Pennsylvania’s CHIP Expansion to Cover

All Uninsured Kids

State Coverage Initiatives MeetingJanuary 2007

George L. Hoover

Deputy Insurance Commissioner

Pennsylvania Insurance Department

PA – A Leader In Children’s Health Care

1993: PA CHIP began providing free and subsidized health insurance coverage to children of low-income families prior to federal SCHIP legislation implementation.

October 2006: PA General Assembly enacted Cover All Kids legislation to assure that all uninsured PA children have access to affordable health insurance by expanding CHIP.

Statistics of the Uninsured in PA

PA Insurance Department identified the number of people in need of insurance and who they are by completing a state-specific

study of the uninsured (2004) 900,000 Pennsylvanians (8% of population) do not have any type of

health insurance coverage (includes adults and children).

About 133,000 (4% of children) under age 19 do not have health insurance coverage. Most of these children are between the ages of 11 and 18.

Reasons that these children do not have coverage:

∙ Increasing health care costs for families∙ Lack of health care coverage with parents employers ∙ People in transition -- between or without jobs

Expanded CHIP Income Guidelines Eligible families with income under 200% of the

Federal Poverty Level (FPL) (ex. $40,000 for a family of 4) receive free CHIP – no co-pays, no premiums.

Eligible families with income up to 300% of the FPL (ex. $60,000 for a family of 4) receive low-cost subsidized CHIP – low co-pays and premiums.

Families above 300% of the FPL may purchase CHIP at full cost, if they meet the program’s criteria.

Criteria for families under 200% of FPL

Eligible families under 200% of FPL receive free CHIP, with no copayments or premiums. Children must:

• Be Pennsylvania residents.• Not be eligible for Medicaid or have any other

health insurance.• Be under age 19 and meet citizenship

requirements.

Criteria for families between 200% and 300% of FPL

Eligible families between 200% and 300% of FPL receive low-cost (subsidized) CHIP, with low copayments and premiums. Children must:

• Meet same requirements as listed under free CHIP• Additionally, applicants must show that their child has

been uninsured for six months, unless:• The child is under age 2 (pending CMS approval); or• The child has lost health benefits because a parent lost

their job; or• The child is moving from another public insurance

program

Criteria for families over 300% of FPL

Eligible families above 300% of FPL receive full-cost CHIP, and are required to pay copayments and full-cost CHIP premiums. Children must:

• Meet free and low-cost CHIP eligibility requirements.• Additionally, families must show that private coverage:

• Was denied due to a pre-existing condition; or• Was not affordable to the family, which happens

when:• Coverage is more than 10% of annual family

income; or• Premium cost is more than 150% of the CHIP

premium.

Expansive Benefits PackageChildren enrolled in CHIP receive comprehensive

health benefits, including: Preventive medical care (ie. shots and check-ups) Prescription drugs Dental, vision, hearing services Emergency medical care Mental health benefits, inc. partial hospitalization Substance abuse treatment Hospitalization (up to 90 days per year)

Why Expand CHIP to Cover All Kids?

Children have access to healthcare and services needed

Healthier communities – preventive care promoted through health insurance

Healthier kids = Better learners with higher school attendance rates

Providers receive

reimbursement for services

CHIP’s Commitment to Cover ALL Uninsured Kids

Governor Rendell is committed to reaching out to and enrolling all uninsured children.

Expanded program implementation goal date: March 1, 2007

First year enrollment goal: 15,000 kids

Governor Rendell’s 5-year enrollment goal: Insure 67,000 more eligible children

Challenges

Gaining CMS state plan approval Systems ReadinessMaking Process Easier for FamiliesAdequate Federal Funding at

Reauthorization

Reaching Out to Uninsured Children Expanded marketing and outreach efforts

Vital community partner and program advocate network. Agency partnerships and connections to the public (unemployment

centers, health departments, county assistance offices, etc.) Schools (school nurses, PTAs, athletic programs, etc.)

Simplified the application and renewal process by providing several ways to apply for and renew benefits – by paper application, phone, and Internet (1-800-986-KIDS and www.chipcoverspakids.com)

Any Form is a Good Form policy: If kids are eligible for Medicaid, CHIP will make sure that their applications are transferred to the Medicaid program for enrollment and vice versa.

Committed to retaining and re-enrolling eligible children in the program at renewal time. If families fail to respond to renewal notices, the CHIP Helpline calls these families to offer renewal assistance over the phone.

What is on PA’s Horizon?

Next Steps