 
Children's Health Reform: State Laws
Updated August 2009
Federal Health Reform and CHIP || State Children's Health Reform || Resources || 2011 Federal Poverty Guidelines
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
Federal Health Reform webpage
Preliminary Draft Summary of the Medicaid and CHIP Provisions
Health Reform Fact Sheet--Key Provisions That Take Effect Immediately
Health Reform: State Examples webpage
Additional Federal Health Reform and CHIP Resources
Key Medicaid, CHIP and Low-Income Provisions in the Health Care Reform Package
Center for Children and Families, Georgetown University Health Policy Institute, March 24, 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 25, 2010
State Children's Health Reform
More than 9 million children are uninsured in the United States. Six and a half million of these children live in families with household incomes below 200 percent of the federal poverty level and are eligible for Medicaid or CHIP, but are not enrolled. Typically, a child's health care needs center around simple preventative care such as immunizations and regular check-ups to ensure proper growth and development. Research shows early intervention makes a measurable improvement in the future health of these children.
On the heels of major reforms like the ones enacted in Maine, Massachusetts and Vermont, states across the nation are considering plans to increase access to health insurance for their citizens. Access to coverage for children is often high on the priority list for states trying to allocate resources and services. For more than a decade, states have provided low-income children with health insurance coverage through Children's Health Insurance Programs (CHIP). CHIP, a state-federal partnership, was created as part of the Balanced Budget Act of 1997 to bridge the safety net gap for low-income children who do not qualify for Medicaid but remain in families that cannot afford insurance. Recently, some states chose to build on established CHIP programs and the corresponding access to federal resources to expand coverage to additional children.
Despite current state budget challenges, ensuring children access to health care remains a priority in a number of states. Due to the vast differences in available state funds, existing programs and uninsured populations, approaches to covering additional children vary. Some states have used state funds without the federal matching dollars to expand CHIP eligibility and other states have focused their funds on outreach to families of children who are eligible for Medicaid and CHIP programs but are not enrolled.
The table below provides a snapshot of recent reforms regarding children's health insurance. For a comprehensive list of state CHIP and Medicaid eligibility levels, see the Kaiser Family Foundation's statehealthfacts.org.
Children's Health Reform: A Snapshot of State Action
Please note: The reforms included in the chart below are intended to offer a snapshot of state actions around children's health insurance. This list is not comprehensive and many state programs enacted/implemented before 2005 may not be included. NCSL appreciates additions and corrections. To submit additions or corrections, please email us at health-info@ncsl.org.
A C D F H I K L M N O P R S T U V W
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State
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Enacted State Initiatives
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Alabama
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In 2009, Alabama enacted HB 746, which appropriated funds for the state's Children's Health Insurance Program for the fiscal year ending September 30, 2010. The law increased eligibility guidelines from 200 percent of the federal poverty guidelines to 300 percent of the federal poverty guidelines. This expansion was implemented beginning October 1, 2009.
For more information about Alabama's CHIP program: ALL Kids
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Alaska
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In 2007, SB 27 (Chapter 48) was enacted, which increases Medicaid/CHIP eligibility for children from 150 percent of the federal poverty level to 175 percent of the federal poverty level.
For more information about Alaska's CHIP program: Alaska Denali KidCare
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Arizona
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In 2007, HB 2789 (the fiscal year 2007-2008 state budget) was enacted which removes the rule that prohibited schools from participating in outreach efforts and clarifies that school districts may distribute information about the Arizona Health Care Cost Containment System to potentially eligible students and their families.
Pursuant to Ariz. Rev. Stat. § 36-2985(A), the Arizona Health Care Cost Containment System Administration instituted an enrollment cap of the KidsCare program effective January 1, 2010, due to insufficient funding.
On March 16, 2010 the Legislature completed its 7th Special Session to address the state's severe budget shortfall for Fiscal Year 2010 and 2011. On March 18, 2010, Governor Jan Brewer signed a budget package (including House Bill 2010/Senate Bill 1010) that eliminated the state’s CHIP program, KidsCare, effective June 15, 2010. KidsCare covers children whose families have income between 100 percent and 200 percent of the federal poverty guideline.
On March 25, 2010 the Arizona Health Care Cost Containment System released a letter to Governor Brewer regarding the impact of federal health reform on the elimination of KidsCare. The letter recognizes that as a result of the maintenance of effort provision in federal health reform, the state will need to restore, at a minimum, the KidsCare program with a freeze on new enrollment. The letter specifies that the projected general fund cost to restore KidsCare with an enrollment freeze is $38 million from July 1, 2010 through September 30, 2019. In addition, the Centers for Medicare and Medicaid Services (CMS) notified the state that the elimination of the KidsCare program would be in violation of the federal maintenance of effort provisions and would result in the loss of an estimated $7.8 billion in federal Medicaid funds per year. On May 6, 2010, Governor Brewer signed Senate Bill 1043, restoring the KidsCare program. On May 12, 2010, AHCCCS submitted a letter to CMS to withdrawal the March 18th request to terminate KidsCare. CMS also provided clarification to the state that the continuation of the KidsCare enrollment freeze would not trigger a maintenance of effort violation.
