The Children's Health Insurance Program (CHIP), formerly known as the State Children's Health Insurance Program (SCHIP), is a program administered by the U.S. Department of Health and Human Services that provides states with matching funds for health insurance for families with children . The program was intended to cover uninsured children in families with modest but too high incomes to qualify for Medicaid. The program was signed into law as part of the Balanced Budget Act of 1997, and legal authority for CHIP falls under Title XXI of the Social Security Act.
CHIP was formulated after the failure of President Bill Clinton's comprehensive healthcare reform proposal. This legislation to create CHIP, the brainchild of First Lady Hillary Clinton after her health care reform work failed, was co-sponsored by Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch. Despite opposition from some conservatives and Senator Bernie Sanders, SCHIP was included in the Balanced Budget Act of 1997, which President Clinton signed into law in August 1997. At the time of its creation, SCHIP represented the largest expansion of taxpayer-funded health insurance. Coverage. for children in the US since the creation of Medicaid in 1965. The Children's Health Insurance Reauthorization Act of 2009 expanded CHIP and extended the program to an additional 4 million children and pregnant women, and the Bipartisan Budget Act of 2018 extended CHIP authorization until 2027. .
CHIP is designed as a federal-state partnership similar to Medicaid; The programs are administered by each state according to requirements established by the federal Centers for Medicare and Medicaid Services. States have the flexibility to design their CHIP policies within broad federal guidelines, resulting in differences regarding eligibility, benefits, and administration among different states. Many states hire private companies to administer certain portions of their CHIP benefits. Some states have been given authority to use CHIP funds to cover certain adults, including pregnant women and parents of children who receive both CHIP and Medicaid benefits.
CHIP covered 7.6 million children during the 2010 federal budget year, and every state has an approved plan. However, the number of uninsured children continued to rise after 1997, especially among families who did not qualify for CHIP. An October 2007 Vimo Research Group study found that 68.7 percent of newly uninsured children came from families with incomes at 200 percent of the federal poverty level or higher, as more employers removed dependents or eliminating coverage altogether because annual premiums nearly doubled between 2000 and 2006. A 2007 study by researchers at Brigham Young University and the state of Arizona found that children who drop out of CHIP cost their states more money due to increased use of emergency care. A 2018 review of existing research found that the availability of “CHIP coverage for children has led to improvements in access to health care and improvements in health in both the short and long term.”
The fact is that SCHIP has covered millions of low-income children who otherwise would not have had access to health care since 1997.
State administration
Like Medicaid, CHIP is a partnership between the federal and the state governments. The programs are administered by individual states in accordance with the requirements of the federal Centers for Medicare and Medicaid Services. States can design their CHIP programs as a stand-alone program separate from Medicaid (separate children's health programs), use CHIP funds to expand their Medicaid program (CHIP Medicaid expansion programs), or combine these approaches (combined CHIP programs). . States receive enhanced federal funding for their CHIP programs at a higher rate than the regular Medicaid match.
As of February 1999, 47 states had established CHIP programs, but were having difficulty enrolling children. That month, the Clinton administration launched the "Secure Kids Now" campaign, aimed at enrolling more children; the campaign would be under the auspices of the Health Resources and Services Administration. As of April 1999, approximately 1 million children were enrolled, and the Clinton administration set a goal of increasing this number to 2.5 million by the year 2000.
States with separate children's health programs follow the regulations outlined in Section 42 of the Code of Federal Regulations, Section 457. Separate children's health programs have much more flexibility than Medicaid programs. Individual programs can impose cost sharing, tailor their benefit packages, and have great flexibility in eligibility and enrollment. The limits of this flexibility are outlined in the regulations, and states must describe the features of their program in their state CHIP plans. Of the 50 governors, 43 support the renewal of CHIP. Some states have introduced the use of private companies to administer portions of their CHIP benefits. These programs, commonly called Medicaid Managed Care, allow private insurance companies or healthcare organizations to contract directly with a state Medicaid department for a fixed price per enrollee. Health plans then enroll eligible individuals in their programs and become responsible for ensuring that CHIP benefits are delivered to eligible beneficiaries.
