Maryland Kids Win with CHIPRA Performance Bonus – Say Ahhh! A Children’s Health Policy Blog

leigh-image.jpgThumbnail image for Maryland Health Care For All.jpg

By Leigh Cobb, Advocates for Children and Youth

and Suzanne Schlattman, Maryland Citizen’s Health Initiative Education Fund

Maryland has just received its second Children’s Health
Insurance Program Reauthorization Act (CHIPRA) performance bonus from CMS.  This recognizes its efforts to identify
and enroll eligible children in Medicaid and the Children’s Health Insurance
Program (CHIP).  Maryland enrolled
an additional 41,000 children in FY 2011 alone, and since 2007 we have seen a
34% overall increase in enrollment. 
Our bonus of $28.3 million represents the highest amount awarded by CMS
this year.

Streamlined eligibility and enrollment have long been a
priority for Maryland advocates. However, at the time CHIPRA passed, Maryland
met 3 only of 5 required bonus criteria: it had eliminated the asset test,
adopted a single, simplified application form for Medicaid and CHIP, and
eliminated the in-person interview requirement.  The state had begun to recognize that many children
continued to fall through the cracks and lose coverage as a result of our
renewal process.  To address this, Maryland
streamlined and automated the renewal process in 2009.  Still, Maryland had to take one more
step to become eligible for a CHIPRA performance bonus.

In 2008, Maryland had passed the Kids First Act creating
a national model.  Under the
legislation, the state tax forms included a question to determine if dependent
children had health care coverage. 
A combined Medicaid/CHIP application was then sent to all families with
incomes under 300% of the federal poverty level who indicated lack of coverage
for their children. The State then recognized the need to create even more
targeted outreach.  In 2010, with
substantial support from the advocacy community, the legislation was modified
to facilitate better coordination between the Comptroller’s Office and the
Department of Health and Mental Hygiene (DHMH).  At the same time, it added a separate opt-in provision to
the tax form.  These steps led to
the realization of true “express lane eligibility” and allowed the State to
apply for and receive its first CHIPRA bonus.  The State also piloted another express lane eligibility
effort that uses Free and Reduced Meals (FARMS) program applications in
Baltimore City.

The substantive expansion in enrollment in 2011, made
Maryland eligible for this year’s Tier 2 bonus–because it increased enrollment
more than 10 percent above the target level needed to earn a bonus.  Commenting on the latest performance
bonus and the lessons learned from child enrollment efforts, DHMH Secretary Dr.
Joshua Sharfstein said, “We have a great foundation for further progress with
the Health Benefit Exchange”.

This second performance bonus will support Maryland’s
ongoing efforts to make sure that all eligible children get enrolled in
Medicaid and CHIP, and can then access the full range of health services they

Scroll to Top