Health Reform Eases Prohibition of Enrolling State Employee Kids in CHIP – Say Ahhh! A Children’s Health Policy Blog

I’m all for light meals but the smorgasbord offered by
the health reform law is something we need to make reform meaningful and to
ensure that all Americans have access to affordable health care. Whether you go
straight to the entrees (the Medicaid expansion or subsidized coverage through
exchanges) or nibble on the appetizers (no more pre-existing exclusions or
lifetime caps), there is something for everyone.

One such tidbit will allow certain dependents of state
employees to enroll in the Children’s Health Insurance Program (CHIP). For the
past thirteen years, children of state employees who are eligible for health
benefits from the State employee health plan have been explicitly excluded from
the definition of “targeted low-income” children who are eligible for CHIP. The
new health reform law has eased those restrictions effective immediately.

State CHIP programs may enroll children of state
employees (who are otherwise eligible) if one of these conditions is met:

  • Maintenance of effort – the amount the State
    contributes to health benefits on behalf of employees including dependent
    coverage for the most recent State fiscal year cannot be less that the amount
    it expended in SFY 97 increased for inflation. (If you want the nitty-gritty,
    the most recent contribution cannot be less than the 1997 contribution
    increased by the percentage increase in the medical care expenditure category
    of the Consumer Price Index for All-Urban Consumers for each preceding fiscal

  • Hardship waiver – The annual aggregate amount of
    premiums and cost-sharing for coverage of the family of the child in the state
    employee plan exceeds 5 percent of the family income.

If the state meets the first condition, any eligible
state employee child can be enrolled in CHIP. The second condition is
applicable on a family-by-family basis. 

Interest is high among advocates and state officials in
this change but federal guidance is needed to answer certain questions. In
particular, given crowd-out rules is this option only available to new
employees or to employees whose children have been uninsured long enough to
meet CHIP waiting periods? How will states estimate a family’s total
cost-sharing to determine if a family meets the hardship waiver?

Whether you like savory or sweet, there’s something to
please everyone’s palate in health reform. While we wait for the meat and
potatoes to be served in 2014, there are lots of tasty treats to satisfy our
hunger in the meantime. And we’ll keep serving them up for you to sample at Say

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