• Money from the federal government given to the states.
• This money can only be spent on certain services & programs.
• The BBA of 1997 allotted $40 billion in federal funds available over ten years to assist states in funding their CHIP programs.

(Ryan, 2009)

("The Children's Health Insurance Program", n.d.)

• Families making less than 41,000, free children’s health insurance.
• Income being less than 71,000, insurance is low cost ranging from $50 and more a month.
• Families making more than 71,000 will pay full insurance ranging from $200 and more a month.
• Past: Small percentage between Medicaid patients and high income families were eligible for health insurance.
• 7 million children are still uninsured- 5.2 million.

("Obamacare Facts", n.d.)

1997

The children health insurance program that provides health coverage to children in families' that make to much income to qualify for Medicaid.

• It was proposed in 1997.

• Enactment was made in 2009 and 2010 when the Affordable Care Act was signed into law.

• Provided in every state (different benefits for each state).

("About CHIP", n.d.)

Preventable Health Services

• Vaccinations
• Obesity screening
• Counseling
• Screening for autism and depression
• Etc

• Providing health insurance coverage to children has been a pressing policy issue for decades.
• Medicaid helped establish the coverage program for the poor, including families with children.
• There was a growing number of uninsured, low-income children throughout the 1970s and early 1980s.
• 1990’s trend showed that there was a growing number of uninsured children with incomes above the FPL.
• Although national health insurance failed in 1994 there was bipartisan support for the creation of a legislation addressing the coverage gap amongst children.

(Hoag, 2011)

State Formulation

Modifications Continued...

("Obamacare Fact", n.d.)

CHIP gave the states three options for designing their programs:

1. Expand the existing Medicaid program.

2. Create a separate child health insurance program.

3. Use a combination of the two approaches.

Expanding Separate Combination

(Ryan, 2009)

Eligibilty

• Using the MAGI (Modified-Adjusted Gross Income) about 30 states including DC are covered- 250% above federal poverty level.
• The other 20, covered with incomes above 300% FPL.

(Rudowitz, Artiga, & Arguello, 2014)

• There are federal guidelines that determine if an individual qualifies for CHIP:

• If the child cannot be covered there is a possibility that Medicaid Funds can cover them.

• Children must be 19 years or younger.

• Must be Uninsured.

• Must be citizen or legal immigrant.

• States are given the option to cover immigrant children who have not been in the country for 5 years (25 states do this).

("About CHIP", n.d.)

Modifications Continued...

Goal of CHIP

• No “ Waiting Period”
• Continuity of coverage.
• Aging off of Foster care - coverage until 26 years old.
• Tax Credits – individuals above Medicaid, but below 400% FPL.
• No employer-based insurance coverage.

(Rudowitz, Artiga, & Arguello, 2014)

To help close coverage gaps for low-income children whose families cannot afford private coverage but whose incomes are too high to qualify for Medicaid.

(Hoag, 2011)

Eligibility Continued...

Children:

• Cover children who are categorized above 200% of poverty level.
• Those at 300% receive a regular Medicaid match coverage.

Pregnant Women:

• Only for those who are categorized at a minimum of 185% FPL (Only 5 states currently do this).
• Must be a greater than or equal to Medicaid Income limit.

Parents or Other Adults:

• Cannot receive services, but can receive waivers by the state.
• Can be eligible for Medicaid not CHIP.

("About CHIP", n.d.)

References

“About CHIP”. (n.d.) Georgetown University Health Policy Institute Center for Children and Families. Retrieved January 29th, 2015 from http://ccf.georgetown.edu/chip/about-chip/

“Obamacare Facts”. (n.d.). ObamaCare and CHIP (Children’s Health Insurance Program). Retrieved January 29, 2015 from http://obamacarefacts.com/

“The Children’s Health Insurance Program (CHIP)”. (n.d.) HealthCare Gov. Retrieved January 29th, 2015 from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/

DeParle, N. A. (1999). Testimony on the Children's Health Insurance Program. Assistant Secretary for Legislation. Retrieved January 29th, 2015 from http://www.hhs.gov/asl/testify/t990429a.html

Hoag, S. (2011). Children’s health insurance program: an evaluation. U.S Department of Health and Human Services. Retrieved January 29th, 2015 from http://aspe.hhs.gov/health/reports/2012/CHIPRA-IRTC/index.pdf

Lambrew, J. M. (2007). The state children’s health insurance program: past, present, and future. George Washington University. Retrieved January 29th, 2015 from http://www.commonwealthfund.org/~/media/files/publications/fund-report/2007/feb/the-state-childrens-health-insurance-program--past--present--and-future/991_lambrew_schip_past_present_future-pdf.pdf

Rudowitz, R., Artiga, S., & Arguello, R. (2014). Children’s Health Coverage: Medicaid, CHIP, and the ACA. The Henry J. Kaiser Family Foundation. Retrieved January 29, 2015 from http://kff.org/health-reform/issue-brief/childrens-health-coverage-medicaid-chip-and-the-aca/

Ryan, J. (2009). The children’s health insurance program: fundamentals. National Health Policy Forum. Retrieved from http://www.nhpf.org/library/background-papers/BP68_CHIPFundamentals_04-23-09.pdf