1. Protecting Tennessee's Children: CHIP (“CoverKids”)
Kinika Young
Director of Children’s Health
Tennessee Justice Center
Andy Schneider
Research Professor of the Practice
Georgetown University Center for Children and Families
May 17, 2017

2. CoverKids CoverKids is Tennessee’s CHIP program
CoverKids provides health insurance for eligible children age 18 and younger and for eligible pregnant women.

3. Public Coverage for TN Children, 2016
CHIP
106,000
Medicaid
874,000
Marketplace
19,000
THIS IS SEDS EVER-ENROLLED for Medicaid and CHIP
Sources: SEDS FY 2016 Ever-Enrolled in Medicaid/CHIP
ASPE. “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report.”

4. Children on Medicaid/CHIP by Congressional District
43-52%
35-43%
26-35%
Source: American Community Survey, Single-Year Estimates, 2015.
Note: In the lowest range, data greater than or equal to the lower limit and less than or equal to the upper limit. In subsequent ranges, data are greater than the lower limit and less than or equal to the upper limit.

5. Children’s Coverage Rate Increasing
Source: CCF analysis of ACS single-year data,

6. Tennessee’s CoverKids Budget, FY 2016
The federal match rate for TN is 98.54%. This means:
State Share - $2,744,187
Federal Share - $185,213,814

7. CoverKids Eligibility
Children
They are under 19 years of age on the date of application;
They are Tennessee residents;
They are not eligible for or enrolled in TennCare;
They are U.S. citizens or qualified legal aliens
Their household income is at or below 250% of federal poverty level (FPL).
Unlike TennCare, CoverKids cannot be used as a second plan

8. CoverKids Eligibility
Pregnant Women
They are Tennessee residents;
They do not have to show immigration documents;
They are not eligible for or enrolled in TennCare; and
Their household income is at or below 250% of federal poverty level (FPL).
If you have a health plan without maternity benefits, you can apply for CoverKids

9. 2017 Federal Poverty Guidelines

10. Application Information
Applicants applying for coverage must apply online at healthcare.gov or call toll-free
Administered by BlueCare via Health Care Finance and Administration
“No wrong door” provision

11. Premiums and Cost Sharing
No premiums
Total cost-sharing cannot exceed 5% of family income
Cost-sharing varies based on income and service
No cost sharing for well-baby and well-child care, including immunizations.

12. Benefits Medicaid-CHIP program (“TennCare Standard”) – same package
Separate CHIP (“CoverKids”) - “benchmark plan”
Medicaid benefits are typically more generous than CHIP benefits, because states have more flexibility in designing their CHIP benefit packages, but as you’ll see, it’s more complicated than it seems at first.

13. How do CoverKids Benefits Compare?
CoverKids provides low-cost, comprehensive health coverage through a managed care plan
Covers preventative health services, doctor visits, hospital visits, vaccinations, well-child visits, developmental screenings and mental health
Children also get vision and dental care.
RECENT REPORT WITH NASHP CATALOGUING BENEFITS IN ALL SEPARATE CHIP PROGRAMS
UPSHOT:
Source: “Benefits and Cost Sharing in Separate CHIP Programs,” National Academy for State Health Policy & Center for Children and Families (May 2014) available at

14. Children’s Health Insurance Program (CHIP)
Passed in 1997 to help states provide coverage to uninsured children who do not qualify for Medicaid
Block grant with capped annual allotments to states
Federal government pays 65% to 85% of costs (E-FMAP); with a 23% percentage point bump in up to annual allotment
States administer and have flexibility to design eligibility, benefits, cost-sharing, payments beyond federal minimums

15. CHIP Reauthorization (CHIPRA)
On February 4, 2009, just three weeks into his term as the 44th President of the United States, Obama signed into law the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
“In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation - health care for children is one of those obligations.”
President Obama, in signing CHIPRA, February 4, 2009
I had the pleasure of working on CHIPRA in the Senate in 2009, and I still recall very clearly when we heard from the White House that the President wanted CHIPRA to be one of the first bills he signed into law. It became the second – following the Lilly Ledbetter Fair Pay Act, making it easier for workers to file an equal-pay lawsuit.

