The Future of CHIP and
Children’s Health Care
Elisabeth Wright Burak
Families USA Health Action 2015
Unprecedented Progress Covering
Children thanks to Medicaid/CHIP
13.0%
Lowest uninsured rate
since Census started
collecting data in 1987!
12.0%
11.0%
CPS
10.0%
9.0%
ACS
8.0%
7.0%
6.0%
5.0%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Source: U.S. Census Bureau, Current Population Survey (CPS),
Annual Social and Economic Supplement;
American Community Survey (ACS).
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Sources of Children’s Coverage, 2013
7.1%
7.2%
Employer-sponsored
Direct-purchase
46.5%
Medicaid/CHIP
Other (i.e., Medicare,
TRICARE VA 2+ types of
coverage)
Uninsured
34.2%
5.0%
Source: American Community Survey, 2013.
Medicaid and CHIP Enrollment,
2013
CHIP,
8,093,927
Medicaid,
37,198,483
Source: Medicaid.gov, available at http://www.medicaid.gov/chip/downloads/fy2013-childrens-ever-enrolled-report.pdf
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CHIP Structure and Funding
• States can use CHIP funds to
cover kids in Medicaid (MCHIP) or create separate CHIP
program (S-CHIP)- most use
some combination
• Capped allotments/block grant
with enhanced match (65 –
80%)
• CHIP Reauthorization (2009) - adequate funding for states,
incentives to enroll already-eligible children, quality focus.
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38 states provide Medicaid or Medicaid-based
benefits for CHIP-financed kids
Source: “Benefits and Cost Sharing in Separate CHIP Programs,” National
Academy for State Health Policy & Center for Children and Families (May 2014)
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ACA - Affordable Care Act (2010)
• New coverage options for parents through
exchanges or Medicaid
• Keeps children’s coverage stable until 2019
(“Maintenance of Effort” or MOE).
• Funds CHIP through FY2015 – no new funding
after September 30, 2015 without
Congressional action
• Increases each state’s matching rate by 23
percentage starting FY2016 until 2019
• Aligns children’s income eligibility in Medicaid (i.e.
“stairstep” kids)
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Who are “stairstep” kids?
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Moving “Stairstep” Kids to Medicaid
o 28% of S-CHIP kids
nationally transfer in
2014
o Ranges from 13%
(TN) to 70% (UT)
o States continue to
receive the CHIP
enhanced FMAP
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Medicaid and CHIP Work Together
• State history and design decisions impact the roles
Medicaid and CHIP play (M-CHIP, S-CHIP,
combination)
• In 2013, 66% of CHIP-funded children in separate
programs (MACPAC)
• With 2014 CHIP to Medicaid “stairstep” transitions, we
estimate more than half of children funded by CHIP
will be in Medicaid, with a minority remaining in
separate S-CHIP programs
• CHIP increasingly a funding source rather than a
program
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What Happens to Kids?
Public/Medicaid
Private: Exchange
Marketplaces, ESI, Other
“Family Glitch”- Could
Become Uninsured
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CHIP Design Drives What Happens In
Each State Without CHIP
CHIP-funded children will fall under one of the following
scenarios:
o Maintain coverage on Medicaid – state receives lower
match/less federal funding
o Fall into “family glitch”– Lose access to affordable
coverage altogether
o Estimates range from 500,000-2 Million kids
o Move to marketplace coverage with tax credits for
families
o Opt in to other private coverage options
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What’s at Stake for Ohio?
Preliminary estimates show a loss of up
to $146 million in 2016
Estimated FY 2016 loss of CHIP federal
funds with current match rate if CHIP
funding is not extended
Potential boost to State Budget if CHIP
funding is extended with 23
percentage point increase in the
match rate
$47 million
$99 million
OH FY 2015 FMAP for
Medicaid
OH FY 2015 Enhanced
FMAP for CHIP
OH FY 2016 Enhanced
FMAP* for CHIP
62.64%
73.85%
96.85%
*This estimate is calculated by adding the 23 percentage point bump to the 2015 enhanced FMAP for Ohio. Actual
percentage in 2016 may vary slightly given that the FMAP is adjusted annually.
Source: Preliminary unpublished estimates from draft memo “CHIP Financing
Considerations and State-level Funding and Coverage Loss Estimates”, CCF
and CBPP, October 2014
What’s the Impact on Virginia?
Current Matching
Rate
23% ACA “Bump”
2016 Match Loss for CHIPfunded Medicaid Coverage (619 yr olds)
Up to $24 million
Up to $61 million
Loss in CHIP Funds
Up to $126 million
Up to $171 million
As many as 104,221* VA kids stand to
lose CHIP coverage.