For more information, see the Arizona Health Care Cost Containment System News and Updates webpage
Arizona Drops Children’s Health Program, New York Times, March 18, 2010
Governor signs Arizona budget-balancing bills, Business Week, March 18, 2010
For more information about Arizona's CHIP program: Arizona KidsCare
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Arkansas
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In March 2009, Chapter 435 (HB 1700) was enacted which increases eligibility for children who are members of a family with a gross family income up to 250 percent of the federal poverty guidelines from 200 percent of the federal poverty guidelines. The expansion will be funded by a tax increase on tobacco, which was enacted by Act 180 (HB 1204) in February 2009. The expansion of the ArKids First program is expected to provide coverage for an additional 8,000 children from low-income families. The law also requests the Department of Human Services to apply to CMS for approval to extend coverage to individuals between 19 and 25 years of age who do not have health care coverage, who are full-time students in an institution of higher education located in the state, who are members of a family with a gross income up to 250 percent of the federal poverty guidelines and who were enrolled in the program before a specified age. The law also requires parity for mental health care services and establishes a copayment for services.
For more information about Arkansas' CHIP program: ARKids First
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California
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In 2001, Chapter 648 (AB 495) was enacted which created the Children's Health Initiative Matching (CHIM) Fund in the State Treasury administered by the Managed Risk Medical Insurance Board. The fund allows for the intergovernmental transfer of local funds used for local County Children's Health Initiatives purposes to draw down federal financial participation matching funds for CHIP eligible children.
In June 2004, CMS approved a pilot program to increase eligibility in four California counties through the County Children's Health Insurance Program (C-CHIP). Children, ages 19 and younger, whose family income is up to 300 percent federal poverty level are covered in three counties (Alameda, San Francisco, San Mateo, and Santa Clara) using federal matching dollars. San Mateo covers children from 300 to 400 percent federal poverty level using county funds.
In September 2008, California passed its budget 85 days into the fiscal year. Within the 2008 budget bill, limitations were put upon the Medi-cal and Healthy Families programs in order to meet budgetary shortcomings. Families with children insured through Medi-cal are now required to engage in mid-year income status reporting rather than the annual status reporting that was previously required. Healthy Families enrollees with incomes above 150 percent of the federal poverty guidelines will experience an increase in premiums of approximately 2 to 3 dollars per month for each child, with a maximum premium of 51 dollars per month for all enrolled children. In addition, Healthy Families enrollees will have a reduced annual maximum dental benefit of 1,500 dollars per year.
In 2009, California's State Budget 2009-10 was enacted, which reduces general fund support for the state's Healthy Families (CHIP) program by $178.6 million. The Managed Risk Medical Insurance Board, which oversees the program, froze new enrollment and established a waiting list effective July 17 because of the budget situation. The Board will disenroll current beneficiaries from the program at their annual eligibility redetermination as necessary. Eligible individuals will subsequently go on the waiting list until they are able to be reinstated as the budget permits. As of July 28, 2009, a total of 33,146 children have been placed on the waiting list. For additional information, see the California Health and Human Service Agency's Budget Facts for 2009-10. To help prevent children from losing coverage, the First 5 California State Commission approved a contribution of up to $81.4 million to the Healthy Families Program. In addition, in September 2009, AB 1422 (Chapter 157) was enacted, which imposes a tax on the total operating revenue of a Medi-Cal managed care plan until January 1, 2011. A percentage of the proceeds of the tax are appropriated to the Healthy Families Program. The law also increases premiums and co-payments for families of children enrolled in the Healthy Families program as of November 1, 2009.
For more information about California's CHIP program: California Healthy Families
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Colorado
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In 2007, Colo. Sess. Laws, Chap. 347 (SB 211) was enacted which declares the state's aim to provide coverage to all low-income children by 2010. The law implements presumptive eligibility for children under Medicaid and the state's CHIP program.
In 2008, SB 160 was enacted which increases CHIP eligibility from 205 percent of the federal poverty guidelines to 225 percent of the federal poverty guidelines. The law allows that if funding is available, the eligibility level can be raised to 250 percent of the federal poverty guidelines. Colorado delayed implementation of this expansion due to budget shortfalls.
In 2009, HB 1293 was enacted which authorizes the state department to charge and collect hospital provider fees. The laws specifies that the hospital provider fees and the available federal matching funds may be used to increases the state's CHIP eligibility level for children and pregnant women, upon federal approval, from 205 to 250 percent of the federal poverty guidelines. The law also provides for 12 month continuous eligibility for children under Medicaid. In addition, the law directs the state department to seek federal authorization to establish a Medicaid buy-in program for disabled adults and disabled children whose families have income up to 450 percent of the federal poverty guideline. The program shall include premium and cost-sharing charges on a sliding scale fee based on the family's income.
For more information about Colorado's CHIP program: Colorado Child Health Plan Plus (CHP+)
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Connecticut
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Conn. Acts, P.A. 185 (2007 SB 1484) increased the HUSKY (CHIP) program eligibility level from 300 percent of the federal poverty guideline to 400 percent of the federal poverty guideline and calls for the automatic enrollment of all eligible newborns into the HUSKY program. The law allowed families with incomes above 400 percent federal poverty level to buy into the HUSKY program at full cost. During the June 2007 Special Session, Public Act 2 was enacted, which repealed section 6 of Public Act 185 and reduced the HUSKY program eligibility level back to 300 percent of the federal poverty guideline. The law also changed the buy-in program eligibility level back to the previous threshold, allowing families with incomes above 300 percent of the federal poverty guideline to buy into the program.
