The Why

Currently the Children’s Health Insurance Program (CHIP) provides insurance coverage for about 220,000 children in Georgia through the state’s PeachCare for Kids program (CHIP covers 7.7 million children nationwide).  Funding for the program, however, is in a precarious position.  By choosing not to appropriate federal dollars for CHIP in the 2016-2019 budgets, Congress would leave millions of children in the lurch without access to health insurance.

The Basics

For those of you not familiar with health-speak, the Children’s Health Insurance Program (CHIP) is a federal assistance program that helps states provide insurance for poor children whose families make too much to allow the children to be covered by Medicaid[1], but make too little to be able to provide insurance for their children themselves.  Georgia’s CHIP program is called “PeachCare for Kids” (PCK).

The eligibility varies by states, but in Georgia, as of January 1st of this year, CHIP covers children of families earning at or below 247% of the Federal Poverty Level (FPL), which amounts to at or below $58,188 for a family of four.

In Georgia, CHIP/PCK covers primary, preventive, specialty, dental and vision care for enrolled children ages 18 and under.  In addition, the insurance covers hospitalization, emergency room visits, prescription medications and mental health care.

For that care, the federal government pays Georgia in the form of a block grant, which covers approximately 75% of the cost (minus premiums paid by families), with the state matching the other 25% or so.  This match is assessed annually but hovers around there.  For a few more details on PCK, click here.

The History

The 105th Congress created the State Children’s Health Insurance Plan (SCHIP) back in 1997.  It started as $40 billion worth of block grants for states to use over 10 years.  At that time, states could use the assistance to either extend their existing Medicaid programs or create stand-alone programs.  Georgia created a stand-alone program.

Almost a decade later, states found their needs were exceeding the capacity of the initial grants.  In 2006 and 2007, Congress increased funding for the program, but was unable to find Executive Branch support for reauthorization.

In 2009, the program was at last reauthorized as “CHIPRA” (Children’s Health Insurance Program Reauthorization Act).  The reauthorization included increased funding and a number of provisions to improve enrollment, quality of care and data collection.  The reauthorization, however, expired at the end of 2013, but support was extended through The Affordable Care Act (ACA).

The ACA was passed in 2010, extending CHIP funding until September 30, 2015 (the end of Fiscal Year 2015).  The ACA also raised the eligibility levels for Medicaid enrollment starting January, 2014 to 133% FPL, which shifted some children from CHIP into Medicaid.

The Rub

The ACA keeps CHIP eligibility standards in place through 2019, and keeps the match rate the same until Oct. 1 2015 (the start of FY 2016), after which the match will go up by 23 percentage points (which will bring the match to somewhere around 93% federal/7% state).  Remember, however, that funding is only guaranteed until September 31, 1015.  Therein lies the rub!

The Message for Congress

The uncertainty as to whether or not Congress will continue to fund CHIP and at what level is disconcerting to say the least.  Currently the Children’s Health Insurance Program (CHIP) provides insurance coverage for about 220,000 children in Georgia[2] (7.7 million children nationwide). Unreliable healthcare funding is not good for children and not good policy for Georgia.  CHIP helps ensure the wellbeing of these children and families, and the economy of our state.  Please make sure that CHIP funding is secured through 2019.  Thank you for your consideration and for all you do for Georgia’s children.

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