*Note: Enrollment data reflect all children ever
enrolled throughout the year
Source: Preliminary unpublished estimates prepared by Georgetown
CCF and Center on Budget and Policy Priorities based on March 2015
MACPAC report to Congress.
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Children’s Coverage in
Arizona: What does it mean
for the future of CHIP?
Michael Perry, PerryUndem Research/Communication
Joseph Fu, Arizona’s Children’s Action Alliance
Arizona’s Dismantling of CHIP: History of KidsCare
and KidsCare II
Arizona’s Dismantling of CHIP: History of
KidsCare and KidsCare II
Arizona’s Dismantling of CHIP: History of
KidsCare and KidsCare II
Arizona’s Dismantling of CHIP: History of
KidsCare and KidsCare II
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Arizona’s Dismantling of CHIP: History of KidsCare
and KidsCare II
Much higher costs on Marketplace (Georgetown
CCF and CAA May 2014 study)
AND all AZ families between
138%-200%
?
Family Glitch
Employer
Uninsured
LIVING WITHOUT KIDSCARE
Insights from Parents of Children Who Lost Their Health
Coverage When Arizona Scaled Back Its Children’s
Health Insurance Program
The Study
Georgetown University’s Center for Children and Families sponsored
two focus groups and three interviews with Arizona parents who had
children enrolled in KidsCare.
Fourteen thousand Arizona children lost their health insurance at the
end of January 2014 when the state ended its KidsCare program. This
study offers a glimpse into what happened to these families.
PerryUndem Research and Communication conducted the focus
groups and interviews. Joe Fu, Director of Health Policy at Children's
Action Alliance, a children’s advocacy organization in Arizona, helped
identify and recruit families who had lost coverage.
The focus groups were held in Phoenix in October 2014. One group
was conducted in Spanish with five Spanish-speaking Latino parents;
the other group was held with five English-speaking parents of mixed
racial and ethnic backgrounds. The three additional interviews were
conducted in November. In all, 13 families participated in this study.
Key Findings
1
2
3
All parents in this study were highly
satisfied with KidsCare.
But some parents were frustrated by
the frequent changes to KidsCare
even before the program ended –
some found it difficult to keep their
children enrolled over the years.
Most parents were unprepared for the
end of KidsCare in January 2014.
They say they did not receive clear
information about why the program
was ending or where they should look
for new coverage.
“[KidsCare] covered
everything. I used to
take my daughters to
their appoint-ments and
I never really had a
problem. I was really
happy.”
Latina, Spanish-Speaking Parent
Key Findings
4
5
Some of these families floundered
when KidsCare ended. Some
children were transferred directly into
the AHCCCS program without any
gaps in coverage. The rest applied to
AHCCCS later, looked to their
employer for coverage, and/or
applied for marketplace coverage.
Four of the children were uninsured
for at least some time period after
KidsCare ended.
There were disruptions in care for
many children when KidsCare ended
and some negative effects on
children’s health.
“[My employer’s
plan] would be
another rent for
me and I just can’t
afford it.”
Mother of Formerly Enrolled Child
Key Findings
6
7
8
Parents who were able to enroll
their children in AHCCCS seem
most satisfied.
Parents with children who did not
qualify for AHCCCS are under
financial stress and their children
face more difficulties accessing
care.
All want KidsCare to be
reinstated. They feel the program
was affordable and offered high
quality care for their children.
They feel there is no safety net
for them anymore.
“KidsCare used
to be the option
before if [my
child] did not
qualify for
AHCCCS. But
now what?”
Mother of Formerly Enrolled Child
Children’s coverage fluctuations
reflect state policy decisions
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What can Arizona’s Experience with
Children’s Coverage tell us about the future
of CHIP?
o CHIP eligibility rollbacks or new restrictions could
make more children uninsured
o Without ACA maintenance of effort (MOE), states
may choose to cut children’s coverage
o Children cannot yet rely on marketplace coverage to
meet their needs
o Without the ACA “stairstep” provision, more
children would lose coverage
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Conclusion
Uncertainty about CHIP’s future threatens
our nation’s progress covering children and
ensuring they get the care they need to
thrive.
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For more information
o CCF website: ccf.georgetown.edu
o Twitter @GeorgetownCCF, @ewburak
o Say Ahhh! Our child health policy blog:
ccf.georgetown.edu/blog/
o Elisabeth.burak@georgetown.edu
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