Pennsylvania’s CHIP Expansion to Cover All Uninsured Kids

1. Pennsylvania’s CHIP Expansion to Cover All Uninsured Kids

2. State Coverage Initiatives MeetingJanuary 2007 George L. Hoover Deputy Insurance Commissioner Pennsylvania Insurance Department

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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.

9. Expansive Benefits Package Children 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)

10. 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

11. 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

12. Challenges • Gaining CMS state plan approval • Systems Readiness • Making Process Easier for Families • Adequate Federal Funding at Reauthorization

13. 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.

14. What is on PA’s Horizon? Next Steps