The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan, federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP, and for making recommendations to Congress, HHS and the states on a wide range of issues affecting these programs. MACPAC’s March 2013 report to Congress includes important recommendations for CHIP programs.

MACPAC Recommendation (page 167 of the report): To reduce complexity and to promote continuity of coverage, the Congress should eliminate waiting periods for CHIP.

Here, here! As my colleague Martha Heberlein and I wrote in our brief on this topic, making kids wait for coverage makes no sense in a reformed health system. Already 16 states have eliminated their waiting periods based on an email survey of states conducted by MACPAC and CCF staff earlier this year.

MACPAC Recommendation (page 174 of the report): In order to align premium policies in separate CHIP programs with Medicaid, the Congress should provide that children with family incomes below 150 percent FPL, not be subject to CHIP premiums.

The ACA’s vision for streamlined, seamless access to coverage promotes consistency across the different insurance affordability programs, including Medicaid, CHIP and subsidized coverage in the marketplaces. But many policies relating to premium administration are not aligned, as I wrote about in this brief on administering premiums.

Although CHIP rules previously allowed states to charge premiums starting at 101% FPL, moving the stairstep kids (CHIP kids, ages 6-18, between 100% – 138% FPL) into Medicaid effectively raised the threshold for premiums to 138% FPL. Only eight states continue to charge premiums or annual enrollment fees for CHIP families under 150% FPL, the highest of which is $15 per child per month. Considering the cost of administering premiums, along with the fact that any increase in state expenditures would qualify for the higher CHIP federal match, such a move won’t be a state budget buster.

While MACPAC tracks CHIP on an ongoing basis, the Commission has begun to consider the future of CHIP during their most recent meetings. As a former CHIP director, I had the privilege of sharing my thoughts with MACPAC in November about  the role CHIP has played in advancing coverage. In February, my colleague, Joe Touschner, had the opportunity to provide the commissioners with a preview of research that CCF and NASHP have been doing on CHIP benefit packages.

Chapter 5 of the March 2013 report focuses on children’s coverage under CHIP and Exchange Plans and is worth the read. The CHIP chapter reveals the commissioner’s thinking that CHIP reauthorization “is an opportunity for policymakers to consider a long-term vision, not just for CHIP, but for coverage of low-income children more broadly.” The March report “begins to sketch out a vision for what coverage might look like beyond FY 2015,” when Congress will need to extend CHIP funding. But the upcoming June report is expected to more fully develop what that vision might be. Eliminating waiting periods and premiums below 150% FPL certainly whets my appetite. I can’t wait for main course!