For more information about Connecticut's CHIP program: Connecticut HUSKY
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Delaware
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In June 2008, Chapter 241 (HB 286) was enacted which requires school districts and state agencies to share data for the purpose of enrolling children in free or reduced price health insurance programs. The law requires each school district to provide to the Department of Health and Social Services (DHSS) the contact information for families of children eligible for free and reduced price meals. DHSS will use this information to inform the family, in writing, that its child may be eligible for enrollment in the state's CHIP and Medicaid programs and provide information about how the family may apply for these programs.
In 2009, HB 139 was enacted, which extends the CHIP program to eligible children under the age of 19 whose families have incomes above 200 percent of the federal poverty guidelines. The Department of Health and Social Services has the authority to determine co-payments, premiums and deductibles for children enrolled in the buy-in program. The family may purchase the healthcare benefit package if the child is over two years of age and has been uninsured for a continuous period of at least 3 consecutive months, with certain exceptions.
For more information about Delaware's CHIP program: Delaware Healthy Children Program
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District of Columbia
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In January 2007, the DC City Council approved the Fiscal Year 2007 Budget Support Act of 2006 that expands Medicaid/CHIP eligibility to 300 percent federal poverty level. CMS approved the expansion in March and the expansion was implemented starting in June 2007.
For more information about the District of Columbia's CHIP program: DC Healthy Families Insurance Program
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Florida
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In May 2008, Chapter 32 (SB 2534) was enacted which removes the enrollment cap for children in the MediKids and Florida Healthy Kids buy-in programs. Children in families with incomes above 200 percent of the federal poverty guidelines are eligible for enrollment in these buy-in programs. Previously, the enrollment of children in these buy-in programs was limited to ten percent of the total program enrollment.
In 2009, SB 918 (Chapter 113; effective July 1, 2009) was enacted, which amends the Florida Kidcare Act. The law reduces the waiting period from 60 to 30 days for reinstatement of coverage upon voluntary cancellation for nonpayment of premiums. The law also reduces the waiting period from 6 months to 60 days for a child who is otherwise eligible to enroll in the premium assistance Florida Kidcare program. An eligible child for premium assistance under the Florida Kidcare program may participate if the cost of the family member's health insurance benefit plan is grater than 5 percent of the family's income. In addition, the law specifies that electronic verification of a family's income shall be used to determine financial eligibility for the Florida Kidcare program.
For more information about Florida's CHIP program: Florida KidCare
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Hawaii
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Hawaii Rev. Stat. § 346-59.4 (2007 HB 1008) establishes a three year pilot program, Keiki Care, in which the state pays half the health insurance premiums (a mutual benefit society pays the other half and manages the administration) for children under the age of 19 who are uninsured (for any reason, including immigration status) and are ineligible for public insurance. Keiki Care is expected to cover as many as 3,500 children. The law also expands Hawaii's CHIP program, QUEST, to cover children in families with incomes below 300 percent federal poverty level. Beginning November 1, 2008, the state will no longer provide funding for the Keiki Care program as a result of state budget shortfalls. Hawaii Medical Service Association will provide funding to cover the approximately 2,000 children enrolled in this program though the end of December, 2008.
In July 2008, Act 239 (SB 69) was enacted to provide temporary insurance coverage for specified children of former employees of a Hawaii-based corporation. The children will be covered under Hawaii's Keiki Care plan through the end of December 2008 or until the former employee parent of the covered child becomes employed and covered by a prepaid health care plan. The law is expected to extend coverage to as many as 900 children.
For more information about Hawaii's CHIP program: Hawaii QUEST; Keiki Care; Covering Kids
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Illinois
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HB 806 was enacted in 2005 and created the All Kids program. The All Kids program provides children up to the age of 18 with comprehensive health insurance which covers preventative care, dental and vision services, hospital costs, and prescription drugs, among other services. The program is available to all Illinois children without private health insurance and has no family income cap. Children do not need to be U.S. citizens for their parents to buy into the program. The children must not be eligible for state programs like Medicaid or Illinois CHIP. Premiums are based on a sliding income scale, starting at $40 per month per child. The All Kids program became effective July 1, 2006.
For more information about Illinois' program: Illinois All Kids; More NCSL information
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Indiana
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In May 2007, HB 1678 was enacted to increase CHIP eligibility for children in families with incomes up to 300 percent federal poverty level. In May 2008, CMS approved the expansion of eligibility to only 250 percent federal poverty level. It is expected that this expansion will allow an additional 5,000 children to enroll in the program in the first year, and up to 10,000 children in subsequent years. The expansion to increase eligibility to 250 percent of the federal poverty level was implemented beginning October 1, 2008.
For more information about Indiana's CHIP program: Indiana CHIP; Hoosier Healthwise
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Iowa
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In 2007, HF 909 was enacted which allocates new state funds to increase outreach to children eligible to be enrolled in CHIP.
In 2008, HF 2539 was enacted which provides an additional $25 million over the next three years to extend coverage to more than 50,000 children. The law increases Medicaid and CHIP eligibility for infants whose family income is at or below 300 percent of the federal poverty guidelines from the previous level of 200 percent of the federal poverty guidelines. The law requires that once initial eligibility for Medicaid is determined for a child, the child shall be continuously eligible for a period of up to 12 months. The law also provides provisions to improve outreach to eligible children. Beginning with the 2008 tax return forms, parents can identify any dependent children who do not have health care coverage. If their income on the tax return meets the income eligibility requirements for any medical assistance program, including hawk-i, information about enrollment will be sent to them. (2009 SF 389 requires this procedure beginning with the 2010 tax return forms.) The law also specifies that it is the intent of the general assembly to expand coverage under Hawk-i to children with family incomes at or below 300 percent of the federal poverty guidelines and to establish cost sharing provisions under Hawk-i for children whose family income is between 150 and 200 percent of the federal poverty guidelines if federal reauthorization of CHIP provides sufficient federal allocations to the state.
