CHIP: HHS Offers New Patient Protections for CHIP Enrollees
HHS Secretary Donna Shalala proposed legislation this week that would extend patient protections to all children enrolled in CHIP, the federal-state program for uninsured children. The proposed rule would include access to specialists, access to emergency services, treatment option guarantees and access to fair and timely appeals processes. CHIP plans have been approved in all 50 states, 5 territories and the District of Columbia -- enrolling more than 1.3 million children since the program's launch two years ago. With continued outreach, the nation's CHIP plans expect to enroll 2.6 million children by September 2000. "The CHIP program is one of the proudest achievements of the Clinton administration," said Shalala, "Not since the creation of Medicaid has the nation taken such an affirmative action to assure the health of its most vulnerable children. This proposed legislation is the next step in improving access to health care for millions of America's children." HCFA Deputy Director Michael Hash noted, "This rule is the culmination of two years of working with states to develop policies that will continue CHIP's success. It is a trustworthy blueprint for the states as they continue strengthening and expanding their CHIP plans." The proposed CHIP legislation will have a 60-day public comment period, after which the final regulation will be published (HCFA release, 11/1). In other CHIP news, several state plans have seen action this week:
- Arkansas: ARKids First, the state's CHIP plan, is under HHS scrutiny for failing to delineate clearly between Medicaid-eligible and CHIP-eligible participants, and for offering Medicaid coverage through the CHIP plan. According to the Arkansas Democrat-Gazette, in a January 28, 1999, letter, HHS wrote that ARKids' federal CHIP funding was designed for children "not otherwise Medicaid eligible." The agency noted that "it appears that many families whose children might be eligible for regular Medicaid are enrolling in the ARKids First program." The ARKids program, which offers fewer benefits than Medicaid and requires a small co-payment, is open to children whose family income is greater than 100% of the federal poverty level. The program insures 46,000 enrollees. But HHS has determined that ARKids must "discontinue enrolling any Medicaid eligible ARKids First applicants in ARKids First. Further, [the state] must screen current ARKids First children and enroll them in Medicaid if they are determined Medicaid eligible." HHS did not provide a deadline for the changes in the ARKids program, which cost $22.4 million in FY 1999 (Simmons, 11/04).
- Kentucky: The Health Services Cabinet expanded KCHIP Monday, making children in families with incomes up to 200% of the federal poverty level eligible for free health coverage. The expansion, covering kids from birth through age 18, means that children in families of four with incomes up to $33,400 may enroll. KCHIP covers office visits, preventive services and hospital stays, but omits special services such as private duty nursing. The cabinet is spending $4 million in federal funds on a public health outreach effort. The plan currently maintains more than 20,500 enrollees (Lexington Herald-Leader, 11/02).
- North Carolina: State Secretary of Health Dr. David Bruton Tuesday proposed an expansion of North Carolina's CHIP coverage. Currently, families with incomes up to 200% of the federal poverty level remain eligible to enroll children; Bruton called for the state to raise the cutoff for taxpayer-subsidized coverage to 350% of poverty, or $58,450 for a family of four. Under the plan, higher-income families could enroll children in CHIP for an "estimated $1,200 to $2,400" per year, depending on family size. Bruton, who estimates that the expansion will cost the state between $20 and $25 million per year, said, "What I'm talking about is making available comprehensive health coverage for all of the children." If the expansion is approved, North Carolina will have the broadest CHIP coverage in the nation; the program currently serves 55,000 children statewide (AP/Charlotte Observer, 10/31).
- Virginia: A year into its own CHIP plan implementation, Virginia officials are wondering how to enroll more of the state's uninsured children. While nearly 17,000 Virginia kids have enrolled, the number falls short of the state's 65,000 enrollee goal. CHIP-Richmond coordinator Barbara Fleming said, "Too many people seem hesitant to get involved with it because they don't want to be involved in a welfare type program." State officials are stepping up the CHIP outreach campaign, mailing informational postcards to about 100,000 potentially eligible households. In addition, the state Department of Social Services has launched marketing campaigns, including television and radio commercials, billboards and newspaper ads (Adams, Richmond Times-Dispatch, 11/01).