After enacting the Children's Health Insurance Program (CHIP) on August 5, 1997, as Title XXI of the Social Security Act, Utah began exploring how to implement the federal program under the Center for Medicare and Medicaid Services.
Overview
CHIP is covered by Medicaid in seven states, five territories, and the District of Columbia. In 26 states it is administered along with Medicaid. In the remaining seventeen states, including Utah, it is an independently administered program. As a publicly funded, majority-funded, and independently administered program, CHIP in Utah has achieved many of the goals for which it was designed; It has successfully helped thousands of children access timely medical care who would otherwise not be covered, as well as coverage for others who would be considered “uninsurable.”
Utah administration
By comparison, in 2012, about one-third of all American children (36 million total in 2011) received health insurance through CHIP or Medicaid; seven million are funded solely through CHIP. In Utah, as of January 2012, 62,071 children (7%) are enrolled in CHIP, 237,125 (27%) in Medicaid, and 100,674 (11.4%) remain uninsured.
Current maximum income thresholds in Utah range from $30,260 per year for a single parent with one child, $46,100 for a family of four (two parents and two children or a single parent and three children), and up to $69,860 for a family of seven. See the chart below for a list of income thresholds in Utah.
| Family Size | Maximum Gross Income Per Month | Maximum Gross Income Per Year |
|---|---|---|
| 2 | $2,522 | $30,260 |
| 3 | $3,182 | $38,180 |
| 4 | $3,842 | $46,100 |
| 5 | $4,502 | $54,020 |
| 6 | $5,162 | $61,940 |
| 7 | $5,822 | $69,860 |
Utah coverage
In Utah, the CHIP program provides coverage for doctor visits, well-child exams, prescription drugs, hospitalization, labs and x-rays, hearing and vision exams, mental health care, physical therapy, and dental care. Enrollment in CHIP requires that the child be a US citizen. CHIP also requires that no other health insurance exists. If a child covered by CHIP is found to have additional insurance, the child will immediately lose his or her CHIP coverage. Currently, parents in Utah cannot enroll in CHIP and pregnant women cannot enroll.
Utah funding
In Utah, the majority of funding is federal, with a federal interest rate of $4 for every $1 Utah spends on CHIP. Most of the state funding comes from the outcome of the Comprehensive Tobacco Agreement.
At the federal level, the CHIP program is also funded in part by appropriations from Congress, using a federal funding formula based on several elements, including the number of eligible children in the CHIP population and the share of uninsured low-income population. income. This formula produces a rate known as the Federal Medicaid Medical Assistance Percentage (FMAP). To generate interest in CHIP and provide an incentive for CHIP enrollment, there is typically an enhanced coverage rate of 15 points higher than that of Medicaid. Therefore, if a state receives a 60% match rate for Medicaid, it will likely receive a 75% match rate for CHIP. As of 2012, the average Medicaid match nationally is 71% and Utah currently receives 79.69% for CHIP.
Because CHIP is a limited program, the Centers for Medicare and Medicaid Services (CMS) determines each budget year how much funding it will allocate to each state. In fiscal year (FY) 2009, states received a total of $3.15 billion from CMS, with an additional $7.48 billion in federal funds. That same year, Utah contributed $14.34 million to the program with federal funding of $55.61 million.
From October 1, 2015, the federal government's enhanced funding rates will increase from 15 to 23 points, bringing the average to 93%.
Utah enrollment
CHIP programs have ambitious enrollment goals. To recruit as many candidates as possible, the program collaborates with other government and educational organizations. At the federal level, CHIPRA provided additional grants to many states to fund these programs. States have used partnerships to supplement coverage. For example, the Utah Health Insurance Premium Partnership (UPP) is designed to help families pay premiums and can be used as a substitute for CHIP or to assist with CHIP premium payments.
Future issues
In the state of Utah, some of the issues facing CHIP involve pregnant mothers, who are not currently covered. Pregnant women who do not receive prenatal care are “more than 3.5 times more likely to have a low birth weight baby (a leading cause of infant mortality) and almost three times more likely to have a preterm birth than other pregnant women.” When adopting CHIPRA 2009, several states decided to modify their programs to include pregnant women; Utah has not made that decision.
Utah children insured
By the 10th anniversary of CHIP's adoption in 2008, Utah had covered 134,735 children, and that year the average monthly enrollment was 34,588. In fiscal year 2010, monthly enrollment was 42,006 and the average cost per child for coverage was $1,812 per year, which is equivalent to $151 per month.
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