In 2009, SF 389 was enacted which requires the development of a joint program application form and the same application and renewal verification process for both the hawk-i and medical assistance programs. The law increases eligibility for children under Hawk-i to 300 percent of the federal poverty guideline from 200 percent of the federal poverty guideline and establishes cost sharing for children whose family income is between 150 and 300 percent of the federal poverty guidelines. The law directs the Hawk-i board to implement the premium assistance program options described under the federal Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA; P.L. 111-3) for the Hawk-i program. The law specifies that translation and interpreter services as specified pursuant to CHIPRA and dental services shall be added to the benefits included under Hawk-i. Requires presumptive eligibility be provided for eligible children under Hawk-i beginning January 2010.
NCSL State Health Notes article: Iowa Takes an Incremental Approach to Universal Coverage (May 27, 2008).
For more information about Iowa's CHIP program: Iowa hawk-i
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Kansas
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In 2008, SB 81 was enacted which, subject to appropriations, increases CHIP eligibility from 200 percent of the federal poverty level to 225 percent of the federal poverty guidelines in 2009 and, finally, to 250 percent of the federal poverty guidelines in 2010. The law establishes cost sharing provisions on a sliding scale basis. New participants would not be eligible for coverage for at least eight months if they previously had comprehensive health benefit coverage, with some exceptions. This law also requires participants in CHIP to present documentary evidence of citizenship or of being a lawful alien to be eligible. The law amends the current CHIP program to allow contributions to health insurance premiums in CHIP to be made to a health savings account. In addition, payments for health insurance premiums can be made in conjunction with an employer sponsored health insurance premium assistance plan.
For more information about Kansas's CHIP program: Kansas Health Wave
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Louisiana
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In the 2007 legislative session, Louisiana passed HB 542 (Act 407) which created the Louisiana Children and Youth Health Insurance Program, expanding Louisiana's CHIP program, LaCHIP. Act 407 aims to expand eligibility to children in families with incomes up to 300 percent federal poverty level from the former eligibility threshold of 200 percent federal poverty level. A request for approval of the plan was submitted to CMS in September 2007. In February 2008, CMS approved the expansion of eligibility to only 250 percent federal poverty level. This expansion will extend coverage to approximately 6,500 additional families, adding to the 115,271 children enrolled in LaCHIP. The coverage under this expansion will be provided through the State Group Benefits program, which also provides insurance to state government employees. Families will contribute premiums (approximately $50), co-payments and deductibles.
For more information about Louisiana's CHIP program: Louisiana LaCHIP
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Maryland
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In April 2008, Chapter 251 (HB 115) was enacted, creating an initiative to increase enrollment into Maryland's CHIP program. The law requires a statement including the eligibility requirements of the Maryland Children's Health Program and relevant contact information to be printed on state-issued child support payment check stubs, state-issued tax refund check stubs and state-issued employee paycheck stubs.
In May 2008, Chapter 692 (HB 1391) was enacted which encourages eligible parents to enroll their children in the Maryland Children's Health Program (MCHP), Maryland's CHIP program. The Kids First Act requires the comptroller to send a notice this summer (2008) regarding eligibility for MCHP to families with incomes up to 300 percent federal poverty level based on state tax return information. The act also requires parents to report on their next income tax return, the presence or absence of health care coverage for each dependent child. The act leaves open the possibility of a mandate for enrollment if more than 3 percent of children remain uninsured by 2010. At that time the state would decide on whether to withhold the child tax exemption from parents whose children are eligible but not enrolled in MCHP. The act also calls for a study of ways to make health insurance affordable for children whose parents' incomes are higher than the state program's eligibility requirements, but too low to afford private insurance coverage.
The following issue brief about this Act was released by the Robert Wood Johnson Foundation in September 2009: Using Information from Income Tax Forms to Target Medicaid and CHIP Outreach: Preliminary Results of the Maryland Kids First Act
In May 2009, Chapter 400 (HB 500) was enacted which requires the Baltimore City Public School System to disclose specified information about each student who is enrolled in the National School Lunch Program to the Department of Health and Mental Hygiene unless a parent elects not to have the information disclosed. The law requires the Department to send eligibility and enrollment information about the Children's Health Program to the parent or guardian of those students.
For more information about Maryland's CHIP program: Maryland Children's Health Program (MCHP)
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Massachusetts
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In April of 2006, Massachusetts passed comprehensive health care reform called the "Act Providing Access to Affordable, Quality, Accountable Health Care." The law does not specifically address children, but it does have components that will increase access for them. The law includes a Medicaid expansion from the previous level of 200 percent of federal poverty guidelines to 300 percent of the federal poverty level. The Commonwealth Insurance Plan will provide low-cost, state subsidized (for specified income levels) insurance that is portable from job to job; presumably, children will gain access to insurance through these programs. The individual mandate that all state residents have health insurance applies only to people over the age of 18. The 2006 HB 4847 was enacted in May 2006 (Chapter 58).
