March 4, 2009

Dear Partners,

The signing of the CHIP bill (the "S" has now been officially been dropped from the name) earlier this month was a huge victory for all of us, and we would like to thank you again for your great work in helping to make this happen. 

With this law comes a new set of opportunities for implementation at the state level. We wanted to provide you with a brief overview of the CHIPRA 2009 provisions to help you better understand the options available to states as you begin CHIP implementation efforts. We also have provided a timeline of the effective dates for new CHIP provisions at the end of the Alert. 

Much of the information in this overview was derived from a more detailed summary of CHIPRA 2009 written by Georgetown's Center for Children and Families. To view the CCF summary, please click here. 

Overview of CHIPRA 2009 Provisions

Eligibility

• Moderate Income Children

Provides states the flexibility to expand CHIP eligibility to any income level, but reduces the federal matching rate for expansions to children above 300% of the Federal Poverty Level (FPL) from the enhanced CHIP rate to the lower Medicaid rate. 

• Legal immigrant children and pregnant women

Allows states the option to receive federal funding to provide Medicaid and CHIP coverage to legally residing immigrant children and pregnant women, with no five year waiting period.

• Pregnant Women

Establishes a new statutory option for states to use CHIP funds to cover pregnant women with incomes at or below the state's income eligibility level for children. To cover pregnant women through CHIP, states must cover children in CHIP up to 200% FPL and pregnant women in Medicaid up to 185% FPL.

• Parents and Childless Adults

Eliminates new CHIP waivers to cover parents and childless adults and phases out existing CHIP waivers for these populations. Current childless adult waivers expire in December 2009 and parent waivers expire in September 2011. Both populations can apply for extensions if their coverage ends before these dates.

Funding

• National Funding Level

Provides $68.9 billion in national CHIP allotments for fiscal years 2009 through 2013. 

• State-Specific Allotments

New formula distributes the available CHIP funds among states based largely on their actual use of and need for such funds. The new law also reduces the period during which a state can use an annual CHIP-allotment from three to two years. To view the federal allotments for each state under CHIPRA 2009, click here.

• Contingency Fund

Provides states with additional money if they face a CHIP funding shortfall and their enrollment of children exceeds a target level based on state enrollment figures and projections.

• "Qualifying States"

The states that significantly expanded Medicaid coverage for children prior to the enactment of CHIP in 1997 are allowed to use funds from their fiscal year 2009 through 2013 CHIP allotments to draw down the difference between the Medicaid matching rate and the enhanced matching rate for children in Medicaid with family incomes above 133% FPL. The "qualifying states" in New England are Connecticut, New Hampshire, Rhode Island, and Vermont.

Outreach and Enrollment

• Citizenship Documentation

Allows states to document citizenship by electronically submitting the names and Social Security numbers of individuals to the Social Security Administration. States will receive an enhanced match for the development and maintenance of such an electronic system beginning January 1, 2010. 

Effective immediately, individuals who meet other eligibility requirements must be provided benefits while they are proving their citizenship.

• Outreach and Enrollment Activities

Allocates $100 million for fiscal years 2009 through 2013 to support Medicaid and CHIP outreach and enrollment activities. $10 million is allocated for a national campaign, $10 for Native American child outreach, and the remaining $80 million will be distributed as outreach and enrollment grants to state and local governments and other eligible organizations.  The HHS Secretary will largely determine how these grants are allocated.

• Translation and Interpretation

Provides an enhanced matching rate in CHIP and Medicaid for translation and interpretation services.

• Performance Bonuses

Provides payments to states that implement at least five of eight enrollment and renewal procedures for CHIP and Medicaid and increase the enrollment of children already eligible for Medicaid above a target level (based on FY2007 enrollment in Medicaid, adjusted over time by a state's annual child population growth plus an additional percentage). The eight enrollment and renewal procedures are:

1. Adopt 12-month continuous eligibility for all children
2. Eliminate the asset test for children
3. Eliminate in-person interview requirements at application and renewal
4. Use joint applications and the same application and renewal verification process for CHIP and Medicaid
5. Allow for administrative or paperless verification at renewal
6. Use presumptive eligibility when evaluating children's eligibility for coverage
7. Exercise the new option to use "Express Lane" eligibility (see bullet below for explanation)
8. Exercise the new option to provide premium assistance subsidies for the purchase of employer-sponsored coverage

• Express Lane

Gives states the opportunity to use relevant findings from other public programs, like school lunch, food stamps, and WIC, when determining children's eligibility for CHIP and Medicaid at enrollment or renewal. Children can then be enrolled in CHIP without an application if information required to make an eligibility determination can be obtained from these other data sources.

Quality

• Quality of Care Funding

Provides $225 million over fiscal years 2009 through 2013 for child health quality improvements, including the development and dissemination of new child-specific health quality measures, the creation of a new model electronic medical record for children, and demonstration projects on quality improvement and health information technology for children.

Benefits

• Dental Requirement

Requires CHIP plans, starting October 1, 2009, to include coverage of dental services. 

• Supplemental Dental-only Coverage

Allows states to provide dental-only supplemental coverage or cost-sharing protections for dental coverage to otherwise eligible children who have private health insurance. A state can determine at what income level children are eligible for this benefit, but the income limit cannot exceed the state's CHIP income level.

Timeline

February 4, 2009 (Implementation Date)	States can receive only the Medicaid (rather than the CHIP) matching rate for new expansions to children above 300% FPL HHS can no longer grant CHIP waivers for coverage of parents New rules for "qualifying states" go into effect States must allow eligible individuals to receive benefits while proving citizenship
April 1, 2009	The effective date of most provisions in the law, including new CHIP financing structure and state options to:  Eliminate the 5-year waiting period for lawfully resident immigrant children and pregnant women in Medicaid and CHIP Cover pregnant women in CHIP without a waiver Use Express Lane eligibility in Medicaid and CHIP Provide supplemental dental coverage to privately-insured children Employ new premium assistance options in Medicaid and CHIP
October 1, 2009	CHIP plans will be required to provide dental coverage
January 1, 2010	Citizenship documentation extended to CHIP; states can begin to use the new electronic option for verifying citizenship status Existing childless adult waivers terminated HHS must release core set of child health quality measures for Medicaid and CHIP
January 1, 2011	HHS must establish Pediatric Quality Measures Program
September 30, 2011	Existing parent waivers are terminated

We will continue to pass along information on the CHIP implementation process as we receive it. As always, please feel free to contact me (617-275-2929, arosenthal@communitycatalyst.org) directly with questions.

Sincerely,

Amy Rosenthal
Project Director