By Joe Touschner

As we all follow the twists and turns of health care reform in Congress, it’s easy to forget that the critical children’s health legislation that’s already been passed this year–CHIPRA–is well on its way to being implemented.  CMS Medicaid and State Operations Director Cindy Mann (CCF’s former fearless leader) took the time this week to update child health advocates on recent CMS actions and guidance on CHIPRA.  She highlighted that $10 million in outreach grants to tribal groups will soon be distributed.  She also passed on news that new guidance will soon be released on a variety of topics and was able to share several updates on issues raised by the new law:

• On dental coverage for kids:

• Dental provider lists are now available for each state at www.insurekidsnow.gov, but it sounds like there will be efforts to improve the quality and accessibility of these lists in the months ahead.
• No state has submitted a plan amendment to alter its dental coverage in response to CHIPRA, but CMS has been talking individually to states. CMS also clarified that states won’t be deemed out of compliance with the new dental benefits until it has officially promulgated regulations.
• The children of state employees can’t be eligible for a CHIP-financed dental wrap-around, just as they are not eligible for CHIP itself.
• On the new option to drop the 5-year waiting period for lawfully residing immigrant kids and pregnant women in Medicaid and CHIP:

• The new option applies to children and pregnant women “lawfully residing” in the U.S., which is a broader category than the “qualified aliens” which the 5-year waiting period referenced. CMS is working with other agencies to develop an accurate definition.
• Eighteen states have plan amendments pending to exercise the new option; one state has been approved to date.  (Most of these states already use their own money to cover lawfully residing immigrant kids and pregnant women during the 5-year waiting period, but might have rolled back in the absence of the new federal help.)
• No “skipping” over Medicaid – states can’t decide to cover lawfully residing immigrant kids and pregnant women in CHIP, but continue to impose the 5-year bar in Medicaid.
• If a state does lift the 5-year bar in Medicaid, the good news is that it can secure the enhanced CHIP matching rate for the cost of covering these kids in Medicaid through the end of the 5-year period.
• On citizenship documentation

• CMS is moving quickly to test Social Security Number matching with the Social Security Administration and expects to have a matching system ready by January 1 for states that choose to use this option to document applicants’ citizenship.
• On performance bonuses

• CMS is currently evaluating 18 states’ applications for performance bonus funds; states may continue to apply.  The awards are expected to be announced by mid-December.