In Ohio, CHIP funds are used to enlarge eligibility for the state's Medicaid program. Therefore, all Medicaid rules and regulations (including cost and benefit sharing) apply. Children from birth to age 18 who live in families with incomes above the 1996 Medicaid thresholds and up to 200% of the federal poverty level are eligible for the Medicaid CHIP expansion program. In 2008, the maximum annual income a family of four needed to fall within 100% of the federal poverty guidelines was $21,200, while 200% of the poverty guidelines was $42,400.
Other states have similar CHIP guidelines, and some states are more generous or restrictive in the number of children they allow into the program. With the exception of Alaska, Idaho, North Dakota and Oklahoma, all states have a minimum coverage threshold of 200% of the federal poverty guidelines. The CHIP Medicaid expansion programs generally use the same names for the expansion programs and Medicaid. Individual child health programs often have different names for their programs. Some states also call the CHIP program the "Children's Health Insurance Program" (CHIP).
States can use Medicaid and CHIP funds for premium assistance programs that help eligible people obtain private health insurance. In 2008, relatively few states had premium assistance programs and enrollment was relatively low. However, interest in this approach remained high.
In August 2007, the Bush administration announced a rule requiring states (starting in August 2008) to enroll 95% of families with children earning 200% of the federal poverty level before using the money to families earning more than 250% of the poverty level. federal poverty level. The federal government said 9 of the 17 states that offer benefits to higher-income families are already complying. Opponents of this rule argued that enrolling higher-income families makes lower-income families more likely to enroll, and that the rule showed no compassion toward children who would otherwise be left without health insurance.
Implementations
Eligibility for CHIP
Children up to age 19 from families with incomes too high for Medicaid, but below 200% to 300% of the federal poverty level (FPL), are generally eligible for CHIP. Exact income requirements may vary from state to state. Additionally, a child must be a U.S. citizen, U.S. citizen, or have qualified immigration status to be eligible.
Impact
A 2018 review of existing research found that the availability of “CHIP coverage for children has led to improvements in access to health care and improvements in health in both the short and long term.”
In 2007, researchers from Brigham Young University and the state of Arizona found that children leaving CHIP cost states more money as they move from routine care to more frequent emergency care situations. The study concludes that an effort to reduce the cost of a state health care program could produce false savings because other government organizations foot the bill for children who lose insurance coverage and subsequently need care.
In a 2007 analysis by the Congressional Budget Office, researchers found that "for every 100 children who gain coverage as a result of CHIP, there is a corresponding reduction in personal coverage of between 25 and 50 children." The CBO speculates that this is because state programs provide better advantage at a lower cost to enrollees than personal alternatives. A briefing paper from the libertarian think tank Cato Institute estimated that the “crowdout” of private insurers by the public program could be as high as 60%.
Reauthorization
SCHIP was established in 1997 as a ten-year program; continuing beyond the 2007 federal budget year required passage of a reauthorization bill. The first two reauthorization bills to pass Congress would also expand the scope of the program; President George W. Bush vetoed inappropriate expansions. In December 2007, the President signed a two-year reauthorization bill into law, which would simply expand current CHIP services without expanding any part of the program. When the 2008 presidential and congressional elections gave Democrats control of the Oval Office and expanded majorities in both houses of Congress, CHIP was reauthorized and expanded through fiscal year 2013 in the same bill.
