States Moving Forward: Child and Family Health Coverage
The following states have implemented initiatives or enacted legislation to provide health coverage to uninsured children and families during 2009. For information on eligibility levels and program elements, by state, see Facts and Statistics.
Alabama |
Eligibility in the State's CHIP program will increase from 200 percent to 300 percent of the FPL as of October 1, 2009. The expansion, part of the State budget adopted over the Governor's veto, is expected to cover an additional 14,000 children. 1 |
Alaska |
Designed to keep eligible children and others enrolled in care, the State made a regulatory change to its Medicaid program; as of April 1, 2009, enrollees will renew their coverage every 12 months as opposed to every six. In addition, effective October 1, 2009, children will no longer be required to be uninsured for a year before they can qualify for CHIP coverage. 2 |
Arkansas |
An expansion of the State's CHIP program, from 200 percent to 250 percent of the FPL, was signed by the Governor on March 18, 2009. The expansion will be funded by a tobacco tax and is expected to bring coverage to about 20,000 uninsured children, including several thousand that are already eligible for coverage and learn about their eligibility as a result of the expansion. Implementation was scheduled to begin on July 1, 2009; however, the State is awaiting CMS approval of its plans. 3 |
Colorado |
The Governor signed legislation on April 21, 2009 that expands CHIP coverage for children from 205 percent to 250 percent of the FPL and Medicaid coverage for pregnant women from 200 percent to 250 percent of the FPL, parents from 60 percent to 100 percent of the FPL, and childless adults up to 100 percent of the FPL. It also provides 12-month continuous eligibility for children in Medicaid, ensuring that children remain covered despite fluctuations in their income or family circumstances. Funded through a provider fee, the expansion is estimated to provide coverage for 100,000 uninsured persons. The State will implement the changes following CMS approval and once the provider fee is in place. 4 Legislation for telephone and online renewals and eliminating the five-year waiting period for lawfully residing immigrant children in Medicaid and CHIP also passed, although without funding. 5 |
Delaware |
The State established a full-cost buy-in program in its CHIP program for children above 200 percent of the FPL. The program will require children over the age of two to be uninsured for three months prior to enrollment, with good cause exceptions. Cost sharing levels, including premiums, co-payments, and deductibles, will be determined by the State, although the State estimates it will be $170, plus administrative costs, per month per child. Signed by the Governor on August 27, 2009, the buy-in program will begin January 1, 2010. 6 |
Florida |
Legislation, signed June 2, 2009, includes a number of measures that are intended to streamline Florida's Medicaid/CHIP enrollment process to make it easier for eligible children to obtain coverage. The changes include: allowing for electronic verification of income; reducing the amount of time an applicant must be uninsured prior to enrollment from six months to 60 days; providing good cause exceptions to the 60-day waiting period; and reducing the disenrollment penalty for non-payment of premiums from 60 days to 30 days. These changes went into effect on July 1, 2009. 7 |
Hawaii |
The Legislature approved a measure that will provide $200,000 per year for the next two years in state funding to Keiki Care, a limited-benefit coverage program for children who are not otherwise eligible for Medicaid. The bill requires that they receive care through federally qualified health centers. The Legislature overrode the Governor's veto in extending the funding. 8 |
Iowa |
The State implemented its CHIP expansion for children with family income from 200 percent to 300 percent of the FPL on July 1, 2009. In addition, in 2009, the State passed a bill designed to increase Medicaid and CHIP enrollment for children, which included provisions for presumptive eligibility, simplified income verification, paperless renewals, and an individual coverage mandate (although it does not include an enforcement mechanism). The bill also extends Medicaid and CHIP coverage to all lawfully residing immigrant children with family income up to 300 percent of the FPL and implements a CHIP dental-only option for children who have private medical, but not dental, coverage. Coverage for lawfully residing immigrant children went into effect on July 1, 2009; implementation dates for the other provisions have not yet been determined. 9 |
Kansas |
The Governor signed the State budget on April 21, 2009, that includes funding for a CHIP expansion from 200 percent to 250 percent of the FPL, which passed the Legislature in 2008. The State estimates that an additional 9,000 children will gain coverage. Implementation will begin January 2010. 10 |
Louisiana
|
The State has adopted plans to implement Express Lane Eligibility (ELE) by automating the Medicaid renewal process for children who have an active Food Stamp case. The State is waiting for federal guidance before it deploys the ELE procedure for new Medicaid applicants. 11 |
Montana |
The State budget provides funding for full implementation of the voter-approved Healthy Montana Kids Plan. The initiative will move children ages six to 19 with family income from 101 percent to 133 percent of the FPL from CHIP to Medicaid, allowing all children in the same family to be covered by the same program. The State will also expand CHIP eligibility for children from 175 percent to 250 percent of the FPL. The Governor signed the bill into law on May 14, 2009 and implementation will begin October 1, 2009. 12 |
