Saturday, April 11, 2009

CHIP (and not the kind you eat)

An update from my first blog post in November about new issues for Obama's administration.I noted that expansion of SCHIP would likely be expanded.  Well, hooray, it was!

CHIP, the state-administered Children's Health Insurance Program was signed into law by President Obama on February 4th, 2009 and will take effect April 1, 2009.  The important act, formally, H.R. 2: Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 renews coverage of health insurance for 7 million children and expands it to 11 million children through 2013.  

Brief History:
CHIP was originally authorized in 1997 for ten years, ending in 2007.  Twice in 2007, it was passed by Congress to be vetoed both times by President Bush.  Stopgap legislation was passed by Congress to extend the program for 18 months, ending in March 2009.  
The act amends title XXI of the Social Security Act.  It was introduced on Jan 13, 2009, passed in the House Jan 14, passed in Senate Jan 29, and signed by Obama on Feb 4.  The program will cost $32.8 billion and is paid for with an increase in tobacco taxes ($.62 rise in cig. tax).  

CHIPRA Provisions:
Some key notes about CHIPRA:  
1) States are allocated funds to pay for the program based on projected trends.  
2) New tools, using Express Lane Eligibility, were created to increase enrollment for the the already-eligible-but-not-enrolled uninsured children.  There is also $100 million allocated for grants to promote outreach and enrollment into CHIP and Medicaid.
3) Eligibility rules were changed to: 
       a) limit states (whom still have the ultimate power on income eligibility) from covering above 300% FPL (would then get Medicaid matching rate instead of SCHIP) 
       b) pregnant women can be covered, 
       c) parents (and childless adults) will not be given new SCHIP coverage and eventually phased out the program/moved to a new grant
       d) the 5-year waiting period for legally-residing children and pregnant women has been removed.  
4) There is also a quality initiative to develop evidence-based quality measures for children in SCHIP and to improve the reporting of quality data by the states.  Hooray! Also, $20m for projects on HIT for kids, $25m for projects to prevent childhood obesity, and MACPAC committee to review payment rates (like Medicare's MEDPAC). 
5) Increased access to dental benefits (re: Deamonte Driver death-see links below)
6) Mental health parity!!  I'll have to write another story soon on this topic as I'm pretty excited about the broader legislation passed (and I wrote a 25 page paper for Managed Care on this topic).  However, CHIPRA says that mental health services now must be covered as equally as physical health services.  (Finally getting toward that 1948 WHO definition of health, encompassing physical, mental, and social well-being---and I digress...again).

Side Note #1:  
Lisa Dubay, one of my Professors at Johns Hopkins, was an instrumental player in the SCHIP reauthorization and was present at Obama's signing of the act into law.  She shared photos with us in class.  Her profile can be found here:

Side Note 2
Formerly known as State Children's Health Insurance Program (SCHIP), CHIP, CHIPRA, and SCHIP are roughly synonymous.  

Side Note 3:
For more information about Deamonte Driver, the boy who died due to a tooth infection that spread to his brain, see the links below:

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