President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) on February 4, 2009. The Act extends and expands the State Children's Health Insurance Program (now referred to as CHIP, not SCHIP). Coverage will expand with the aid of $33 billion over the next four and one half years, financed by a 62 cent increase in the tax on a pack of cigarettes as well as other tobacco excise taxes. The new law will provide coverage for an estimated additional 4.1 million children nationally. CHIP is a program that provides health insurance coverage for low-income children who are ineligible for Medicaid. In New York, SCHIP funds the Child Health Plus program. Under CHIP, state spending is matched at a better ratio than the state Medicaid match. However, because CHIP is not an entitlement program, it is possible for states to run out of CHIP funds. Reimbursement New York State will receive the CHIP match rate to cover children with family incomes up to 400% of the Federal Poverty Level. New York began covering children up to this level in September using only state funds. Immigrants CHIPRA provides new opportunities for states to grant CHIP and Medicaid coverage to legal immigrant children and pregnant women. Previously, CHIP coverage did not extend to legal immigrants during the five-year period after arriving in the United States. New York extended Child Health Plus to children in this category using only state funds, but can now receive the CHIP match. Dental and Mental Health Benefits Under CHIPRA, states are now required to include dental coverage in their CHIP plans. New York's Child Health Plus program has always covered this benefit, but can now opt into a new provision that allows states to provide wrap around dental coverage. If New York participates in this option, dental coverage would be available to children who would qualify for CHIP coverage, but are enrolled in private health insurance plans that do not include dental coverage. CHIPRA also requires mental health parity in coverage if the state decides to include mental health coverage in its CHIP plan. New York does provide mental health benefits in Child Health Plus, but the current law has not required them to comply with the state's parity law that now applies to private health insurance. The state will need to determine the best way to comply with the parity portion of the new law. Enrollment Included in CHIPRA are many measures to facilitate enrollment in Child Health Plus and Medicaid. States are now allowed the option of fulfilling documentation requirements by using Social Security numbers to verify citizenship. CHIPRA also establishes a system of bonus payments to give states incentives to increase Medicaid enrollment. States must fulfill five out of eight eligibility requirements as well as meet a target level of Medicaid enrollment before receiving a federal bonus payment per child over the target level. For more information on SCHIP, you can visit the Kaiser Commission on Medicaid and the Uninsured website. They also offer a good summary of the CHIPRA law. CHIP Dental Coverage | In addition to extending to a greater number of children, the coverage CHIP provides is more comprehensive. The new law introduces many dental components to the insurance program. CHIPRA establishes additional dental provisions as follows: - Required Dental Coverage
- All states now must include dental coverage in their CHIP plans.
- Option for Dental Wrap Around Benefit
- States may use CHIP funds to develop programs that provide dental coverage for children who are eligible for CHIP coverage, yet are enrolled in private insurance plans without dental coverage.
- State Reports on Performance
- States have to conduct reports on the dental programs' performance, give relevant dental healthcare statistics about children treated under CHIP coverage.
- Federal Reports on Quality
- Requires that federal reports are conducted on the quality of children's health care; dental experts are to be included in the drafting of these reports.
- Education for Parents of Newborns
- Establishes the requirement that the parents of newborns are given a minimum level of educational materials regarding early childhood health.
- Legality of public-private contracting
- Clarifies and reinforces the legality of federally qualified health centers to contract with private dental providers.
- Accessibility study
- The Governmental Accountability Office will conduct a study that analyzes children's access to dental services, as well as the willingness and capability of midlevel dental providers to serve the children.
- Availability of Oral Healthcare Information
- Requires that people enrolled in Medicaid and CHIP are given the relevant information about dental health providers and the dental health benefits contained in their health plan.
It will take some time for the federal Department of Health and Human Services to develop regulations around these provisions but the New York State Oral Health Coalition has already written to Health Commissioner Richard Daines asking him to consider adding the dental wrap around benefit. Watch this newsletter and other communications from the Coalition for more information as it becomes available. The Children's Dental Health Project and their chair, Dr. Burton Edelstein must be given congratulations and sincere thanks for their tireless work to get these provisions into CHIPRA. Without their dedication and determination working the halls of Congress, dental care would probably have been neglected once again. Visit their website, www.cdph.org for more information on the dental provisions of CHIPRA and information on children's dental health. | 2009 Advoacy Day | Advocacy Day 2009 will be held in May this year! Please check the Coalition's website within the next few weeks for details. We look forward to a successful day! | Late Breaking News... | President Obama today released a broad budget outline for Federal Fiscal Year 2010 that includes a proposal to set aside funds to be used to support health reform. Information on the budget outline is available at http://www.whitehouse.gov/omb/budget/ |
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