2007 reauthorization
HR 976
In 2007, both houses of Congress passed a bipartisan ad measurement to expand the CHIP program, H.R. 976. The measure would have expanded coverage to more than 4 million additional participants by 2012, while phasing out most state expansions of the program, which would include adults other than pregnant women. The bill called for a budget increase over five years to a total of $35 billion, which would increase total CHIP spending to $60 billion for the five-year period. Opposition to HR 976 focused on the $35 billion increase in government health insurance, as well as the $6.5 billion in Medicaid benefits for illegal immigrants. Originally intended to provide health care coverage to low-income children, HR 976 was criticized as a giveaway that would have benefited both adults and non-U.S. citizens. The expansion of the program would have been financed by a sharp increase in federal excise taxes on tobacco products. On the other hand, opponents said this proposed expansion was aimed at families with annual incomes up to $82,600 (400 percent of the federal poverty level).
On October 3, 2007, President Bush vetoed the bill, stating that he believed it would "federalize" health care, expanding CHIP's reach far beyond its original intent. The veto was the fourth of his administration. After his veto, Bush said he was open to a compromise that would include more than the $5 billion originally budgeted, but that he would not accept any proposal that would dramatically expand the number of children eligible for coverage.
On October 18, 2007, the House of Representatives fell 13 votes (273–156) short of the two-thirds majority needed to override the president's veto, although 44 Republicans joined 229 Democrats in supporting the measure.
HR 3963
A week after the failed vote to override the veto, the House passed a second bill seeking a similar expansion of CHIP. According to Democrats, the second bill, H.R., created 3,963, stricter income eligibility limits, barred adults from participating, and barred children of illegal immigrants from receiving benefits. However, opponents say this proposed second expansion targeted families with annual incomes up to $62,000 (300 percent of the federal poverty level). The Senate passed the measure on November 1, 2007, but on December 12, 2007, Bush also vetoed this bill, saying it was "essentially identical" to previous legislation, and a vote in the House of Representatives in January of 2008 failed to annul it. the veto.
Pub. L.Tooltip Public Law (United States), which extended CHIP funding through March 31, 2009, and was signed into law by the President on December 21, 2007.
The reauthorization law also changed the name of the program from "SCHIP" to simply "CHIP."
2009 reauthorization
Following the inauguration of President Barack Obama and the emergence of Democratic majorities in both chambers of Congress, legislative leaders moved quickly to break the political impasse over CHIP expansion. On January 14, 2009, the House of Representatives approved H.R. 2 by a vote of 290-138. The bill authorized spending and added $32.8 billion to expand the health care coverage program to approximately 4 million additional children, including coverage for legal immigrants without a waiting period for the first time. A 62-cent increase in the cigarette tax, bringing the total tax on a pack of cigarettes to $1.01; an increase in the chewing tobacco tax of $0.195 per pound. up to $0.50/lb. – as well as tax increases on other tobacco products were proposed as a funding source for program expansion. On January 29, the Senate passed the House bill by a margin of 66 to 32, with two amendments. The House passed the amended version by a vote of 290 to 135, and President Obama signed the bill into law on February 4, 2009 as Pub.L.Tooltip Public Law (United States).
2017 expiration and 2018 reauthorization for 6 additional years
CHIP expired on September 30, 2017. At that time, most states had enough resources to keep the program running for months.
On September 18, 2017, Senators Orrin Hatch and Ron Wyden introduced the Keeping Children's Insurance Safe and Reliable (KIDS) Act (Bill S.1827), which would fund CHIP through 2022. On November 3, 2017, The House of Representatives passed the CHAMPION Act, which would also fund CHIP through 2022.
On January 22, 2018, President Trump signed legislation reauthorizing CHIP for six years. Bill H.195 (known as the Federal Register Printing Savings Act of 2017, including the Continuing Appropriations Extension Act of 2018) passed the House of Representatives by 266 votes to 150, and the Senate by 81 to 18. Fifteen Senate Democrats and 144 House Democrats voted against the bill because they opposed ending a three-day government shutdown without legally enshrining the DACA program for certain undocumented immigrants.
On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, reauthorizing CHIP for four years. The bill passed by a vote of 71 to 28 in the Senate and by a vote of 240 to 186 in the House of Representatives. President Trump signed the bill that same day, extending CHIP through 2027.
See also
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