Health Reform Eases Prohibition of Enrolling State Employee Kids in CHIP

I’m all for light meals but the smorgasbord offered by the health reform law is something we need to make reform meaningful and to ensure that all Americans have access to affordable health care. Whether you go straight to the entrees (the Medicaid expansion or subsidized coverage through exchanges) or nibble on the appetizers (no more pre-existing exclusions or lifetime caps), there is something for everyone.

One such tidbit will allow certain dependents of state employees to enroll in the Children’s Health Insurance Program (CHIP). For the past thirteen years, children of state employees who are eligible for health benefits from the State employee health plan have been explicitly excluded from the definition of “targeted low-income” children who are eligible for CHIP. The new health reform law has eased those restrictions effective immediately.

State CHIP programs may enroll children of state employees (who are otherwise eligible) if one of these conditions is met:

  • Maintenance of Effort – the amount the State contributes to health benefits on behalf of employees including dependent coverage for the most recent State fiscal year cannot be less than the amount it expended in SFY 97 increased for inflation. (If you want the nitty-gritty, the most recent contribution cannot be less than the 1997 contribution increased by the percentage increase in the medical care expenditure category of the Consumer Price Index for All-Urban Consumers for each preceding fiscal year.)
  • Hardship waiver – The annual aggregate amount of premiums and cost-sharing for coverage of the family of the child in the state employee plan exceeds 5 percent of the family income.

If the state meets the first condition, any eligible state employee child can be enrolled in CHIP. The second condition is applicable on a family-by-family basis.

Interest is high among advocates and state officials in this change but federal guidance is needed to answer certain questions. In particular, given crowd-out rules is this option only available to new employees or to employees whose children have been uninsured long enough to meet CHIP waiting periods? How will states estimate a family’s total cost-sharing to determine if a family meets the hardship waiver?

Whether you like savory or sweet, there’s something to please everyone’s palate in health reform. While we wait for the meat and potatoes to be served in 2014, there are lots of tasty treats to satisfy our hunger in the meantime. And we’ll keep serving them up for you to sample at Say Ahhhh!

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.

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