In 2004, in an effort to more accurately identify remaining gaps in health care coverage, the Pennsylvania Insurance Department commissioned a survey on the insurance status of citizens in the state. The Department found that while 96 percent of Pennsylvania’s children had coverage, more than 133,500 were uninsured. Of these, approximately 108,000 were eligible for Medicaid and CHIP (Pennsylvania’s State Children’s Health Insurance Program), while 25,600 were identified as being ineligible for publicly funded health care coverage.

In response to this information, efforts began to close this final gap in coverage for the state’s children (the state at the time covering children with family incomes up to 235 percent of the federal poverty level (FPL).  With solid support from Pennsylvania’s health care advocacy community and bi-partisan legislative support for CHIP, in January 2006, Governor Edward Rendell announced a Cover All Kids initiative to expand CHIP coverage to children.

A broad-based coalition of health and children’s advocates along with health care providers worked to move Cover All Kids forward. It was signed into law on November 2, 2006.  Milestones on the way included:

• The Governor’s proposed FY 2006/07 budget included a plan to offer CHIP to uninsured children in Pennsylvania.
• In July 2006, the legislature passed a state budget that included $2.1 million for the first year of Cover All Kids, but did not approve “enabling” legislation.  However, members of the General Assembly signed a letter of agreement promising this legislation by early October, 2006.
• When the General Assembly reconvened in September, the governor pushed for an implementation agreement, but legislative leaders did not, initially, pursue it.
• The Cover All Kids coalition advocated extensively, in the halls of the capitol and in the media, for legislation that would allow the program to launch in 2007.
• Enabling legislation (House Bill No. 2699) was overwhelmingly passed by the House and Senate in October 2006.
• Cover All Kids was signed into law by the Governor on November 2, 2006.

The program went into effect March 1, 2007. Under Cover All Kids, CHIP was expanded to cover children with family incomes up to 300 percent of the FPL, with cost-sharing for those above 200 percent. Children must meet federal Medicaid or SCHIP rules in regard to immigration status. However the program does provide coverage to legal immigrants, regardless of time in the country, with state funds as needed. Families above 300 percent of the FPL can, under certain circumstances, purchase coverage for their children at the state’s cost for coverage.

Since Cover All Kids, total CHIP enrollment through December 2007 has expanded by more than 12,000 children (an increase of 8 percent). As of December 2007, there were 5,976 children enrolled in CHIP who would not have been eligible before the expansion.  In addition, there were two consecutive months after the implementation of Cover All Kids in which CHIP experienced the largest monthly increases in enrollment since September 1998.

For a summary of the state’s expansion see Pennsylvania At a Glance.