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Children's Health Insurance Program

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The Children's Health Insurance Program (CHIP) is a public healthcare program for children in low-income families that make too much to qualify for Medicaid. CHIP is financed by both the states and the federal government, while states retain general flexibility in the administration of its benefits. CHIP was created in 1997 when Congress passed the Balanced Budget Act; $20 billion was appropriated for the program through 2007. The program has been reauthorized several times since then. In 2014, Medicaid and CHIP together covered 37 percent of children nationwide. About 8.9 million children were enrolled in CHIP in 2016.

HIGHLIGHTS
  • Upper income limits for eligibility for CHIP vary across the country, from 175 percent of the federal poverty level (FPL) in North Dakota to 405 percent of the FPL in New York.
  • As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing.
  • Total spending on the Children's Health Insurance Program nationwide amounted to $15.4 billion in fiscal year 2016.

    • Overview

    The Children's Health Insurance Program (CHIP) is a public healthcare program for low-income children who are ineligible for Medicaid. CHIP and Medicaid are closely related programs, and the former was meant to build on Medicaid's coverage of children. States may run CHIP as an extension of Medicaid, as a separate program, or as a combination of both. Like Medicaid, CHIP is financed by both the states and the federal government, and states retain general flexibility in the administration of its benefits.[1]

    However, there are some differences between the two programs. CHIP is available specifically for children whose families earn too much income to qualify for Medicaid, meaning they must earn incomes above 138 percent of the federal poverty level, or $33,534 for a family of four in 2016. States also have greater flexibility in designing their CHIP programs than Medicaid. Fewer benefits are required to be covered under CHIP, and states can charge copayments for some services and a monthly premium; the total cost of these requirements may be no more than 5 percent of a family's annual income.[1][2][3][4]

    Additionally, federal appropriations for CHIP are capped, meaning the Centers for Medicare and Medicaid Services (CMS) receives a fixed allotment each year for the program, which is then doled out to states. State CHIP programs receive matching federal funds similar to Medicaid, but at a higher rate: the average federal match rate for CHIP was 70 percent in 2014, compared to 57 percent for Medicaid.[1][5]

    According to the Henry J. Kaiser Family Foundation, Medicaid and CHIP together covered 37 percent of children nationwide in 2014. About 8.9 million children were enrolled in CHIP in 2016. In 2012, the percentage of children that were uninsured was 7 percent, compared to 15.4 percent of the nation at large.[1][6][7]

    Eligibility limits

    Eligibility limits for the Children's Health Insurance Program (CHIP) are expressed as a percentage of the federal poverty level and vary across the country, from 175 percent of the federal poverty level (FPL) in North Dakota to 405 percent of the FPL in New York.[8]

    The Affordable Care Act (ACA), also known as Obamacare, required states to cover children 18 years old and younger through Medicaid if their families earn incomes less than 138 percent of the FPL. Low-income children whose families earn more than 138 percent of the FPL, and are therefore ineligible for Medicaid, may be enrolled in CHIP, and states have some flexibility in determining the upper income limits for eligibility to enroll. However, under the ACA, states cannot reduce the eligibility thresholds for CHIP from the date of the law's enactment through 2019.[1]

    The map below displays the upper income limits for eligibility to enroll in CHIP by state as of 2017. Hover over a state to view the upper income eligibility limit in that state. One caveat that should be noted is that in some states, eligibility limits vary by age group. For instance, the upper income limit in New Mexico was 305 percent of the FPL for children ages five and under, but for children ages six to 18, the eligibility limit was 245 percent of the FPL. These variations are not reflected in the map below; the map only displays the highest eligibility limit in each state, for whichever age group it may be. Below the map is a table displaying various percentages of the 2016 federal poverty level as dollar amounts. Click [show] on the red bar to view the table.

    Premiums and cost sharing

    Under the Children's Health Insurance Program (CHIP), states have greater flexibility than in Medicaid to require enrollees to pay monthly premiums or cost-sharing amounts such as copayments. As with Medicaid, the total cost of these payments for enrollees may not exceed 5 percent of household income, but states do not need a waiver to charge premiums and cost sharing under CHIP like they do under Medicaid.[9]

    As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing. Because of the tighter restrictions on premiums and cost sharing under Medicaid, just three of the nine states that serve CHIP enrollees exclusively through Medicaid impose either requirement on enrollees.[9]

    The map below displays CHIP premium and cost-sharing requirements across the country as of October 2017. Hover over a state to view the requirements for that state, as well as the lowest income level—shown as a percentage of the federal poverty level—at which such requirements begin to apply. One caveat that should be noted is that in some states, the income level at which premium and cost-sharing requirements apply may vary by the child's age; these variations are not reflected in the map.[9]

    General information

    The table below contains general information about each state's CHIP program. As of October 2017, 29 states served CHIP enrollees through a combination of a separate program and Medicaid (known as combination programs). Nine states, including the District of Columbia, served CHIP enrollees only through Medicaid, and 13 states administered only a separate program. About 8.9 million children were enrolled in CHIP in 2016, and total spending for the program amounted to $15.4 billion during that year. The minimum federal match percentage was set at 88 percent for 2017, meaning at least 88 cents of every state dollar spent on CHIP was eligible for matching federal funds. Click [show] on the red bar below to view the data for all 50 states.[10][11][12][13]

