2016 chip fact sheetalaska 2016 chip fact sheet for more information, visit . the david and lucile...

Alabama 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2

Participation Rate: 93.7% of eligible children in Alabama participated in either Medicaid or ALL Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3

Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Alabama (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

Medicaid Expansion N/A N/A 107-141% FPL

Separate CHIP 142-312% FPL 142-312% FPL 142-312% FPL

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Alabama’s CHIP program include (but are not necessarily limited to):

Inpatient and outpatient behavioral health services Physical and occupational therapy

Vision exams and corrective lenses Services for speech, hearing, and language disorders

Hearing exams and hearing aids Durable medical equipment

1 The increased federal CHIP matching rate began in FY2016; states’ federal matching rates currently range from 88 to 100 percent. 2 Information in this fact sheet has been verified by the state. 3 Genevieve Kenney et al., Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA. May 2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf

Key Highlights:

Program Type: Alabama operates a combination* CHIP program, called ALL Kids.

Number of Children Covered: In FY2014, 105,491 children were covered by ALL Kids.**

State’s Enhanced Federal Match Rate: For FY2017, the federal match is 100%.

*While the state considers the CHIP program to be a separate program, technically it is a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.

http://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Modified-Adjusted-Gross-Income-and-Medicaid-CHIP.pdf

http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf


Alabama 2016 CHIP Fact Sheet

For more information, visit www.nashp.org. The David and Lucile Packard Foundation supported the development of this factsheet.

Delivery System: ALL Kids uses a preferred provider, a discounted fee-for-service network developed and managed by Blue Cross Blue Shield. The Medicaid system uses a unique provider network that the Medicaid agency manages. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in ALL Kids, 2016

Family Income Level Premiums Office Visits Inpatient Services Prescription Drugs

≤156% FPL $52 per year $2-$6 $200 per admission $1-$5

157-312% FPL $104 per year $12-$20 $200 per admission $5-$25 No family is charged more than three premiums even if the family has more than three children.

Strategies to Simplify Enrollment and Renewals Implemented in Alabama

Strategy Used

Use of presumptive eligibility No

Use of 12-month continuous eligibility Yes

Use of express lane eligibility No

Premium assistance No The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of ALL Kids.

Does Alabama…

Require a waiting period?4 No

Offer a buy-in option?5 No

Cover dependents of public employees?6 Yes

Cover lawfully residing children without a five-year waiting period?7 No

Source: Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost Sharing Policies as of January 2016: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families.

Quality Measures: States may report on a "core set" of quality measures for children. Alabama reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.

Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)

12-24 month 25 months – 6 years 7-11 years 12-19 years

Alabama 98.6% 94.4% 95.6% 93.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.

http://www.nashp.org/

https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf


http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/CHIPRA-Initial-Core-Set-of-Childrens-Health-Care-Quality-Measures.html

Alaska 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 81.5% of eligible children in Alaska participated in either Medicaid or Denali KidCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Alaska (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

159-203% FPL 159-203% FPL 124-203% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Alaska’s CHIP program include (but are not necessarily limited to):




1 The increased federal CHIP matching rate began in FY2016; states’ federal matching rates currently range from 88 to 100 percent. 2 Information in this fact sheet has been verified by the state. 3 Genevieve Kenney et al., Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation under the ACA. May 2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf

Key Highlights:

Program Type: Alaska operates a Medicaid expansion CHIP program, called Denali KidCare.

Number of Children Covered: In FY2014, 9,661 children were covered by Denali KidCare.*

State’s Enhanced Federal Match Rate: For FY2017, the federal match is 88.00%.

*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.




Alaska 2016 CHIP Fact Sheet


Delivery System: The provider network in Denali KidCare is the same as Medicaid. The delivery system is fee-for-service as there is no managed care or primary care case management in Alaska. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Denali KidCare has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in Alaska

Strategy Used

Use of presumptive eligibility No4




Other Program Characteristics: Below are some other key program characteristics of Denali KidCare.

Does Alaska…



Cover dependents of public employees?7 No



Quality Measures: States may report on a "core set" of quality measures for children. Alaska reported on 13 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Alaska 93.5% 79.0% 79.0% 80.1% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 Alaska did implement hospital presumptive eligibility beginning 1/1/14. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Arizona 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.

