An introduction to managed care in CHIP
- Collection:
- Health Policy and Services Research
- Author(s):
- Schneider, Andy, author Klukoff, Hannah, author Lehan, Maclaine, author
- Contributor(s):
- Georgetown University. Center for Children and Families, issuing body.
- Publication:
- [Washington, DC] : Georgetown University Health Policy Institute, Center for Children and Families, March 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Managed Care Programs Medicaid State Health Plans United States Children's Health Insurance Program (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- The Children’s Health Insurance Program (CHIP) was enacted 25 years ago.1 Today it provides coverage for children whose family incomes are too high to allow them to qualify for Medicaid but too low to enable them to afford private health insurance coverage. Together, CHIP and Medicaid insure over half of the nation’s 77.8 million children under 19. (Medicaid insures 34.2 million children and 47.2 million adults). These two programs are the main reason that the rate of uninsured children has fallen to 5.4 percent. CHIP is a block grant. The federal government makes a fixed allotment of funds available on a matching basis to each participating state each year to provide health care services to children (and/or some pregnant women) in low-income families who are not eligible for Medicaid or enrolled in private health insurance coverage. The federal matching rate4 for state spending (up to each state’s allotment) is significantly higher (ranging from 65 percent to 84.5 percent in 2023) than the matching rate a state receives under Medicaid (ranging from 50 percent to 78 percent in 2023). Federal spending on CHIP in FY 2023 is estimated6 at $18 billion. States are not required to participate, but all have chosen to do so. They have broad flexibility in designing and administering their programs. One of many CHIP design choices states have is whether to operate a separate CHIP program or enroll CHIP children in their Medicaid program (or do a combination of both). According to the Medicaid and CHIP Payment and Access Commission (MACPAC), only 10 states (Alaska, Hawaii, Maryland, New Hampshire, New Mexico, North Dakota, Ohio, South Carolina, Vermont, and Wyoming) and the District of Columbia currently do not have a separate CHIP program. (These categories are not static; North Carolina, currently a combination state, has announced it will merge its separate CHIP program into Medicaid on April 1, 2023). Six states operate separate CHIP programs for pregnancy coverage only (Illinois, Michigan, Minnesota, Nebraska, Oklahoma, and Rhode Island). In these six states, as well as in the ten states (and the District of Columbia) that do not have a separate CHIP program, all of the CHIP-eligible children are enrolled in Medicaid. That leaves 34 states with separate CHIP programs for children from birth up to age 19. (California’s separate CHIP program is limited to three counties (San Francisco, Santa Clara, and San Mateo)). Two of the 34 states (Connecticut and Washington) enroll all of their CHIP-eligible children in separate CHIP programs. The remaining 32 states enroll some of their CHIP children in a separate CHIP program and others in Medicaid. MACPAC reports10 that of the 8.6 million children ever enrolled in CHIP during 2021 (even for only one month), 3.4 million were served by separate CHIP programs.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (10 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918697352706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918697352706676