Nebraska |
The Governor signed legislation on May 22, 2009 that increased eligibility in Medicaid from 185 percent to 200 percent of the FPL, as of September 1, 2009. The expansion is part of a larger bill that will also create a statewide hotline for families with children with behavioral health issues and provide additional funding for services and resources for these families. 13 |
New Hampshire |
On July 16, 2009, the Governor signed a bill that will allow the State to expand coverage through a full-cost buy-in to young adults ages 19 to 26 who cannot be included in their family's health insurance plan and whose incomes are at or below 400 percent of the FPL. Details on the plan and when it will be implemented have yet to be determined. 14 |
New Jersey |
As part of efforts to reach more eligible uninsured children, the State began sending out a one-page "Express Lane" application for Medicaid and CHIP to families that indicated on their state tax return that they have uninsured children at home. This outreach effort, which began in May 2009, is part of a coverage mandate passed in 2008 that requires all children to have coverage (although there is no enforcement mechanism). In addition, as part of the fiscal year 2010 State budget, Medicaid and CHIP premiums for children in families earning between 150 percent and 200 percent of the FPL were eliminated. 15 |
New York
|
The State budget included a Medicaid expansion for parents from 150 percent to 200 percent of the FPL and for childless adults from 100 percent to 200 percent of the FPL. The expansion will begin April 1, 2010. The budget also included a number of simplification measures, including the elimination of the face-to-face interview requirement in Medicaid for children and parents and the elimination of finger printing and the asset test for parents. 16 |
North Dakota |
As part of the State budget, North Dakota passed a CHIP expansion from 150 percent to 160 percent of the FPL and dedicated additional funding for outreach to eligible but uninsured children. The expansion went into effect on July 1, 2009. 17 |
Ohio
|
The State planned on implementing an expansion of Medicaid for children from 200 percent to 300 percent of the FPL on July 1, 2009. The State's fiscal year 2010-2011 budget called for funding the expansion, and other non-health related measures, with a portion of the State's tobacco settlement dollars; however, whether the State can use this funding source is unclear and the expansion remains on hold. 18 |
Oklahoma |
The State is awaiting CMS approval for an expansion of Insure Oklahoma, the State's Medicaid premium assistance program, to children with family income up to 300 percent of the FPL. The expansion has a planned implementation date of January 1, 2010. 19 |
Oregon
|
On January 1, 2009 the State implemented 12-month continuous eligibility for certain low-income children enrolled in Medicaid. In addition, Oregon passed legislation signed by the Governor on August 4, 2009. The legislation will expand CHIP from 185 percent to 200 percent of the FPL, including coverage to all lawfully residing immigrant children, as of October 1, 2009. The legislation also provides 12-month continuous eligibility for Medicaid children under the age of 19, eliminates the asset test for CHIP, simplifies the application and renewal process, and provides funding to cover more adults. In addition, as of January 1, 2010, the State will provide subsidized coverage through private health exchanges for children with family income between 200 percent and 300 percent of the FPL and offer a full-cost buy-in for children with family income above 300 percent of the FPL. 20 |
Rhode Island |
The State's fiscal year 2010 budget reinstates coverage for lawfully residing immigrant children. Medicaid premiums, which were increased in Fall 2008, were restored to July 1, 2008 levels and the new monthly premium charged to families between 133 percent and 150 percent of the FPL was eliminated entirely. 21 |
Washington |
The State implemented its expansion from 250 percent to 300 percent of the FPL in CHIP on February 23, 2009, with retroactive coverage for those who applied after November 24, 2008. 22 Washington also passed legislation that includes ELE, administrative renewal, and program retention improvements. In addition, the State approved the development of a full-cost buy-in for children with family income above 300 percent of the FPL, but has not announced an implementation date. 23 |
West Virginia |
Continuing to implement a planned, phased-in CHIP expansion to 300 percent of the FPL adopted in March 2006, the State expanded eligibility for children with family income from 220 percent to 250 percent of the FPL on January 1, 2009. 24 |
Wisconsin |
Effective April 1, 2009, the State made changes to its presumptive eligibility system to encourage the timely enrollment of Medicaid-eligible children. The State expanded presumptive eligibility to newborns with family income at or below 250 percent of the FPL, to children ages one to five with family income at or below 185 percent of the FPL, and to children ages six to 18 with family income at or below 150 percent of the FPL. On January 1, 2009, Wisconsin extended 12-month continuous eligibility to infants eligible for Medicaid born to non-citizen women. 25 |
The following states have made significant budget cuts or program changes that negatively affect child and family coverage in 2009. For information on eligibility levels and program elements, by state, see Facts and Statistics.