The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2

Participation Rate: 87.8% of eligible children in Arizona participated in either Medicaid or KidsCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Arizona (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Arizona’s CHIP program include (but are not necessarily limited to):



Key Highlights:

Program Type: Arizona operates a combination* CHIP program, called KidsCare.

Number of Children Covered: In FY2014, 54,361 children were covered by KidsCare.**


*While the state considers the CHIP program to be a separate program, technically it is a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report (Report notes that children who transitioned between CHIP and Medicaid were reported in both programs rather than the program in which they were last enrolled, resulting in artificially high totals.) Note: Enrollment in Arizona’s CHIP program, KidsCare, had been previously frozen but was reopened in July 2016. Although the program enrollment had been frozen since 2010, thousands of children were added to the state’s CHIP-funded coverage through the KidsCare II waiver, effective from May 2012-January 2014.




Arizona 2016 CHIP Fact Sheet




Delivery System: Both Medicaid and KidsCare use a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in KidsCare, 2016


≤150% FPL $10/$15 max None None None

151-175% FPL $40/$60 max None None None

176-200% FPL $50/$70 max None None None Note from state: Because Arizona’s CHIP program had no income deductions, there was no MAGI conversion.

Strategies to Simplify Enrollment and Renewals Implemented in Arizona

Strategy Used


Use of 12-month continuous eligibility No



Other Program Characteristics: Below are some other key program characteristics of KidsCare.

Does Arizona…

Require a waiting period?4 Yes, 3 months5





Quality Measures: States may report on a "core set" of quality measures for children. Arizona reported on 3 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below. Percentage of Eligibles Receiving Preventive Dental Services and Dental Treatment Services (FFY2014)

Preventive Dental Services Dental Treatment Services

Arizona 45.7% 22.1% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 Information provided by the state. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Arkansas 2016 CHIP Fact Sheet


Participation Rate: 95.8% of eligible children in Arkansas participated in either Medicaid or CHIP (ARKids-A or ARKids-B (1115(a) waiver) in 2014. The national average was 91% in 2014.3

Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Arkansas (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

143- 211% FPL 143- 211% FPL 107- 211% FPL

Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; also information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Arkansas’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Arkansas operates a separate CHIP program, called ARKids-B.

Number of Children Covered: In FY2014, 100,112 children were covered in ARKids-B program.**


* The ARKids-B program transitioned from a CHIP Medicaid expansion program to a separate CHIP program effective 8/1/15. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.




Arkansas 2016 CHIP Fact Sheet


Delivery System: The provider network in ARKids-B is the same as Medicaid. Each child must have a primary care physician, and services are fee-for-service. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in ARKids-B, 2015


>143-211% FPL None $10 10% of first day $5

Strategies to Simplify Enrollment and Renewals Implemented in Arkansas

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of ARKids-B program.

Does Arkansas…

Require a waiting period?4 Yes, 90 days





Quality Measures: States may report on a "core set" of quality measures for children. Arkansas reported on 14 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Arkansas 93.5% 85.0% 90.7% 86.2% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






California 2016 CHIP Fact Sheet


Participation Rate: 92.3% of eligible children in California participated in either Medi-Cal or HFP in 2014, the last year for which we have national data. The national average was 91% in 2014.3

Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under ACA maintenance of effort requirements, they must maintain CHIP eligibility levels in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in California (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

208-261% FPL 142-261% FPL 108-261% FPL

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Note: Eligibility levels do not include the mandatory 5% income disregard. Children 0-18 in three California counties, San Francisco, San Mateo, and Santa Clara are covered up to 317% percent FPL (without 5% disregard). Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. States in separate CHIPs have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in California’s CHIP include (but are not necessarily limited to):



Key Highlights:

Program Type: California operates a combination CHIP program, the Optional Targeted Low Income Children Program (OTLICP), which is part of the Medicaid Expansion. Its separate CHIP programs are the Medi-Cal Access Program (unborn option) and the County Children’s Health Initiative.*

Number of Children Covered: In FY2014, 1,874,939 children were covered by

HFP.**

California’s Enhanced Federal Match Rate: For FY2017, the federal match is 88%.

