This week, National Academy for State Health Policy and Georgetown University’s Center for Children & Families released a joint report analyzing Children’s Health Insurance Program (CHIP) coverage in 42 separate programs in 38 states. For the past 17 years, CHIP has given states federal funds to operate public health insurance programs designed for children. New York’s own version of the program, Child Health Plus, has been running even longer – 2014 marks it’s 24th year!
Why the focus on CHIP coverage now? The ACA extends CHIP funding through 2015, but after that point the future is somewhat uncertain. By April 15, 2015, the Secretary of HHS will have to determine if coverage offered under the new Qualified Health Plans is “at least comparable” to the benefits and cost-sharing in CHIP. States will soon after have the option to cover children through comparable QHPs. It’s important that advocates and consumers alike know and voice the benefits of CHIP, which has been responsible for millions of children gaining coverage since it’s inception. More children are gaining coverage through the program all the time – recent enrollment numbers show over 80,000 children enrolled in New York’s Child Health Plus program between October 1 and April 15, nearly 70,000 of whom are newly uninsured.
There are federal rules for certain aspects of CHIP coverage and costs – for example, the cost paid by families can’t be more than 5% of their income. Within these requirements States still have a fair amount of flexibility to choose benefits and cost-sharing for enrollees. The report finds that CHIP programs generally offer comprehensive coverage with low cost-sharing. About 1/3 of the programs provide benefits very like the Medicaid packages in their state, which are known for being very comprehensive. Plans generally cover basic physical, hospital, and laboratory services without limitations; all plans cover dental, vision, and hearing services, though with varying limitations. Most programs charge some sort of premium, but about 1/3 of the programs have no cost-sharing.
New York’s Child Health Plus, is one of the most generous in the country, offering subsidized coverage for any child up to 19 from families up to 400% of the Federal Poverty Level. Premiums range from $9 per child for those just above the Medicaid level, to $180 for those at the 400% of FPL who live in high cost regions of the state. New York is also one of the states with no cost-sharing beyond premiums, making Child Health Plus a particularly affordable option. And, coverage is open to any child, regardless of immigration status. Children in families with incomes above 400% FPL can still buy into the program at full price.
Child Health Plus covers most services without limitations, including physician, hospital, and lab services, prescription drugs, pre-natal care vision and dental services. Uncovered services include nursing care, case management, and care coordination, as well as non-Emergency Transport. And, a few services, like orthodontics and outpatient mental health services, are covered with limitations.
For more on coverage and costs, including a handy table for Child Health Plus on page 91, visit the full report.
Want to learn more about children’s health coverage in New York? Join HCFANY for our Children, Youth and Families Task Force Meeting on May 28 in Albany. More details here.