Congress created the Children’s Health Insurance Program (CHIP) in 1997, but the Affordable Care Act (ACA) gave the program new life. Under the 2010 health law, federal funding for the program is extended by 2 years, until Oct. 1, 2015. The law also provides another $40 million in grants to states to promote enrollment and retention in both Medicaid and CHIP.
The ACA assumes that CHIP will be around beyond 2015 by setting current eligibility levels through 2019. The law also calls for increasing the state matching rate for CHIP starting in October 2015, boosting the rate by 23%. That would bring the average federal matching rate to 93% for the program, according to the Centers for Medicare and Medicaid Services. Although the law sets the new enhanced matching rate, Congress will need to pass legislation setting aside the funds in 2015.
Marsha Raulerson
Dr. Marsha Raulerson, who tracks CHIP policy for the American Academy of Pediatrics, discusses the program.
Question: How has CHIP helped to expand access health care?
Dr. Raulerson: CHIP is an extremely important program for children. It provides low-income children from working families with the health care coverage that they need. It’s been a very popular program and continues to expand. In fact, CHIP grew by 1.5 million children nationally in 2010-2011, the last year for which I could find statistics.
In my state, Alabama, there are now 85,000 children covered by a CHIP program run separately from Medicaid. Even though funding for outreach has decreased due to the state budget crisis, the program continues to grow. When you add in the almost 450,000 Alabama children on Medicaid, that means that public insurance covers almost half the children in my state. Outreach under CHIP has also helped to identify uninsured children and bring them into traditional Medicaid as well.
Question: Will CHIP play as big a role in insuring children in 2014, once the state health exchanges come online?
Dr. Raulerson: The exchanges are still pretty much an unknown. In fact, only about half of the states have initiated plans for exchanges right now and I don’t think they’re all going to be up and running by 2014. I also don’t really think that the emphasis on children is going to be as great in the exchanges as it has been in CHIP. So my hope is that we will continue to fund CHIP and it will continue to expand.
Question: Medicaid can be challenging for physicians to deal with. Do you have any similar issues with CHIP?
Dr. Raulerson: In Alabama, we have not had a lot of challenges with CHIP. It’s been a very user friendly program. We have had budget cuts this year, so the outreach is not as good. However, the system was so well set up that it’s continued without a lot of formal outreach efforts. So most pediatricians know about the CHIP program and they know how to get children enrolled. We, as physicians, have stepped up to the plate to see that our patients that are eligible for CHIP have the application and know where to send it, or know how to go online and apply for it.
Question: Are there still children who fall through the cracks? Is there anything in the ACA that can help address this problem?
Dr. Raulerson: We now know that if the parents are insured, it increases the chances that the children will be insured. So some of those children who fall through the cracks live in families where neither parent has insurance and the parents really don’t even think about insurance because they can’t get it themselves. I think once the ACA moves into place and we have the exchanges, and in many states the expansion of Medicaid, more parents can be insured themselves. Then, they will be much more likely to know how to get their children insured.
Question: The ACA extends CHIP funding until October 2015. What happens after that?
Dr. Raulerson: We hope that CHIP will continue. It has been such an excellent program. It has been well received by communities. It’s known as that program for children from working families who previously didn’t have access to employer-sponsored insurance. Families with CHIP coverage feel like they are contributing because they make small copayments. The insurance is affordable, but they do pay something for the insurance so they have ownership. We’ve worked very hard to see that CHIP has benefits that are good for children. In most states, CHIP helps children gain access to dental care, mental health services, and a medical home. The goal is that every child has not only an insurance card, but a card that means something, that has good benefits.