As we have noted in earlier posts, the Continuing Resolution (CR) passed on January 22 includes six years of funding for CHIP and other CHIP-related provisions that we’ll unpack here.
CHIP is now funded through federal fiscal year 2023, or September 30, 2023. Though the Secretary will have to determine the allotment amount for each state, the overall appropriations are as follows:
- FFY 2018: $21.5B
- FFY 2019: $22.6B
- FFY 2020: $23.7B
- FFY 2021: $24.8B
- FFY 2022: $25.9B
- FFY 2023: $25.9B
Based on current spending levels and projections for future spending, the funding is expected to be sufficient to cover the costs in all states. Because this funding comes part way through FFY 2018, there is also a provision to prevent duplicate appropriations. States will not have to pay back any money they have already received, but the next installment in their FFY 2018 allotment will be reduced to reflect these earlier, partial payments. Money that CMS has received but has not paid out to states will be sent back to the treasury.
The HEALHTY KIDS Act also extends the child enrollment contingency fund (§ 2104(n)) and the qualifying states option (§ 2105(g)) through FFY 2023.
CHIP Match Rate
Under current law, the federal match for CHIP (known as e-FMAP, or enhanced federal medical assistance percentage) is increased by 23 percentage points through FFY 2019 – this is known as “the bump.” The HEALTHY KIDS Act extends but reduces this match increase in FFY 2020 such that the e-FMAP will be increased by 11.5 percentage points that year before returning to the regular e-FMAP rate in FY 2021 and beyond.
Maintenance of Effort
Under current law, states are required to maintain income eligibility standards, methodologies, and procedures for children in Medicaid and CHIP through FFY 2019. In the HEALTHY KIDS Act, this provision is extended through FFY 2023, but modified beginning in FFY 2020. As of October 1, 2019, states may scale back CHIP income eligibility above 300 percent of FPL. Though we will have to wait for official guidance from CMS, we believe that states with coverage above 300 percent of FPL as a result of the MAGI transition as well as those states with eligibility levels above 300 percent FPL before transitioning to MAGI may scale back.
Other CHIP-Related Extensions
CHIP Look-Alike Plans. Some states operate CHIP look-alike or buy-in programs whereby families with income above the CHIP eligibility threshold are able to purchase CHIP coverage for their children. Because the buy-in programs are not federally funded, they are not under the purview of Congress or CMS. However, the HEALTHY KIDS Act includes two policies related to CHIP buy-in programs. First, it clarifies that states may use a blended risk pool – combining CHIP and buy-in enrollees. Second, it adds buy-in programs to the list of programs that automatically meet the minimum essential coverage requirements under the ACA as long as the benefits in the buy-in are identical to the benefits in the state’s CHIP plan.
Express Lane Eligibility. States will also be able to continue to take advantage of the Express Lane Eligibility (ELE) option through FFY 2023. ELE allows states to use findings from other means-tested programs, like the Supplemental Nutrition Assistance Program (SNAP), to determine eligibility for and enroll children in Medicaid and CHIP.
Childhood Obesity Demonstration. The HEALTHY KIDS Act extends this demonstration, which provides grants to help combat childhood obesity, through FFY 2023 and appropriates an additional $30 million.
Pediatric Quality Measures Program. The HEALTHY KIDS Act extends the pediatric quality measures program, which funds centers of excellence to improve and strengthen pediatric quality measures, through FFY 2023 and appropriates an additional $90 million.
Outreach and Enrollment Program. The HEALTHY KIDS Act also extends outreach and enrollment grants to community-based organizations. The program is now authorized through FFY 2023 and an additional $120 million is available for future grant-making. In this extension of the outreach and enrollment program, Congress also makes organizations using parent mentors eligible for the grants and excludes compensation to such parent mentors from income when making eligibility determinations under modified adjusted gross income (MAGI).
That’s all for now, but we’ll be back with more on CHIP and this funding extension in the future. And we may see yet another funding extension soon.