Enhanced CHIP Benefits

Some states operate their CHIP programs as extensions of their Medicaid programs, ensuring access to the Medic­aid benefit package for children enrolled in CHIP. Other states operate their CHIP programs separately, offering coverage through a standard commercial health plan. In states with separate CHIP programs, children often receive a more limited package of benefits, similar to the benefits commercial health plans offer their privately insured enrollees.

Two states, Alabama and Connecticut, have enhanced the coverage offered by commercial CHIP plans with supplementary benefit packages specifically for CYSHCN.

Through the Alabama All Kids Plus Program, the state Title V and Early Intervention programs and the State Depart­ment of Mental Health’s Division of Intellectual Disabilities Services jointly expand CHIP benefits for children they serve by paying the state match for CHIP. The agencies enhance the basic CHIP package, providing additional benefits for CYSHCN such as case management, life skills training, psychological counseling and testing, durable medical equipment, and physical and occupational therapy.

Connecticut offers the HUSKY Plan for uninsured children, which consists of two programs; HUSKY A and B.  HUSKY A (Medicaid) is for children, parents and other caregivers with incomes under 185% of the federal poverty level. HUSKY B is only for children with family incomes over 185% of poverty.  There is no income limit for HUSKY B, so any child can qualify.  HUSKY A and B have similar benefit packages; however, HUSKY A has no co-pays or premiums.

There is also an enhanced benefit package available for children enrolled in HUSKY B called the Husky PLUS Program, which is designed to meet the needs of children with physical health conditions. (As Medicaid enrollees, children with special health care needs covered under HUSKY A have access to EPSDT benefits.) The HUSKY Plus program covers care coordination, family resource coordinators, advocates, and multidisciplinary clinical teams, with no deductibles, no co-pays, and no additional premiums. Extra services include adaptive seating, audiometry, casting, diagnostic imaging, durable medical equipment, general dental care, hearing aids, medical and surgical supplies, therapies, and nutritional formulas.

Mental health and substance abuse treatment services are available to HUSKY enrollees through the Connecticut Behavioral Health Partnership. The behavioral health program covers in-home child and adolescent psychiatric and substance abuse services, mo­bile crisis services and care coordination. It also provides coverage for children who exhaust their mental health benefits through private coverage.

 Printable version of table (PDF)

Income Eligibility Levels for Children’s Separate CHIP Programs by Annual Incomes and as a Percent of the Federal Poverty Level, 2011

* In the above table, asterisks indicate states which do not have a separate CHIP program. Income eligibility levels as a percent of the Federal Poverty Level (FPL) for states with a Children’s Medicaid/CHIP Expansion Program  can be accessed here.

1. Arizona instituted an enrollment freeze in its CHIP program, KidsCare, on December 21, 2009. The program remains closed to new applicants.
2. Infants born to mothers in California’s Access for Infants and Mothers (AIM) program are automatically enrolled in CHIP. The income guideline for these infants, through their second birthday, is 300% of the FPL.
3. Colorado increased eligibility from 205% to 250% of the FPL on May 1, 2010. The state has also passed legislation authorizing coverage of lawfully residing immigrant children, but has not provided funding for the expansion.
4. Connecticut, Florida, Illinois, Maine, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Tennessee, and Wisconsin allow families with incomes above the levels shown buy into Medicaid/CHIP. See Table 2 (available at the data source link) for income eligibility guidelines and premiums for these buy-in programs.
5. Florida operates three CHIP-funded separate programs. Healthy Kids covers children ages 5 through 19, as well as younger siblings in some locations. MediKids covers children ages 1 through 4. The Children’s Medical Service Network serves children with special health care needs from birth through age 18.
6. Illinois provides state-financed coverage to children with incomes above CHIP levels. Eligibility is shown in parentheses.
7. Kansas increased eligibility from 200% to 250% of the 2008 FPL (approximately 241% of the 2009 FPL) on January 1, 2010.
8. In Massachusetts, children at any income are eligible for more limited state-subsidized coverage under the state’s Children’s Medical Security Plan; premiums are charged on a sliding scale based on income.
9. Oregon increased eligibility from 200% to 300% of the FPL on February 1, 2010.
10. South Carolina converted its separate CHIP program to a Medicaid expansion in October 2010.
11. Tennessee reopened its separate CHIP program (CoverKids) to new applicants on March 1, 2010.
12. In Vermont, Title XIX funding covers uninsured children in families with income at or below 225% of the FPL; uninsured children in families with income between 226% and 300% of the FPL are covered via Title XXI funding under a separate CHIP program. Underinsured children are covered in Medicaid through Title XIX funding up to 300% of the FPL.

Source

The Henry J. Kaiser Family Foundation (2011). Income Eligibility Levels for Children’s Separate SCHIP Programs by Annual Incomes and as a Percent of Federal Poverty Level, 2011. Retrieved March 4, 2011 from http://www.statehealthfacts.org/comparemaptable.jsp?ind=204&cat=4.