HHS: CHIP Coverage More Comprehensive Than ACA Exchange Plans

U.S. children cannot receive comparable benefits and cost-sharing requirements through plans sold through the Affordable Care Act's exchanges as they can through coverage available under the Children's Health Insurance Program, according to an HHS analysis released last week, Modern Healthcare reports.

The ACA directs HHS to ensure that health plans with benefits and cost-sharing requirements comparable to those accessible under CHIP are available for children if CHIP funding expires. The analysis found that CHIP offers more affordable coverage for children, as well as more comprehensive benefits, including:

• Dental care;
• Habilitation services;
• Vision care; and
• Services for children with special health care needs.

Since the analysis did not find exchange plans comparable to coverage offered through CHIP, HHS Secretary Sylvia Mathews Burwell suspended an ACA provision that required states to create policies to automatically move children who do not qualify for Medicaid from CHIP to ACA plans if funding for CHIP expires. Burwell stated in the analysis, "At this time and in the foreseeable future, the requirement of the act that requires states to establish processes to enroll children in certified [qualified health plans] does not apply."

According to Modern Healthcare, federal funding for CHIP is set to expire in 2017. However, a CMS spokesperson noted that President Obama's fiscal year 2016 budget proposal calls for CHIP to be funded through 2019. According to Rachel Klein, director of organizational strategy at Families USA, Congress likely will extend funding for CHIP before it runs out in 2017.

Reaction

Experts said they were not surprised by the analysis' findings.

Sara Rosenbaum, a health care policy expert at George Washington University, said, "This confirms what has been well-documented and underscores the need for ACA changes that strengthen pediatric coverage," adding, "Without those changes, continuing CHIP funding remains an imperative."

Bruce Lesley -- president of First Focus, a children's advocacy group -- said the findings "show how great CHIP is for children and their families and [are] further validation that CHIP provides the most comprehensive benefits at the lowest cost for kids" (Dickson, Modern Healthcare, 11/30).