For more information about Massachusetts' program: MassHealth
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Minnesota
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In 2007, Chapter 147 (HF 1078) was enacted which allocates funds to increase outreach to individuals eligible for public health coverage programs. The law calls for implementation of a statewide public awareness and education campaign on the importance and availability of health coverage. The law also includes measures to simplify application and renewal policies.
For more information about Minnesota's CHIP program: Minnesota CHIP
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Missouri
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Senate Bill 577, enacted in May 2007, changed Missouri's Managed Care Plus (MC+) for Kids Program (the state's CHIP program), eligibility requirements. Under the new law children continue to be eligible for the program if they lack access to affordable employer-sponsored health insurance and their family income is between 150 percent and 300 percent of the federal poverty level. This law redefined the definition of "affordable employer-sponsored health insurance" based on the family's gross income, family size, and the monthly premium for coverage as a percentage of a specified percent of the federal poverty level. In addition, plans that do not cover an eligible child's pre-existing condition is not considered "affordable employer-sponsored health care insurance." If a child has exceeded the annual coverage limits for all health care services, the child is not considered insured and does not have access to affordable health insurance. The law also specified that the program will remain in effect only if the federal government appropriates funds.
For more information about Missouri's CHIP program: Missouri MC+ for Kids
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Montana
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In 2007, SB 22 was enacted to increase the CHIP eligibility level for children in families with income up to 175 percent of federal poverty guidelines--from the current level of 150 percent--provided there is funding available. The bill requires the state to leverage any federal dollars available to fund the program, possibly through a Medicaid waiver.
In November 2008, Montana voters approved the I-155 ballot initiative, the Healthy Montana Kids Plan Act. This initiative establishes a plan to expand and coordinate coverage for Montana children under the Children’s Health Insurance Program (CHIP), the Montana Medicaid Program, and employer-sponsored health insurance. The initiative allows the State Health Department to raise income eligibility levels for children under CHIP and Medicaid to 250 percent of the federal poverty guidelines; simplify transitions between CHIP and Medicaid coverage; provide assistance for children in employer-sponsored insurance; and work with health care providers, schools, organizations, and agencies to encourage enrollment of uninsured children. Funding for I-155 will come from a share of the insurance premium tax and federal matching funds. The initiative also requires the establishment of automatic enrollment mechanisms, a board of directors for the premium assistance purchasing pool plan, and an outreach campaign to encourage enrollment.
In 2009, the Montana legislature approved the state’s budget (HB 2), which appropriated funds to implement the Healthy Montana Kids Plan Act to be effective October 1, 2009.
For more information about Montana's CHIP program: Montana CHIP
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In 2009, LB 603 was enacted, which increases Medicaid/CHIP eligibility for children from 185 percent of the federal poverty guidelines to 200 percent of the federal poverty guidelines. The expansion was implemented beginning September 1, 2009.
For more information: Nebraska Kids Connection |
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New Hampshire
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Chapter 345 (SB 192), enacted in July 2007, creates a public education and outreach program within CHIP. The purpose of the outreach program will be to increase enrollment by informing new parents of the program's availability and assisting families in the completion of the application process as necessary. The law instructs the Department of Health and Human Services to allocate funds for the development of a volunteer program, with tasks including promoting the program to eligible families and identifying families who may require assistance with the application process. Agencies that provide additional follow-up with applicants will be reimbursed with an enhanced application fee for outreach assistance.
In 2009, Senate Bill 115 (Chapter 224) was enacted, which establishes the New Hampshire healthy kids corporation to administer the state's CHIP program, Healthy Kids. The law allows uninsured young adults to buy insurance through the Healthy Kids program. Young adults who are 19 to 25 years old, who cannot be included in their family's insurance plan and whose incomes are at or below 400 percent of the federal poverty guidelines are eligible for the buy-in program.
In 2009, House Bill 529 (Chapter 317) was enacted, which directs the department of health and human services to seek CMS approval for a limited Medicaid expansion to provide transitional Medicaid eligibility for children whose eligibility for Healthy Kids Gold terminates mid-month and who are eligible for Healthy Kids Silver, but who will not receive coverage until the first of the month following Healthy Kids Gold ineligibility. Coverage of Medicaid services during the transition period shall be funded with CHIP funds.
For more information about New Hampshire's CHIP program: New Hampshire Healthy Kids
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New Jersey
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In 2005, New Jersey enacted SB 2236 creating a new program within CHIP, FamilyCare Advantage, that allows families whose income is above 350 percent of the federal poverty level to buy into CHIP coverage for their uninsured children. Families are responsible for paying the full premiums, but rates are lower than the average private insurance plan ($137/month for one child to $411/month for 3 or more children). This buy-in program does not rely on any federal funding. The state reached an agreement with the insurance provider, Horizon Blue Cross Blue Shield of New Jersey, in December 2007 and implementation of the FamilyCare Advantage program began in January 2008. The program expects to extend coverage to 15,000 children. This legislation included other reforms to New Jersey's CHIP program, FamilyCare, such as streamlining the application process and reversing the governor's freeze on covering parents through FamilyCare. In 1999, New Jersey expanded CHIP eligibility from 200 percent of the federal poverty level to 350 percent of the federal poverty level. Currently, children in families with incomes between 150 percent federal poverty level and 350 percent federal poverty level are required to pay monthly premiums and co-payments based on a sliding scale by income.