16. MACRA: Medicare Access and CHIP Reauthorization Act (2015)
Part of larger package to permanently prevent cuts to Medicare payment rates for doctors, also called “doc fix”
“Clean” CHIP extension through 2017
Funds ACA’s 23 percentage point increase in match rate for 2016 and 2017
New outreach funds
PIC?
The Medicare Access and CHIP Reauthorization Act is commonly called the “doc fix” because it prevented a large cut to Medicare payment rates for doctors.
It also included a 2-year extension of CHIP

17. CHIP: Federal-State Partnership
Federal Government
States
Administration
Oversight
Direct administration
Financing
Pay 65% to 81% of costs, up to cap; ACA/MACRA increased by 23 percentage points through at least 2017 to maximum of 100%
Pay a share of cost (if under 100% federal matching rate)
Program Rules
Minimum standards- more flexibility relative to Medicaid
Sets provider payment rates and decides eligibility rules, benefits, and cost sharing within guidelines
Coverage Guarantee
None required
Can freeze or cap enrollment (ACA prohibits this until 2019 with some exceptions!)
CHIP is a federal-state partnership program meaning that it is jointly administered and financed by the federal government and state governments.

18. Children's Health Insurance Program (CHIP) Financing
Block grant with capped annual allotments
Unused allotment available for up to 2 years
Contingency fund covers shortfalls
ACA bump = 23 percentage points up to 100% starting in FFY 2016
eFMAP Formula
FMAP + (0.3 x (1 – FMAP))
2017 eFMAP Rates
2017 eFMAP with Bump
Minimum
65%
88%
Tennessee
75.47%
98.47%
Maximum
82.2%
100%
Source: ASPE “FMAP 2017 Report.” Valid October 1, 2016-September 30, 2017.

19. CHIP Not a Typical Block Grant
Adequate initial funding levels. The program’s original ten-year authorization more than met states’ projected need.
Redistribution. Unused funds from low-spending states are redistributed to states in need of additional funds.
Shortfall funding. Congress stepped in multiple times to provide additional targeted funds allowing states to operate their CHIP programs as if they weren’t capped.
Funding extension permits growth. CHIP’s later funding extensions included increases to accommodate health care cost inflation, population growth, and program growth.
Contingency fund. Dedicated fund to prevent enrollment-related shortfalls.
These are Edwin’s slides—not sure how we want to source.

20. CHIP Funding
Congress must act before September 30, 2017 to extend CHIP funding
Together, Medicaid and CHIP have driven our success in covering children
CHIP is popular program that has bipartisan support – a clean extension NOW could be a win for both sides and stabilize kids’ coverage
Uncertainty about Medicaid and the future of the marketplace
Will it be used as leverage in gaining support for detrimental changes to Medicaid?

21. Why is Health Coverage Important for Children?
Access to preventive care to detect and treat delays or disease
Healthy children better able to learn in school
Ensure long-term productivity and success in life
Family financial security
CHIP is still a relatively young program, but we can look to Medicaid to see the impact of health coverage for children over the long term. When Medicaid turned 50 last year, we looked at the long-term benefits of childhood Medicaid and found many important benefits for the children themselves and society as a whole. A review of the research revealed, for example:
Children with Medicaid become healthier adults – ex. Longitudinal analysis showed a 26 %pt decline in the incidence of high blood pressure in adulthood and lower rates of hospitalizations and emergency room visits in adulthood. And some benefits accrued faster – children with Medicaid had lower rates of eating disorders, drinking and mortality as adolescents.
We also found that children with Medicaid were less likely to drop out of high school and more likely to go to college
And had greater economic success as adults. Children with Medicaid access had higher incomes later in life and were more likely to surpass their families’ economic status.
Source: A. Chester, J. Alker, “Medicaid at 50: A Look at the Long-Term Benefits of Childhood Medicaid,” Georgetown University Center for Children and Families (July 2015).

22. What Happens to Kids without CHIP?
Exchange Marketplaces, Employer-Sponsored Insurance, Other
Some Could Become Uninsured
Public/Medicaid
If Congress had not extended CHIP funding in 2015, the impact on kids coverage and on states would vary depending on the structure of the state’s CHIP program.
In states with a CHIP-financed Medicaid expansion program, the CHIP kids would have continued to be covered by Medicaid, but the state would have received less federal financial support.
In states with a separate CHIP program, some CHIP kids would have found a new source of coverage through the new marketplaces or through employer sponsored insurance, but some kids would have become uninsured. These same questions will face Congress in 2017.

23. Tools for Organizations
Children’s landing page
Branded and unbranded fact sheets and shareable images
Monday, Wednesday and Friday Facebook children’s posts at 2:30 pm CDT
Please let us know what you need

24. How to Get Involved Join our email list for timely updates
Let us know if you have any stories of families who benefit from CHIP for our story bank

25. Children’s Health Team
Kinika Young,
Director of Children’s Health
Anna Walton,
Health Action Associate
De Vann Sago, King Child Health Fellow

26. Questions?