The Child Health Plus (CHP) program was created by the New York State legislature in 1990 and by August 1991 children had begun receiving coverage under the program. New York’s CHP program served as a blueprint for the federal State Children’s Health Insurance Program (SCHIP) statute, which was enacted in 1997. CHP in NYS originally provided services to children under age 13, but after enactment of SCHIP, NYS expanded the program to include children through age 18.
In 2001, in an effort to provide a seamless health care system for children, the NYS Department of Health renamed Child Health Plus to Child Health Plus B (CHP B). Medicaid’s expanded income eligibility for children became Child Health Plus A (CHP A). A significant change occurred in 2008 when NYS expanded the program’s income eligibility guidelines up to 400% of the federal poverty, simplified the enrollment process and expanded outreach and education efforts.
In 2009 New York State reversed the name of CHP B back to Child Health Plus, and now refers to CHP A as Children’s Medicaid. The distinction is important because Children’s Medicaid is an entitlement program that includes due process rights to notices and fair hearings, whereas Child Health Plus is not an entitlement and has more limited protections, i.e. the grievance process and external review available from all the managed care plans.
Effective January 1, 2014, the ACA requires states to adopt a consistent method for budgeting income when determining eligibility for Child Health Plus. The method is on the applicant’s adjusted gross income that s/he reports on his/her federal income tax with certain modifications, and is known as Modified Adjusted Gross Income (MAGI). When determining household size, the principles of tax dependency will be implemented with a few exceptions. In addition, families now apply for Child Health Plus online through the NY State of Health Marketplace. The benefit package and cost sharing remains the same in NYS, at least through 2019 as states are required to maintain income eligibility levels for their Child Health Insurance Program (CHIP) through September 30, 2019.
WHO ADMINISTERS THE PROGRAM
Within federal guidelines, each state determines the design of its individual CHP program, including benefit package, payment levels for coverage, who qualifies, and administrative procedures.
On the federal level, the overall responsibility for the administration of the Child Health Plus program lies with the Centers for Medicare & Medicaid Services (CMS), an agency of the Department of Health and Human Services.
In New York State, CHP is administered by the NYS Department of Health, Division of Planning, Policy and Resource Development.
The Children’s Health Insurance Program (CHIP) is funded by both Federal and State dollars. New York State receives a federal matching rate of 65%. The remaining amount is covered by New York State funds.
The current reauthorization period of CHIP is extended until September 30, 2015. Beginning October 1, 2015, the ACA will enhance the federal matching rate and funding will continue through September 30, 2019. Beginning October 1, 2019, states will need to demonstrate that they can offer comparable coverage for children through their Marketplace or a Basic Health Plan (if a state establishes one), but only upon a finding by the HHS Secretary that comparable pediatric coverage is provided by participating qualified health plans.
Summary of Child Health Plus
Child Health Plus in NYS offers free or low cost health insurance to uninsured children birth through 18 years old who are ineligible for Medicaid. To qualify, families must have incomes below 400% of the federal poverty level and must be residents of NYS. There are no resource requirements and no immigration criteria. There are no cost-sharing requirements (deductibles, co-payments or co-insurance), but families with incomes above 160% FPL are required to pay a monthly premium.
All CHP health services in NYS are provided through managed care plans. Application for CHP is through the NY State of Health Marketplace, where consumers will be able to apply for and enroll in a CHP health plan online. Currently, until the NY State of Health Marketplace can support the administration of the renewal process, health plans will continue to recertify those children enrolled in their plans on annual basis.
Because CHP is not a Medicaid program, CHP applicants and members do not have the same notice and fair hearing rights that exist under Medicaid. They do, however, have the right to file grievances, request utilization reviews and obtain an external review of plan decisions.