Arizona
|
The Legislature passed a budget that eliminated CHIP coverage, effective October 1, 2009, for 9,000 parents with income between 100 percent and 200 percent of the FPL. Eligibility for parents through Medicaid up to 100 percent of the FPL will remain in place. It is unclear whether any further changes will be made to CHIP as a special session of the Legislature works to pass a budget for the remainder of the fiscal year. 26 |
California
|
As part of budget legislation passed in July 2009, California cut $194 million from the CHIP program, which resulted in the State ceasing new enrollment in CHIP on July 17, 2009. Due to the shortfall, the State also considered terminating almost 670,000 currently enrolled children. The State has identified other funding sources, including monthly CHIP premium increases for families with income above 150 percent of the FPL, to prevent the disenrollments and eliminate the waiting list. 27 In addition, in March 2009, California temporarily reinstated an annual renewal period and 12-month continuous eligibility for children in Medicaid until January 1, 2011. To reduce coverage costs, the State originally proposed mid-year reporting requirements for these children. 28 |
Wyoming
|
The Governor, under authority from the Legislature, instituted a cap of 5,900 enrollees in the State's CHIP program; 5,500 are currently enrolled. The cap is part of a nearly $43 million reduction in funding for the Department of Health. 29 |
Footnotes
1. P. Rawls, "Budget Provides Children Increased Insurance Coverage," Montgomery Advertiser (May 13, 2009); communication with Kimble Forrister, Arise Citizens' Policy Project (May 15, 2009). Back
2. "Medicaid Assistance Eligibility, Continuous Eligibility," Alaska Administrative Code, Register 189, 7 AAC 100 (April 2009); and communication with Barbara Hale, Alaska Department of Health and Social Services (May 24, 2009). Back
3. H.B. 1700, 87th General Assembly (Arkansas 2009); and C. Frago & M. Wickline, "ARKids Proposal Gets Resounding House OK," Arkansas Democrat Gazette (March 10, 2009). Back
4. H.B. 09-1293, 67th Legislative Session (Colorado, 2009); and T. Hoover & J. Brown, "Federal Funds Will Help Enroll More People in Medicaid," Denver Post (April 22, 2009). Back
5. H.B. 09-1020, 67th Legislative Session (Colorado, 2009); and H.B. 09-1353, 67th Legislative Session (Colorado, 2009). Back
6. H.B. 139, 145th General Assembly (Delaware, 2009); and Office of the Governor, Markell Signs Healthy Children Bills Into Law , Press Release (August 27, 2009). Back
7. S.B. 918, 2009 Legislative Session (Florida, 2009). Back
8. The program was launched April 2008 with the costs shared by the State and its private partner, the Hawaii Medical Service Association (HMSA). In November, the Governor eliminated state funding for the program; however, HMSA paid to extend coverage for the 2,000 enrollees through the end of 2008. The most recent bill extends coverage for a smaller number of children. H.B. 989, 2009 Regular Session (Hawaii, 2009); and communication with Kenneth Fink, State of Hawaii Department of Human Services. Back
9. S.F. 389, 83rd General Assembly (Iowa, 2009). Back
10. H.B. 2373, 2009 Legislative Session (Kansas, 2009); D. Klepper, "Sebelius Tweaks, Signs Budget," Wichita Eagle (April 14, 2009); and communication with Suzanne Wikle, Kansas Action for Children (July 1, 2009). Back
11. The Children's Partnership, "Express Lane Update: April 2009" (April 7, 2009). Back