*California previously operated a separate CHIP program called the Healthy Families Program (HFP). During 2013, all children enrolled in HFP were transitioned to the state’s Medicaid program (Medi-Cal) under OTLICP.

**Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that the data reported contain duplicates and are artificially high.)




California 2016 CHIP Fact Sheet




Delivery System: The provider network in HFP was similar to Medi-Cal Managed Care plans therefore a majority of the transitioned children have been able to maintain access to the same primary care providers they had while enrolled in HFP. Premiums & Cost Sharing: Within federal parameters, states can set CHIP premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in OTLIP, 2016


160-261% FPL $13 per child/month* None None None *Maximum of $39 per month for all children in household. Families of infants from ages 0-1 do not pay a monthly premium in a household with income up to 261% FPL. Children between age 1 up to age 19 in a family with income below 160% FPL do not pay premiums.

Strategies to Simplify Enrollment and Renewals Implemented in California

Strategy Used

Use of presumptive eligibility Yes


Use of express lane eligibility Yes


Other Program Characteristics: Below are some other key program characteristics of California’s CHIP.

Does California…




Cover lawfully residing children without a five-year waiting period?7 Yes8


Quality Measures: States may report on a "core set" of quality measures for children. California reported on 12 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



California 95.3% 86.3% 86.1% 82.9% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families, with incomes above the upper income eligibility limit, to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 8 In 2015, legislation was passed to cover all income-eligible children regardless of immigration status statewide, financed primarily by state only funds, and it was implemented in May 2016.





Colorado 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 89% of eligible children in Colorado participated in either Medicaid or CHP+ in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Colorado (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18 Ages 19+ (Prenatal Women)

143-260% FPL 143-260% FPL 143-260% FPL 196-260% FPL

Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; also information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Colorado’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Colorado operates a combination CHIP program, called Child Health Plan Plus (CHP+).

Number of Children Covered: In FY2014, 125,471 children were covered by CHP+.*






Colorado 2016 CHIP Fact Sheet


Delivery System: CHP+ uses the managed care delivery system, with most of its members in a participating HMO whereas most Medicaid clients receive services using an accountable fee-for-service delivery system.

Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Child Health Plan Plus, 2016 Family Income Level Premiums Family Income Level Office Visits Inpatient Services Prescription Drugs

<157% FPL None <101% FPL $0 $0 $0

157-213% FPL $25-$35 max per year

101-156% FPL $2 $2 $1

214-260% FPL $75-$105 max per year

157-200% FPL $5 $20 $3-$10

196-260% FPL (Prenatal women)

None 201-260% FPL $10 $50 $5-$15

196-260% FPL (Prenatal women)

$0-$10 $0-$50 $0-$15

Note: For prenatal women, all pregnancy care is free, including prenatal and postpartum care, labor and delivery. Other medical care, such as prescriptions, may have small co-payments.

Strategies to Simplify Enrollment and Renewals Implemented in Colorado

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of CHP+.

Does Colorado…




Cover lawfully residing children without a five-year waiting period?7 Yes


Quality Measures: States may report on a "core set" of quality measures for children. Colorado reported on 15 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Colorado 95.0% 81.5% 85.8% 85.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Connecticut 2016 CHIP Fact Sheet


Participation Rate: 95.1% of eligible children in Connecticut participated in either Medicaid or HUSKY B in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Connecticut (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

197-318% FPL 197-318% FPL 197-318% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Connecticut’s CHIP program include (but are not necessarily limited to):




Delivery System: HUSKY B uses the same delivery system and provider networks as Medicaid.


Key Highlights:

Program Type: Connecticut operates a separate CHIP program, called the HUSKY B Program.

Number of Children Covered: In FY2014, 19,927 children were covered by the HUSKY B Program.*






Connecticut 2016 CHIP Fact Sheet



Premiums and Selected Cost Sharing in HUSKY B, 2016


197-249% FPL None $10-$15 None $5-$10

250-318% FPL $30/$50 max $10-$15 None $5-$10

Strategies to Simplify Enrollment and Renewals Implemented in Connecticut

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of the HUSKY B Program.