In June 2008, Chapter 38 (SB 1557) was enacted requiring all children 18 years of age and younger to have health insurance coverage. The law appropriates $1 million to create and carry out the NJ FamilyCare initiative to increase outreach, enrollment and retention. The initiative requires the Commissioner of Human Services to establish the Outreach, Enrollment, and Retention Working Group to increase enrollment and retention in public health coverage programs. Additional information is provided in the following NCSL State Health Notes article: The Garden State Plows New Ground (August 4, 2008).
For more information: New Jersey FamilyCare
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New Mexico
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In 2006, SB 267 was enacted to create the Premium Assistance for Kids (PAK) program for uninsured children up to age 11 who are ineligible for Medicaid or CHIP. Through this state-funded program, the state pays up to 50 percent of the premiums for participating plans. In addition, the state expanded Medicaid eligibility for children under six by increasing allowable earning and childcare disregards.
In September 2008, Chapter 10 (Special Session SB 22) was enacted which made a $32,500,000 appropriation to the human services department. Portions of this appropriation are designated to provide coverage for individuals enrolled in or eligible for the developmental disabilities Medicaid waiver program, provide coverage for more children under age 18 years through the Medicaid and CHIP, and to provide behavioral health services to individuals through age 18 enrolled in Medicaid or CHIP. This law is effective January 1, 2009.
For more information about New Mexico's CHIP program: New Mexico New MexiKids
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New York
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The state legislature approved the state budget for 2008 (SB 2108; 2007 N.Y. Laws, Chap. 58), which includes an CHIP eligibility level increase from 250 percent of the federal poverty level up to 400 percent of the federal poverty level. Families with incomes above 400 percent may buy-in to the program for their children. Due to the August 17 directive, CMS denied New York's request for this expansion.
In April 2008, Chapter 58 (SB 6808), the 2009 budget was enacted and appropriated state funds for the implementation of the expansion of the Child Health Plus program to 400 percent of the federal poverty guidelines. This expansion was implemented beginning September 1, 2008.
For more information about New York's CHIP program: New York Child Health Plus
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North Carolina
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In 2007, North Carolina enacted HB 1473 which created the North Carolina Kids' Care that will increase CHIP eligibility for kids whose family income is between 200 percent federal poverty level and 300 percent federal poverty level. The law states that the expansion will become effective July 1, 2008. Due to the August 2007 CMS directive, North Carolina is exploring funding options for the expansion.
For more information about North Carolina's CHIP program: North Carolina Health Choice for Children
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North Dakota
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In 2007, HB 1463 was enacted which increased CHIP eligibility levels from the current level of 140 percent of federal poverty guidelines to 150 percent for children up to age 19; CMS approved this expansion on June 5, 2008.
In 2009, HB 1012 (Chapter 12) was enacted, which increased the net income eligibility limit from 150 percent to 160 percent of the federal poverty guidelines for the state's children's health insurance program. The law also requires the department of human services to award a contract for outreach services for the state children's health insurance program to an entity other than an insurance company, for the biennium beginning July 1, 2009 and ending June 30, 2011.
For more information about North Dakota's CHIP program: North Dakota CHIP
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Ohio
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In June 2007, the 2008-09 state budget (HB 119), was signed into law, which includes an expansion of CHIP eligibility for children with family incomes up to 300 percent of the federal poverty level from the previous level of 200 percent of the federal poverty guidelines. This bill also allows children under 19 years of age with family incomes above 300 percent of the federal poverty guidelines to buy-in to the program if the individual has not had creditable coverage for at least six months and is unable to obtain coverage due to a pre-existing condition, lost coverage because the individual has exhausted a lifetime benefit limitation, the premium for the only coverage available is greater than 200 percent of the premium under the buy-in program, or the individual participates in the program for medically handicapped children. In response to the August 2007 CMS directive, Ohio explored additional funding options. In April 2008, an executive order was signed by the governor establishing the Children's Buy-In program, which enables families with incomes above 300 percent federal poverty level to purchase public coverage for their children. The program intends to target children from middle-class families with serious health conditions that make private coverage unaffordable or unavailable. The program accepted applications starting April 1, 2008 and began enrollment June 1, 2008. Additional information is provided in the following NCSL State Health Notes article: Ohio to Cover Children with Serious Health Conditions (April 28, 2008).
In June 2008, House Bill 562 was enacted which changes the minimum income eligibility requirement for the Children's Buy-In program to be income above 250 percent of the federal poverty guidelines. An individual's countable family income, rather than just the individual's income shall be used to determine whether the individual meets the income eligibility requirements. An individual may be granted an exception to the requirement that the individual not have had credible coverage for at least six months before enrolling in the program if the individual exhausted a lifetime benefit limitation. The act requires specified cost sharing provisions, including monthly premiums and co-payments.
For more information about Ohio's CHIP program: Ohio Healthy Start
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Oklahoma
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SB 424, the All Kids Act, was enacted in 2007 which creates a premium assistance program within Medicaid for children under age 18 whose family income is between 185 percent and 300 percent of the federal poverty level. The program is expected to assist as many as 42,000 additional children in obtaining health care coverage. As a result of the August 2007 CMS directive, Oklahoma will only provide this premium assistance program to children whose family income is up to 250 percent of the federal poverty level.
