Child Health Plus

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.

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.

CHP is funded by both Federal and State dollars. Federal funding pays for two-thirds of the program, the remaining third is covered by New York State funds. The Children’s Health Insurance Program Reauthorization Act of 2009 reauthorized the Children’s Health Insurance Program (CHIP). CHIPRA finances CHIP through FY 2013. The premium contribution from families who are required to pay a premium is an additional funding source.

Child Health Plus offers free or low cost health insurance to uninsured children birth through 18 years old in families that are ineligible for Medicaid. To qualify, families must have incomes below 400% of the federal poverty level and must be residents of NYS. No premiums are required for families earning less than 160% FPL. There are no resource requirements and no immigration criteria.

Unlike Medicaid, all CHP health services are provided through managed care plans. Enrollees in CHP, therefore, must participate in a managed care plan. Application for CHP is through facilitated enrollers, which are community based agencies or managed care plans that have contracted with the NYS Department of Health to assist uninsured individuals and families to apply for CHP. On an annual basis plans must recertify children who are enrolled in their plans. Unlike Medicaid, managed care plans are responsible for eligibility determinations and recertification.

Because CHP is not Medicaid, CHP members and applicants 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.