    History

    In 1997, creating a public health program for children was a priority of then-President Bill Clinton (D), as outlined in his State of the Union address that year. The first proposal for the program, however, was killed in Congress because it "threatened budget negotiations with Republicans," according to The Washington Post. A few weeks later, legislation for the program was again introduced, and then-First Lady Hillary Clinton encouraged the White House to support the bill. In August 1997, the Balanced Budget Act was enacted, which created the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. The law provided $20 billion for the program over 10 years and set it to expire in 2007. Because it is a block grant program with fixed annual funding, CHIP requires reauthorization from Congress in order to remain in place. CHIP was reauthorized for two years in 2007 after funding for the program lapsed for about two weeks. In 2009, CHIP was reauthorized through fiscal year 2013.[1][14][15][16][17][18]

    In 2010, President Barack Obama signed the Affordable Care Act (ACA). Among its provisions were some changes related to CHIP. The ACA prohibited states from narrowing CHIP eligibility thresholds from those that were in place on the date of the law's enactment. The law also extended CHIP's reauthorization past 2013, appropriating funds for the program through September 2015. States also received a 23 percentage point boost to the match rate for federal funds from 2016 through 2019, contingent upon further reauthorization. Congress granted a further reauthorization of CHIP in April 2015 with the passage of the Medicare Access and CHIP Reauthorization Act (MACRA), extending CHIP through September 2017. This meant that in 2016 and 2017, a greater percentage of state funding for CHIP was eligible for federal matching funds.[1][14]

    Only one state has ever closed its CHIP program, Arizona. In 2010, citing a budget deficit, the state froze enrollment in the program, allowing individuals already enrolled to remain in the program, but no new enrollees to join. In 2012, the federal government negotiated with Arizona to open a temporary CHIP program that would run until the ACA's health insurance exchanges opened in January 2014. After that date, the program closed and only about 1,000 children were served through CHIP in the state. On May 6, 2016, Governor Doug Ducey (R) signed legislation restoring Arizona's CHIP program, with an opening date of July 26, 2016.[19][20][21]

    Recent news

    The link below is to the most recent stories in a Google news search for the terms Children's Health Insurance Program. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

    Children's Health Insurance Program - Google News

    See also

    Medicaid spending in the 50 states

    Click on a state below to read more about Medicaid spending and benefits in that state.

    http://ballotpedia.org/Medicaid_spending_in_STATE

    External links

    Footnotes

    1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 The Henry J. Kaiser Family Foundation, "Children’s Health Coverage: Medicaid, CHIP and the ACA," March 26, 2014
    2. ↑ Healthcare.gov, "The Children's Health Insurance Program (CHIP)," accessed March 24, 2016
    3. ↑ National Health Law Program, "Q & A: The Supreme Court's Decision on the ACA's Medicaid Expansion," July 23, 2016
    4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named poverty
    5. ↑ Medicaid.gov, "Financing," accessed May 26, 2016
    6. ↑ Medicaid.gov, "Children's Health Insurance Program (CHIP)," accessed May 24, 2016
    7. ↑ United States Census Bureau, "Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2012," accessed November 4, 2015
    8. ↑ The Henry J. Kaiser Family Foundation, "Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level," accessed May 25, 2016
    9. ↑ 9.0 9.1 9.2 Kaiser Family Foundation, "Premium, Enrollment Fee, and Cost Sharing Requirements for Children, January 2017," accessed June 9, 2017
    10. ↑ Medicaid and CHIP Payment and Access Commission, "CHIP Spending by State," accessed October 4, 2017
    11. ↑ The Henry J. Kaiser Family Foundation, "Enhanced Federal Medical Assistance Percentage (FMAP) for CHIP," accessed October 4, 2017
    12. ↑ The Henry J. Kaiser Family Foundation, "CHIP Program Name and Type," accessed October 4, 2017
    13. ↑ The Henry J. Kaiser Family Foundation, "Total Number of Children Ever Enrolled in CHIP Annually," accessed October 4, 2017
    14. ↑ 14.0 14.1 National Conference of State Legislatures, "Children's Health Insurance Program Overview," accessed May 26, 2016
    15. ↑ American Dental Education Association, "Children’s Health Insurance Program Funding Extended Through 2017," May 19, 2015
    16. ↑ The New York Times, "Through Senate Alchemy, Tobacco Is Turned Into Gold for Children's Health," August 11, 1997
    17. ↑ The Washington Post, "Recidivism Watch: Hillary Clinton’s claim about her role in creating a child health program," June 27, 2016
    18. ↑ Children's Defense Fund, "Timeline of SCHIP Reauthorization," accessed November 30, 2017
    19. ↑ FiveThirtyEight, "What Canceling An Insurance Program Meant For Arizona’s Kids," January 16, 2015
    20. ↑ Arizona Capitol Times, "Ducey signs KidsCare children’s health insurance bill," May 6, 2016
    21. ↑ Arizona Health Care Cost Containment System, "KidsCare - Arizona's Children's Health Insurance Program (CHIP)," accessed May 27, 2016
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