For more information about Oklahoma's CHIP program: Oklahoma SOONERCARE
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Oregon
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In 2009, HB 2116 was enacted, which directs the Office of Private Health Partnerships to administer a private health option to expand access to health insurance for Oregon's children. The premium assistance shall be equal to the full cost of the premium for children whose family income is at or below 200 percent of the federal poverty guidelines and who have access to employer sponsored health insurance. The premium assistance shall be based on a sliding scale for children whose family income is above 200 percent but at or below 300 percent of the federal poverty guidelines, regardless of whether the child has access to coverage under an employer sponsored health benefit plan. A child whose family income is more than 300 percent of the federal poverty guidelines shall be offered the option of purchasing a health benefit plan through the private health option at full cost. A press release from the Oregon House of Representatives, Office of the Speaker on June 8, 2009 estimates that the legislation will cover 80,000 Oregon children.
For more information about Oregon's CHIP program: Oregon Health Plan
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Pennsylvania
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In 2006, Act 136 (HB 2699) was enacted to create the Cover All Kids program, which expands eligibility for the CHIP program. Prior to the expansion, Pennsylvania covered children in families with income up to 200 percent of federal poverty guidelines through CHIP. The state will continue that coverage and open the program to children in families with income up to 300 percent of federal poverty guidelines with premiums based on a sliding income scale, ranging from $36 to $57 per child per month. Families with incomes above this threshold may buy into the CHIP program if coverage has been denied due to a preexisting condition, private insurance premiums are 150 percent higher than the state's monthly premium, or the cost of insurance exceeds 10 percent of annual family income. For parents at this income level who can access private insurance but cannot afford the premiums, the state will subsidize the cost. The expansion was approved by CMS in February and the program began implementation in March 2007.
For more information about Pennsylvania's CHIP program: Pennsylvania CHIP
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Rhode Island
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In May 2008, Chapter 9 (HB 7204), removed coverage for noncitizen children lawfully residing in the United States under the RIte Care, Rhode Island's CHIP program. The RIte Care program currently covers children up to age 19 in families with income up to 250 percent of the federal poverty guidelines and continues to cover legal immigrant children after five years of residency as provided under federal law.
For more information about Rhode Island's CHIP program: RIte Care
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South Carolina
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A provision in the 2007-2008 budget (2007 HB 3620) passed the state legislature in June 2007 and creates a separate Children’s Health Insurance Program, Healthy Connections Kids, that expands eligibility to children with family incomes up to 200 percent of the federal poverty level. This provision was vetoed by the Governor, but the legislature overrode the veto.
For more information about South Carolina's CHIP program: South Carolina Partners for Healthy Children; Healthy Connections Kids
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Tennessee
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Cover Kids (2006 Tenn. Pub. Acts, Chap. 867) was enacted in 2006. The state received federal approval in January 2007 and the program began implementation in April 2007. The Cover Kids plan expands health insurance to uninsured children under age 19 who are not eligible for Medicaid and who have been uninsured for at least three months. Cost-sharing for more services is required for all participants. Eligible enrollees with income less than 250 percent of federal poverty guidelines do not pay premiums. Families whose income is above 250 percent federal poverty level can buy-in to the program by paying monthly premiums (approximately $225 per month per child for the year 2008). The benefits of the plan are based on the state employees' health insurance plan and focus on preventative and well-child care.
For more information about Tennessee's CHIP program: Tennessee CoverKids
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Texas
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In June 2007, HB 109 was enacted which created a community outreach campaign for CHIP and extended continuous coverage for children from 6 to 12 months and eliminated a 90-day waiting period, except for certain applicants.
In May 2009, Senate Bill 187 (Chapter 34) was enacted, which directs the executive commissioner of the health and human services commission to develop and implement, not later than December 1, 2009, a Medicaid buy-in program for children with disabilities whose family incomes do not exceed 300 percent of the federal poverty guidelines. Monthly premiums according to a sliding scale based on family income shall be required.
For more information about Texas's CHIP program: Texas CHIP
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Utah
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The Governor pledged $4 million to lift the enrollment cap on the state's CHIP program to enroll 14,000 additional children in his 2007 State of the State address. Funding was approved in the 2007 state budget, and enrollment was re-opened in July 2007. In March 2008, Chapter 386 (HB 326) was enacted which requires the Department of Health to keep enrollment in Utah's CHIP open so that all eligible children who apply for coverage under CHIP can enroll in the program and designates appropriations.
Also in March 2008, Chapter 383 (HB133) was enacted which specifies that adults who enroll in Utah's Premium Partnership for Health Insurance (UPP), must also enroll their children in the program, who would then be ineligible to enroll in Utah's CHIP program. UPP is a premium assistance program that helps adults and families pay for monthly premiums when they enroll in their employer's health insurance plan. In addition, the bill allows approval for UPP to be considered a qualifying event for applicants to enroll in their employer-sponsored health insurance plan at any time.
For more information about Utah's CHIP program: Utah CHIP
For more information about the UPP program: Utah's Premium Partnership for Health Insurance
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Vermont
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Enacted in 2006, HB 861 (Act 191) aimed to achieve near-universal coverage for state residents. Before this legislation, eligibility levels for children for Medicaid/CHIP programs were already at 300 percent of federal poverty guidelines. However, the reforms reduce premiums for children in the Dr. Dynasaur, Vermont's CHIP program, by half. A private insurance plan that is subsidized by the state (for individuals or families with income below 300 percent of federal poverty guidelines) will be available for children and families who are not eligible for other public insurance. Individuals and families with income above 300 percent of federal poverty guidelines may buy-in to the program. In addition, the reforms provided funding for outreach efforts.
