New Brief: An Introduction to Managed Care in CHIP

Some three million kids in states with separate CHIP programs are enrolled in Managed Care Organizations (MCOs). Who are those MCOs, and how are they performing for those children?  Unlike Medicaid, there’s no publicly available national database that answers those questions.  Our new brief attempts to fill that gap. We utilized a variety of methods, including reviewing publicly available websites, CHIP annual reports, and Annual Technical Reports, to compile data for the 27 states with separate CHIP programs that utilize MCOs to manage these programs.

Some of our key findings include…

  • Of the seven million children enrolled in CHIP, about four million receive coverage through their state Medicaid programs; the remaining three million are covered through a separate CHIP program.
  • Currently, 34 states operate a separate CHIP program, either exclusively or in combination with enrolling CHIP children in Medicaid; 27 of these 34 states utilize MCOs to deliver covered services to CHIP children. The other seven use the fee-for-service delivery system.
  • Of the 154 MCOs contracting with the 27 separate state CHIP programs, 136 had parent companies that also contracted with the Medicaid program in the same state – a significant overlap in the context of the COVID-19 Public Health Emergency continuous enrollment policies which are set to end on April 1, 2023.

Our major takeaway? There is huge variation in the amount, quality, and accessibility of information available about the MCOs participating in CHIP.

Some state separate CHIP programs provide a fair amount of MCO-specific performance information, but most don’t.  Some don’t even have their own websites. While there is a lot of work to be done to improve transparency in CHIP, we hope that our brief helps kick start these efforts.