CCF-NASHP Report Details CHIP Benefits and Cost Sharing and Considers ACA Context

By Joe Touschner (CCF) and Joanne Jee (NASHP)

We know CHIP gives millions of children access to affordable health coverage, but what exactly does it cover?  Because of the flexibility built into the CHIP law, the answer varies by state—states can choose both the benefits and the cost sharing in their separate CHIP programs, as long as they stay within federal guidelines.

CCF and the National Academy for State Health Policy worked together to examine the details of CHIP coverage and costs across separate CHIP programs and today we released the report of our findings.  We decided to dive into these questions now because with CHIP funding authorized through next year, state and federal policymakers and other stakeholders need to know how CHIP compares to other coverage options.  We hope our report can serve as a resource that presents CHIP benefits in a consistent and comparable way across states and that it can aid in making those comparisons between CHIP and other coverage, such as marketplace qualified health plans.

So what did we find?  Overall, benefits in separate CHIP programs were generally comprehensive and the cost sharing was limited.  Coverage for basic medical services was robust and while limits were common for certain benefits, only a few of the services we examined were entirely uncovered in some programs.  The limits we found varied by state and were most common for services like orthodontics, hearing aids, and physical and occupational therapy.  Cost sharing was common as well; only two of the programs we examined charged neither premiums nor other cost sharing.  The cost-sharing amounts were in most cases modest, but a few programs did have somewhat higher charges.

Another interesting finding was the distribution of “benchmark” choices states made for their CHIP programs.  The law allows states to choose a benchmark as their model for CHIP benefits, offer benefits equivalent to a benchmark, or to seek approval from the Secretary of HHS for a different benefit package—known as “Secretary-approved coverage.”  More than half of the programs—25 of 42—dispensed with the benchmark approach and instead received the Secretary’s approval of their benefits.  Of these, 14 programs used the same coverage as Medicaid, Medicaid coverage with exceptions, or Medicaid waiver coverage as their CHIP benefits package.  Nine programs used benchmark-equivalent coverage and only five used the benchmark package itself.

There’s much more in the report! Be sure to check out the state tables in Appendix 2 of the report if you are interested in the benefits and cost sharing in a particular CHIP program.   You can find out which separate CHIP programs place a dollar limit on dental benefits or how many physical therapy visits your state’s program allows.  You’ll see how much it costs for a family to fill a prescription or whether your state limits out-of-pockets costs in CHIP more than federal rules require.

And for those who are interested in digging still deeper, we hope our report provides a good starting point to look at the question of how current coverage options for children compare in your state – i.e. how would coverage stack up for kids in marketplace plans compared to those in the CHIP program.