In June 2008, Chapter 192 (HB 891) was enacted which increases the premiums for Dr. Dynasaur, Vermont's CHIP program, from $40.00 to $60.00 for children in households whose income is greater than 225 percent and less than or equal to 300 percent of the federal poverty level.
For more information about Vermont's CHIP program: Vermont Dr. Dynasaur
For more information about Vermont's Catamount Health program: Catamount Health 2006 Legislation; Vermont's 2006 Health Reform Initiatives
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Washington
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SB 5093, enacted in 2007 (Chapter 5), expands Washington's CHIP eligibility level to children, regardless of their citizenship status, in families with incomes at or below 250 percent of federal poverty guidelines. Cost sharing on a sliding scale is required for families with incomes between 200 and 250 percent of federal poverty guidelines. The law includes outreach and administrative measures, including consolidating applications for three state-sponsored insurance programs into one application. The law also states that effective January 1, 2009, upon appropriation of funds, eligibility shall be increased to 300 percent of the federal poverty level and that families above 300 percent of the federal poverty level shall be able to buy-in to the program.
For more information about Washington's CHIP program: Washington SCHIP
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West Virginia
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In 2006, HB 4021 (Chapter 106) was enacted which expanded CHIP eligibility up to 300 percent of the federal poverty level. The government requested that the expansion be delayed until Congress reauthorized the SCHIP program; the state then decided to implement the expansion incrementally. As of January 1, 2007, the state began enrolling children with incomes up to 220 percent of the federal poverty level. As of January 1, 2009, eligibility of the CHIP program was expanded to 250 percent of the federal poverty guidelines. Families with income between 200 and 250 percent of the federal poverty guidelines are required to pay premiums and co-payments.
For more information about West Virginia's CHIP program: West Virginia WVSCHIP
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Wisconsin
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In 2007, SB 40 (Act 20) was enacted to expand CHIP eligibility to families with incomes up to 300 percent of the federal poverty level. Due to the August 2007 CMS directive, state-only funds will be used to finance coverage for children with family incomes between 250 and 300 percent of the federal poverty level. Under the BadgerCare Plus program, Wisconsin's SCHIP program, families with annual incomes between 200 percent and 300 percent of the federal poverty level are eligible for health coverage for their children and will be required to pay premiums (approximately $10 to $90.74 per month). Families with annual incomes more than 300 percent of the poverty level may buy-in to the program and must contribute the full cost of coverage, about $1,089 per child per year. The program does not cover undocumented immigrant children or parents whose employers cover 80% of the cost of family coverage.
For more information about Wisconsin's CHIP program: Wisconsin BadgerCare Plus; BadgerCare Eligibility Handbook
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Source: National Conference of State Legislatures, Kaiser Family Foundation: State Coverage Initiatives for Children
Note: List may not be comprehensive, but is representative of state plans and proposals. NCSL appreciates additions and corrections. To submit additions or corrections, please email us at health-info@ncsl.org
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, June 2009
Children's Health Insurance Program (CHIP)
National Conference of State Legislatures
Frequently Asked Questions on SCHIP
National Conference of State Legislatures
Care and Coverage of the Nation's Children
A resource page from the Kaiser Family Foundation
The Garden State Plows New Ground
National Conference of State Legislatures, State Health Notes, August 4, 2008
ABCs of The State Children's Health Insurance Program (SCHIP)
National Conference of State Legislatures, 2007
Understanding the Uninsured: Tailoring Policy Solutions for Different Subpopulations
National Institute for Health Care Management (NIHCM), April 2008
Children's Health Insurance Program Plan Activity Map
This map shows CHIP programs by type (stand-alone program, Medicaid expansion, combination program) and a summary of state amendments under review.
Centers for Medicare and Medicaid Services
Related NCSL Webpages
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.
2011 Federal Poverty Guidelines
Source: Department of Health and Human Services (HHS), 2011. For more information: View HHS's webpage and the January 20, 2011 Federal Register Notice.
Guidelines for the 48 Contiguous States and the District of Columbia
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People in Family Unit
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Poverty Guidelines
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|
1
|
$10,890
|
|
2
|
$14,710
|
|
3
|
$18,530
|
|
4
|
$22,350
|
|
5
|
$26,170
|
|
6
|
$29,990
|
|
7
|
$33,810
|
|
8
|
$37,630
|
|
More than 8
|
Add $3,820 for each additional person
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Guidelines for Alaska
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People in Family Unit
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Poverty Guidelines
|
|
1
|
$13,600
|
|
2
|
$18,380
|
|
3
|
$23,160
|
|
4
|
$27,940
|
|
5
|
$32,720
|
|
6
|
$37,500
|
|
7
|
$42,280
|
|
8
|
$47,060
|
|
More than 8
|
Add $4,780 for each additional person
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Guidelines for Hawaii
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People in Family Unit
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Poverty Guidelines
|
|
1
|
$12,540
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|
2
|
$16,930
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|
3
|
$21,320
|
|
4
|
$25,710
|
|
5
|
$30,100
|
|
6
|
$34,490
|
|
7
|
$38,880
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|
8
|
$43,270
|
|
More than 8
|
Add $4,390 for each additional person
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