12. H.B. 0676, 61st Legislature (Montana, 2009); 2008 Montana Ballot Issue I-155, Healthy Montana Kids Plan Act; and communication with Katherine Quittenton, Montana Department of Public Health and Human Services (July 14, 2009) and Jackie Forba, Montana Department of Public Health and Human Services (July 22, 2009). Back
13. L.B. 603, 101st Legislature, 1st Session (Nebraska, 2009); and communication with Jennifer Carter, Nebraska Appleseed Center for Law in the Public Interest (July 20, 2009). Back
14. S.B. 115, 2009 General Court Session (New Hampshire, 2009); and communication with Amy Ellrod, New Hampshire Healthy Kids (July 15, 2009). Back
15. A.B. 4100, 213th Legislature (New Jersey, 2009); and B. Groves, "Aiming to Ease Child Health Care," The Star-Ledger (April 15, 2009). Back
16. New York also received CMS approval for federal funding of its state-funded CHIP expansion for children to 400 percent of the FPL on June 11, 2009, retroactive to September 1, 2008. New York Department of Health, "Medicaid Update Special Edition: 2009-10 Budget Highlights" (April 2009); Office of the Governor, Governor Paterson Announces Federal Approval of New York's Expansion of Children's Health Insurance, Press Release (June 12, 2009); and communication with Judith Arnold, New York State Department of Health (July 1, 2009). Back
17. H.B. 1012, 61st Legislative Assembly (North Dakota, 2009); D. Kolpack, "N.D. Lawmakers Approve Human Services Budget," The Bismarck Tribune (May 5, 2009); and communication with Jodi Hulm, North Dakota Department of Human Services (July 14, 2009). Back
18. "Ohio Report," Gongwer News Service (August 11, 2009). Back
19. Communication with Cindy Roberts, Oklahoma Health Care Authority (May 7, 2009). Back
20. H.B. 2116, 75th Legislative Assembly (Oregon, 2009); communication with Cathy Kauffman, Children First for Oregon (July 9, 2009); and communication with Michelle Mack, Oregon Department of Human Services (July 16, 2009). Back
21. H. 5983, 2009 General Assembly (Rhode Island, 2009); and communication with Jill Beckwith, Rhode Island Kids Count (July 1, 2009). Back
22. Communication with Teresa Mosqueda, Children's Alliance (February 18, 2009). Back
23. H.B. 2128, 61st Legislature (Washington, 2009). Back
24. Communication with Renate Pore, West Virginia Center on Budget & Policy (February 24, 2009). Back
25. The State has also requested federal funding for its Medicaid expansion to children from 250 percent to 300 percent of the FPL, which is currently state-funded. Communication with Jon Peacock, Wisconsin Council on Children and Families (June 29, 2009). Back
26. Communication with Monica Coury, Arizona Health Care Cost Containment System (July 21, 2009); and communication with Matt Jewett, Children's Action Alliance (August 31, 2009). Back
27. P. McGreevy & E. Halper, "California Board Votes to Drop Healthcare Coverage for 60,000 Children," Los Angeles Times (August 14, 2009); communication with Ernesto Sanchez, California Managed Risk Medical Insurance Board (August 28, 2009); communication with Cliff Sarkin, Children's Defense Fund - California and Kelly Hardy, Children Now (August 31, 2009); Managed Risk Medical Insurance Board, Healthy Families Program Will Re-Open to Children of California, Press Release (September 3, 2009); and A.B. 1422, 2009 Legislative Session (California, 2009). Back
28. S.B. 24, 2009 Legislative Session (California, 2009); and communication with Kennalee Gable, California Department of Health Care Services (July 20, 2009). Back
29. State of Wyoming, "Budget Reduction Plan, Fiscal Year 2010" (June 4, 2009). Back