Using CHIPRA Bonus Payments in Advocacy


Jon Gould, Children’s Alliance

While celebrating the anniversary of the Affordable Care Act last month, I couldn’t help but think how vital CHIPRA’s passage was a year before the ACA – in February 2009.

With President Obama’s signature on the five-year children’s health reauthorization law came a powerful new tool in our advocacy toolbox: annual performance bonus payments to states that are leading the way on health coverage for kids.

The CHIPRA performance bonus funds have provided a game-changing opportunity for us. Through a variety of methods, my colleagues in Washington state and I have capitalized on these annual bonus payments to protect our gains in children’s health coverage and access to care.

First, some context. In 2007, Washington state adopted a Cover all Kids law and created Apple Health for Kids – the program that provides health care coverage to low and moderate income families. Because of this law, 96.4 percent of Washington kids now have health coverage. In some legislative districts, 70-80% of the children get their health care through the program.

A key feature is that all resident children are eligible based on family income, without regard to immigration status. However, the “all kids” aspect of the law is threatened this year, as our Governor and some lawmakers have proposed eliminating coverage for all 25,000 children (even kids living in deep poverty) whose coverage costs are not matched with federal funds.

In response to this threat, we have escalated our advocacy with creative uses of CHIPRA’s past and future performance bonus funds.

First, we’ve worked hard to be sure that our state qualifies for the 5 of 8 program features that are necessary to be considered for a CHIPRA bonus. We have had consistent and diligent communication with our state Medicaid/CHIP agency. During the first round of bonus payments in the fall of 2009, we helped craft our state’s application to CMS. We wanted to be sure that we put the best foot forward regarding the 5 of 8 program features. It was a close call, but CMS ultimately determined that our state qualified.

Next, we consistently make the link between higher Apple Health for Kids caseloads and a larger CHIPRA bonus. This has helped us to advocate for measures that efficiently and swiftly grow the Apple Health for Kids caseload, such as Express Lane Eligibility.

Finally, we estimated future CHIPRA annual performance bonus payments and asked legislators to include this funding in revenue projections. 

Using a detailed spreadsheet created by our technical assistance providers at CCF, we calculated that Washington state was in line to receive approximately $80 million in CHIPRA bonus payments in the next two years. This is significant because it is $64 million more than our Governor projected in her two year budget proposal.


Last week, we held a press conference to announce our findings. To emphasize that the amount of bonus payments is directly related to the size of the Apple Health for Kids caseload, we provided both low and high estimates of future bonus payments. To ensure our message reached legislators, we created a massive “Prescription for Protection” that children signed below the words “Take Immediately and Protect Apple Health for Kids.”

We won a big victory when state officials validated our estimates and legislators included this funding in their proposed 2011-13 budget.

Our message about what legislators should do with the CHIPRA bonus funds is clear: funding earned from our success in children’s health should be reinvested in children’s health. And, the amount of the bonus funds is more than enough needed to prevent the loss of coverage for the 25,000 kids at risk.

We are now in the thick of lobbying, mobilizing, and urging legislators to fully protect Apple Health for Kids for all kids.

Stay tuned for the outcome on our blog, No Kidding.


Caption:  Children and adults signed a “Prescription for Protection” at a Seattle children’s clinic March 21. The giant foam board prescription form ordered lawmakersto use future CHIPRA performance bonuses in order to protect health coverage for kids. Photos courtesy Children’s Alliance.