The Children’s Health Insurance Program (CHIP) is designed to provide health insurance coverage to children in families, who are unable to afford private insurance on their own, yet having an income that is too high for them to qualify for Medicaid. Just like the Medicaid program, CHIP is administered by the states, and is jointly funded by the federal government and the individual states as well, with a federal matching rate for state CHIP programs being typically 15 percentage points higher than that of Medicaid.  To clarify, if a state has a 50% matching rate on Medicaid, the matching rate for CHIP would be 65%.

The CHIP Program began in 1997 and covers more than 8 million children in families with income which is too high for Medicaid coverage.

Each state administers its own CHIP program with broad guidance from CMS.  The guidelines allow for the CHIP program to be designed as follows:

  • As a Medicaid Expansion –  which has been done in 7 states, Washington DC and 5 Territories
  • As a separate Child Health Insurance Program – which has been done in 17 states
  • A combination of a Medicaid Expansion and as a separate child health insurance program – which has been done in 26 states.

CHIPRA

The Children’s Health Insurance Program Reauthorization Act or CHIPRA was signed in 2009. CHIPRA provided additional funding for CHIP along with making improvements to both the Medicaid and CHIP programs. In addition, CHIPRA authorized new federal funding designated to be used at outreach to children who are eligible for CHIP or Medicaid, yet were not enrolled. This included a $100 million funding to which would be made available between fiscal years 2009 and 2013. Those funds were to be used in this fashion:

  • $10 million for a national outreach campaign
  • $10 million in grants to Native American tribes, Native American Health Service providers and other tribal health care providers
  • $80 million in grants to promote both enrollment and retention in Medicaid and CHIP.

How The Affordable Care Act Affects CHIP

The Affordable Care Act, signed in 2010, will maintain the CHIP eligibility standards that are currently in place through the year 2019. The Affordable Care Act also extends CHIP funding through to October 1, 2015. At that time, the already enhanced CHIP federal matching rate will increase to 23%. This will bring the average federal matching rate for CHIP to 93%. In addition, the Affordable Care Act also provides for an additional $40 million in federal funding to continue the efforts already in place by CHIPRA for the promotion of enrollment – and retention – in CHIP and Medicaid.

Who can qualify for CHIP?

Every state has its own CHIP program, each with a unique design of coverage, benefits, eligibility and application process.  The following are standard guidelines for coverage – each individual states criteria may be slightly different.

  • Uninsured families with uninsured children up to age 19
  • Children and Pregnant women who are lawfully residing in the United States.
  • Children of public employees
  • Income eligibility – this varies by state, however 46 states and the District of Columbia will cover children under CHIP if the family income is at (or above) 200% of the Federal Poverty Level. While 24 states cover children in families with an income at (or above) 250% of the Federal Poverty Level.

What is covered under CHIP?

The CHIP program provides comprehensive benefits to children, however, each state has flexibility to design their own CHIP program (within federal guidelines) so benefits will vary state to state.  However, the following services are covered universally under CHIP:

  • Routine check-ups
  • Immunizations
  • Dental care, visit to dentist, cleanings, and fillings
  • Vision care including eye exams and glasses
  • Inpatient and outpatient hospital care and services
  • Laboratory and X-ray services
  • Medical supplies
  • Choice of doctors and regular checkups and visits
  • Prescription drugs
  • Services of medical specialists
  • Mental health care
  • Treatment of special health needs
  • Treatment of preexisting conditions
  • Preventive care at low premiums and other cost-sharing

Costs for CHIP

Health insurance through CHIP is designed so that insurance can once again be affordable for families. The enrollment fees and co-sharing payments are decided on the basis of family’s income. Some services such as routine check-ups are free whereas certain services may require a  co-sharing fee – similar to a co-payment. Some states charge a monthly premium for this type of health coverage. The premium differs state to state, however it cannot exceed 5% of the families monthly income.