 Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP, formerly the State Children's Health Insurance Program (SCHIP)) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced federal match (greater than the state's Medicaid match) to provide for this coverage. In 2007, after President Bush and Congress could not agree on CHIP reauthorization details, the program was extended through March 2009. In February 2009, the Children's Health Insurance Program Reauthorization Act of 2009 was approved by Congress and signed by President Obama. In concert with the signing, President Obama sent a memorandum to the Centers for Medicare and Medicaid Services (CMS) requesting that they immediately withdraw the August 17, 2007 Directive sent to state health officials which imposed conditions on states and limited their options to provide coverage to uninsured children. He requested that they implement CHIP from this time forward without these requirements.
Federal Health Reform and CHIP
President Obama signed the Patient Protection and Affordable Care Act, H.R. 3590, on March 23rd and the Reconciliation Act of 2010, H.R. 4872, on March 30, 2010. (See the combined full text of Public Laws 111-148 and 111-152 here.) Among many provisions, the laws extend the authorization of the federal CHIP program for an additional two years, through September 30, 2015. The laws require states, upon enactment, to maintain current income eligibility levels for CHIP through September 30, 2019. States are prohibited from implementing eligibility standards, methodologies or procedures that are more restrictive than those in place as of March 23, 2010, with the exception of waiting lists for enrolling children in CHIP.
Additional provisions in the health reform package related to CHIP are summarized in the following resources:
NCSL Federal Health Reform Resources
Health Reform Implementation Resources
Health Reform Fact Sheet--Key Provisions That Take Effect Immediately
State Legislative Tracking Database on Health Reform
Additional Federal Health Reform and CHIP Resources
Summary of Medicaid, CHIP and Low-Income Provisions in Health Care Reform
Center for Children and Families, Georgetown University Health Policy Institute, April 2010
Holding the Line on Medicaid and CHIP: Key Questions and Answers About Health Care Reform's Maintenance-of-Effort Requirements
Center for Children and Families, Georgetown University Health Policy Institute, March 26, 2010
NCSL CHIP Resources
The Children's Health Insurance Program: A Primer for State Legislatures
National Conference of State Legislatures, April 2009
Covering Kids
This State Legislatures magazine article focuses on outreach and enrollment efforts in the states to cover kids.
National Conference of State Legislatures, June 2009
Express Lanes, Premium Assistance and Contingency Funds: The New Provisions in CHIPRA
State Health Notes, National Conference of State Legislatures, June 22, 2009
CHIP Gets Renewed
State Legislatures magazine, National Conference of State Legislatures, April 2009
Children's Health Reform Laws
National Conference of State Legislatures webpage
News and Additional CHIP Resources
Two Year Anniversary of Children's Health Insurance Law Sees Millions of Newly Insured Children, Families
U.S. Department of Health and Human Services, Press Release, February 3, 2011
An Overview of the CHIPRA Outreach and Enrollment Grants
Center for Children and Families, Georgetown University Health Policy Institute, July 2009
$10 Million in Grants Aimed at Enrolling American Indiana, Alaska Native Kids in Health Care to be Awarded
U.S. Department of Health and Human Services, Press Release, November 19, 2009
Secretary Sebelius Awards $40 Million to States to Find, Enroll Children in CHIP, Medicaid
U.S. Department of Health and Human Services, Press Release, September 30, 2009
HHS Secretary Sebelius Announces Availability of $40 Million in Grants to Help Insure More Children
U.S. Department of Health and Human Services, Press Release, July 6, 2009
Additional information: Grants.gov, Full announcement
HHS Secretary Sebelius Announces Release of $6 Billion in New CHIP Funds to Insure Children
U.S. Department of Health and Human Services, Press Release, June 19, 2009
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State Health Official Letter, April 17, 2009
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Statement Related to Premium Assistance Provision in CHIPRA Section 311
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State Health Officials Letter, May 11, 2009 Pregnant Women Coverage Option
Pregnant Women Coverage Option Attachment
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State Health Official Letter, August 31, 2009: Medicaid Managed Care Requirements Applied to CHIP Managed Care Delivery Systems
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State Health Official Letter, August 31, 2009: Further Guidance on the Eligibility of Deemed Newborns
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State Health Official Letter, September 3, 2009: Further guidance on CMS policies regarding options for coverage of pregnant women under CHIP
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State Health Official Letter, October 7, 2009: Dental Coverage in CHIP
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State Health Official Letter, October 21, 2009: Guidance on the application of section 1932(c) of the Act (Quality Assurance Standards) to State CHIP managed care programs
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State Health Official Letter, November 4, 2009: Guidance on implementation of section 502 of CHIPRA, the mental health and substance use disorder parity requirements
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State Health Official Letter, December 16, 2009: CHIPRA Performance Bonus Payments
Federal Fiscal Year 2009 State Bonus Payment Awards, Release December 16, 2009
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State Health Official Letter, January 22, 2010: Guidance on CHIPRA Premium Grace Period
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State Health Official Letter, February 2, 2010: Premium Assistance Option
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State Health Official Letter, February 4, 2010: Express Lane Eligibility Option
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State Health Official Letter, February 4, 2010: Prospective Payment System for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs)
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State Health Official Letter, March 2, 2010: Applicability of Federal Matching Rates in CHIP and Medicaid
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State Health Official Letter, July 1, 2010: Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women
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State Health Official Letter, July 1, 2010: Increased Federal Matching Funds for Translation and Interpretation Services under Medicaid and CHIP
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State Health Official Letter, October 1, 2010: CHIPRA Performance Bonus Payments
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State Health Official and Medicaid Director Letter, November 30, 2010: Medicaid/CHIP Dental Provider Information
CHIP Tips
A series of implementation briefs called “CHIP Tips” examines new opportunities for covering children following the reauthorization and expansion of CHIP.
The Kaiser Commission on Medicaid and the Uninsured
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Updated August 2011
This site is made possible by project, UC4MC21528, from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.
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