Sate Children's Health Insurance Program (CHIP)
16/12/2013 13:50
Sate Children's Health Insurance Program (CHIP)
The program is designed to cover children of working families with a modest income and who are not eligible for Medicaid but cannot afford private health insurance. Enrollment fees and co-pays are generally based on the family's income. Enrollment fees average around $50 or less for each 12 month term of eligibility. Copayments for doctor visits and prescription medication vary from $3 to $10. An average four person household with an income of $60,000 a year can expect an average monthly premium of $60 per child.
CMS began administering CHIP in 1997 when the program helped the states expand health care coverage to over 5 million uninsured children. On February 4, 2009, the President signed into law the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Public Law 11-13). This finances CHIP through 2013 and will maintain coverage for millions of children who rely on its services. It also provides states with the resources needed to reach additional uninsured children. This legislation will help ensure the well-being of the nation's children. (CMS CHIP Overview)
The programs are run by each state. By February 1999, 47 states had set up SCHIP programs with much effort required into getting children enrolled. States with separate child health programs are supposed to follow the regulations described in Section 42 of the Code of Federal Regulations, Section 457. In 2007, both houses of Congress passed a bipartisan measure to expand the SCHIP program, H.R. 976. (H.R.976 CRS Summary) By 2012, the coverage would expand to cover 4 million more children. The Reauthorization Act's amendments were effective on October 1, 2007, regardless of whether final regulations were in place to carry them through. (H.R. 976 CRS Summary)
The benefits offered through this program are numerous. Families have the benefits of choosing their doctor, regular checkups, dental visits and cleanings, prescription medication, access to specialists, vaccinations, hospital services, x-rays, lab tests, mental health care, special health needs care, pre-existing condition treatments and eye care. When selecting CHIP it's important to consider certain factors just as with any other insurance provider. Consider what hospitals and medical service providers participate in CHIP. Also, look into what services and benefits are covered while away from home and if the insurance company was helpful in answering your questions. The cost is also a consideration with monthly rates averaging between $29-$231. (CHIP Service Areas, CHIP rates)
Dental services under CHIP are to include coverage required to prevent diseases and promote good oral health. It also covers oral structure restoration for health and function as well as emergencies for eligible children up to the age of 19. Individual states may elect to provide benchmark dental coverage. This would include benchmark dental equivalent coverage, existing coverage that is equal to the Federal Employees Health Benefit Plan, the State employee dependent coverage, coverage offered through a commercial plan with the largest insured commercial, non-Medicaid enrollment of dependents of such plans that is offered in that State. (CMS CHIP Dental Coverage Overview)
The states are also given the option to target low-income pregnant women through a state plan, only if certain conditions are met. The state must have an established income eligibility level of at least 185% of the federal poverty line for pregnant women under Medicaid. The minimum income eligibility level for children under 19 must be at 200% of the poverty line applicable to a family of the size involved. It must also provide automatic enrollment to the children born to women receiving assistance during pregnancy.(H.R. 976 CRS Summary)
The U.S. has the third highest public healthcare expenditure per capita. When SCHIP was created, it became the largest expansion of health insurance coverage for children funded by taxpayers. The new CHIP law allows for $100 million in funding that is to be allotted for grants to organizations that promote the outreach and enrollment for CHIP and Medicaid. To break it down further, $10 million will be used for national outreach campaigning, $10 million for grants to reach out to Native American Children, and the remaining $80 million will go toward grants for state and local organizations. The grants will be awarded by The Secretary of Health and Human Services with preference given to organizations in areas with a high percentage of uninsured children and those that specifically serve minority groups. (Google docs, CHIPRA 101) The law achieves this funding by the addition of $44 billion in new federal funding between 2009 and 2013. This goes on top of a baseline of $5 billion per year. The total amount available for CHIP will then be $69 billion. One way this increase was funded was by increasing the federal tobacco tax by .62 cents. (Google docs, CHIPRA 101)
Annual allotments for each state will be distributed taking into account how much each state spends on CHIP. Each state's FY(fiscal year) 2009 CHIP allotment is based on the highest of the following; it's FY 2008 CHIP spending including an inflation factor, it's FY 2008 allotment including an inflation factor, or its projected spending for CHIP in FY 2009. Each state's FY 2009 allotment will be much higher than ever before. In FY 2010 and FY 2012, the allotment will be automatically increased over the previous year's according to inflation factor which accounts for medical inflation and growth in the state's population of children. In FY 2011 and 2013, allotments will be reviewed according to how much each state actually spent the previous year, rather than how much it received, as well as increased due to medical inflation and the growth in the state's population of children. This review ensures state that are not spending their allotments can't withhold that unused funding from states that do. States can request additional funds from CMS if they want to expand CHIP and require more funding than the rebased allotments for FY 2011 or FY 2013 allow. (Google docs, CHIPRA 101)
States are allowed flexibility when designing their eligibility requirements and policies within federal guidelines. The statutory authority for SCHIP is under the title XXI of the Social Security Act. SCHIP is a partnership between federal and state governments. Once a child is enrolled, they are covered for 12 months unless they no longer meet the basic eligibility requirements. A family must renew their coverage every year. Renewal notices are sent 90 days before the end of the benefits. The family must fill out and return the information back to their CHIP insurance company to continue with the benefits.
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