The Government Accountability Office (GAO), which provides reports to Congress that evaluate federal policies, released two reports in the last week confirming what we already know about CHIP: it’s a vital coverage source to millions of kids and kids and families would be worse off without it. The first study, Coverage of Services and Costs to Consumers in selected CHIP and Private Health Plans in Five States, provides more evidence that CHIP offers the same or better services at a lower cost than qualified health plans (QHPs) (this finding was clear despite a questionable headline that suggested otherwise). The second study, Effects on Coverage and Access, and Considerations for Extending Funding, is essentially a review of the literature on CHIP supplemented by an assessment of the Medical Expenditure Panel Survey (MEPS) and interviews with CHIP officials in 10 states.

Both reports on CHIP come to similar – and familiar – conclusions: CHIP has been vital in reducing the rate of uninsured children in the United States through the provision of comprehensive and affordable coverage to low-income children. These reports add to a growing body of nonpartisan, data-driven research on the importance for Congress to extend CHIP funding after 2015.

CHIP Versus QHPs

The report on Coverage of Services and Costs to Consumers in selected CHIP and Private Health Plans in Five States adds to a number of studies confirming that CHIP offers a wide range of services at an affordable cost to children and their families (see, for example, Wakely, NASHP/CCF, and Health Affairs reports on CHIP benefits and cost-sharing).

GAO reviewed coverage and costs (deductibles, copayments, coinsurance, and premiums) for a CHIP plan compared to a benchmark QHP, and, if applicable, a stand alone dental plan (SADP) in five states – Colorado, Illinois, Kansas, New York, and Utah. GAO found:

• Coverage: Coverage in CHIP and QHPs is generally comparable (most covered the services that GAO reviewed), but CHIP programs provided more enabling services (translation and transportation services). In addition, CHIP integrated pediatric dental services with medical coverage while most QHPs offered dental coverage in a stand-alone dental plan (SADP) which families would need to purchase separately.
• CHIP plans generally imposed fewer limits on services (day, visit, or dollar limits) than QHPs. Where CHIP did impose limits, they were generally less restrictive than QHP limits – particularly for dental coverage.
• Cost: The ACA limited the cost that families’ would face in QHPs. Despite these restrictions, costs for families’ in CHIP were far lower than for those in QHPs. CHIP generally did not require deductibles, had lower copayments (particularly for physician visits), lower premiums and had lower dental costs particularly in states where dental coverage in the exchange is optional and offered as a SADP.

CHIP: Coverage, Access, and Funding

The second GAO report, Effects on Coverage and Access, and Considerations for Extending Coverage, provides a thorough summary of the research on the cost, coverage, and access for children in CHIP. In particular, GAO’s review found:

• According to a mandated evaluation, CHIP enrollees had better access to care, service use, and preventive care than uninsured children and comparable coverage with privately insured children
• HHS reported that states receive fewer dental services in CHIP. States also struggle with reporting Child Core Set measures.
• In GAO’s interviews with CHIP administrators, “several states raised concerns about negative implications for children’s coverage if CHIP funding is not reauthorized, including concerns that their states would lose gains made in covering children, who would also lose access to providers and dental care.”

While the headline may not offer new “news” to those of us that follow children’s coverage closely, the GAO reports provide helpful reviews of all the recent literature confirming what we already know: After 18 years of CHIP, the program continues to be an important source of high-quality, affordable coverage to low-income families in the nation. Will it continue after this year? We will be watching the Senate next week to find out…