Expect changes to CHIP as ACA ramps up

A Government Accountability Office (GAO) report says there is still some uncertainty on what will or should happen with children who are currently on the Child Health Insurance Program (CHIP) as Affordable Care Act (ACA) provisions come into play.

CHIP is a joint federal-state program that covers over 8 million children living in households that had incomes too high for Medicaid, but that could not afford private health insurance, at least not before ACA implementation.

The ACA appropriated CHIP funding through October 2015, the end of the 2015 fiscal year. At that point, states without enough CHIP funding must ensure that children who would otherwise be eligible for CHIP are enrolled either in Medicaid or in a qualified health plan under the ACA, certified by the Department of Health and Human Services (HHS) as comparable to CHIP. The question is: Will those qualified health plans really be equivalent to CHIP?

To get a preview, the GAO looked at the “benchmark plans” that have been chosen in 5 states (Colorado, Illinois, Kansas, New York, and Utah) as models for benefits under the ACA. It found that although the plans were comparable to CHIP in what they covered, there were some differences. For example, the benchmark plan in Kansas did not cover hearing aids or hearing tests, although all CHIP plans cover at least 1 of those services.

“Similarly, 2 states’ CHIP plans and 3 states’ benchmark plans did not cover certain outpatient therapies-known as habilitative services-to help individuals attain or maintain skills they had not learned due to a disability,” the GAO said.

In addition, costs to the children’s families were almost always less in the 5 reviewed states’ CHIP plans than they were in their state’s benchmark plans for a number of services. The GAO says the cost difference was “particularly pronounced for physician visits, prescription drugs, and outpatient therapies.”

The report pointed out that a specialist’s office visit in Colorado would cost a CHIP enrollee $2 to $10 compared with $50 for a benchmark plan enrollee.

The GAO notes Congress must decide about funding CHIP past 2015 and HHS must decide how qualified health plans will be considered comparable to CHIP.

In the meantime, a National Center for Health Statistics (NCHS) report supplies some numbers indicating how health insurance matters for children. Only about 6.6% of children were uninsured in 2012, the report found, but for those aged 12 to 17 years, 8.7% were uninsured, as were 9.9% of American Indian or Alaska Natives; 8% of Asians; 11.1% of Hispanics or Latinos; 12.5% of Mexican or Mexican Americans; and 12% of those whose parents had less than a high school education.

About 98% of children with either private insurance or Medicaid or with another public form of insurance had a usual place for health care, but only 73% of uninsured children did, according to data for 2012 from the National Health Interview Survey. The usual site of care was a doctor’s office for 85% of insured children, for 62% of publicly insured children, and for 56% of uninsured children.

Seventy-six percent of privately insured children had seen a health professional in the last 6 months. That rate was 79% for Medicaid or other public insurance but only 54% for uninsured children. Seventy percent of privately insured children had a dental visit in the last 6 months as had 63% of those with Medicaid or other health insurance, but only 35% of uninsured children had seen a dentist.

Both the GAO report, “Children’s Health Insurance: Information on Coverage of Services, Costs to Consumers, and Access to Care in CHIP and Other Sources of Insurance,” and the NCHS survey, “Summary Health Statistics for US Children: National Health Interview Survey, 2012,” are available online.

MS FOXHALL is a freelance writer in the Washington, DC, area. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that might have an interest in any part of this article.