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Child Health Plus

Overview

T + T

Background

HISTORY

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 2008 NYS expanded the program’s income eligibility guidelines up to 400% of the federal poverty level, simplified the enrollment process and expanded outreach and education efforts.

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 based on the applicant’s adjusted gross income that s/he reports on his/her federal income tax with certain modifications, which is known as Modified Adjusted Gross Income (MAGI). When determining household size, the principles of tax dependency are implemented with a few exceptions. In addition, families now apply for and renew Child Health Plus through the NY State of Health Marketplace.

WHO ADMINISTERS THE PROGRAM

Within federal guidelines, each state determines the design of its individual CHP program, including benefit package, payment levels for coverage (monthly premiums), 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.

FUNDING

The Children’s Health Insurance Program (CHIP) is funded by both Federal and State dollars. Under the Affordable Care Act, the federal match that funds CHIP is scheduled to decrease to 93% in 2019 and to 70% in 2021. On January 22, 2018 after an unprecedented 114 days lapse in funding for CHIP and a government shutdown, Congress extended funding for six years and then added another four years in the February 2018 budget deal.

Summary of Child Health Plus

Child Health Plus in NYS offers free or low-cost health insurance to uninsured children from birth through 18 years old. To qualify, families must have incomes below 400% of the federal poverty level, be ineligible for Medicaid, and be residents of NYS. There are no resource requirements and no immigration criteria. There are no 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 and renewal for CHP is through the NY State of Health Marketplace, where consumers will be able to apply for and renew CHIP coverage, as well as enroll in a health plan.

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.