Does Connecticut…


Offer a buy-in option?5 No (as of 8/1/15)




Quality Measures: States may report on a "core set" of quality measures for children. Connecticut reported on 19 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Connecticut 98.4% 93.0% 94.5% 93.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Delaware 2016 CHIP Fact Sheet


Participation Rate: 90.8% of eligible children in Delaware participated in either Medicaid or Delaware Healthy Children Program in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP in Delaware (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

Medicaid Expansion 194-212% FPL N/A 110-133% FPL

Separate CHIP Program N/A 143-212% FPL 134-212% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Delaware’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Delaware operates a combination CHIP program, called Delaware Healthy Children Program (DHCP).

Number of Children Covered: In FY2014, 18,650 children were covered by DHCP.*






Delaware 2016 CHIP Fact Sheet


Delivery System: DHCP and Medicaid use the same delivery system of managed care for most services and fee-for-service for dental services. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in DHCP, 2016


143-176% FPL $15 per family None None None


Strategies to Simplify Enrollment and Renewals Implemented in Delaware

Strategy Used


Use of 12-month continuous eligibility Yes*


Premium assistance No *12-month continuous eligibility is only used in Delaware’s separate CHIP program. The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of DHCP.

Does Delaware…






Quality Measures: States may report on a "core set" of quality measures for children. Delaware reported on 22 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Delaware 97.1% 90.9% 94.4% 92.3% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.





District of Columbia 2016 CHIP Fact Sheet


Participation Rate: 98.1% of eligible children in D.C. participated in either Medicaid or Healthy Families in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in D.C. (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 14 Ages 15-18

206-319% FPL 146-319% FPL 112-319% FPL 64-319% FPL

Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; and information from D.C. officials. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in D.C.’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: D.C. operates a Medicaid expansion CHIP program, called Healthy Families.

Number of Children Covered: In FY2014, 7,085 children were covered by Healthy Families.*


* Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.




District of Columbia 2016 CHIP Fact Sheet


Delivery System: Healthy Families Program serves Medicaid and CHIP eligible beneficiaries in Managed Care Arrangements.


Healthy Families does not have any premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in D.C.

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Healthy Families.

Does D.C. …






Quality Measures: States may report on a "core set" of quality measures for children. The District of Columbia reported on 17 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



District of Columbia 95.0% 89.3% 96.6% 92.4% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 8 D.C. covers income-eligible children regardless of immigration status using state-only funds.





Florida 2016 CHIP Fact Sheet


Participation Rate: 88.4% of eligible children in Florida participated in either Medicaid or KidCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Florida (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Florida’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Florida operates a combination CHIP program, called Florida KidCare.

Number of Children Covered: In FY2014, 423,351 children were covered by KidCare.*






Florida 2016 CHIP Fact Sheet


Delivery System: KidCare is a partnership of Healthy Kids, MediKids, the Children’s Medical Services Network, and Children’s Medicaid (Title XIX). Each component utilizes a unique network of providers. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in KidCare, 2016


≤158% FPL $15 per family None None $5

>158-210% FPL $20 per family $5 None $5 All copayments are only for Healthy Kids, which provides coverage to children ages 5-18.

Strategies to Simplify Enrollment and Renewals Implemented in Florida

Strategy Used


Use of 12-month continuous eligibility Yes*


Premium assistance No *12-month continuous eligibility is only used in Florida’s separate CHIP program. The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of KidCare.

Does Florida…

Require a waiting period?4 Yes, 2 months

Offer a buy-in option?5 Yes, >215% FPL6




Quality Measures: States may report on a "core set" of quality measures for children. Florida reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Florida 93.9% 78.3% 80.0% 83.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 In Florida, families can buy into Healthy Kids coverage for children ages 5 to 19 and into MediKids coverage for children ages 1 to 4. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 Information provided by the state.




Georgia 2016 CHIP Fact Sheet


Participation Rate: 89.2% of eligible children in Georgia participated in either Medicaid or PeachCare for Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Georgia (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Georgia’s CHIP program include (but are not necessarily limited to):




Key Highlights

Program Type: Georgia operates a combination* CHIP program, called PeachCare for Kids.

Number of Children Covered: In FY2014, 231,270 children were covered by PeachCare for Kids.**


*While the state considers the CHIP program to be a separate program, technically it is a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment system challenges, some CHIP-funded Medicaid enrollees were included in Medicaid enrollment counts, rather than CHIP.)




Georgia 2016 CHIP Fact Sheet



Delivery System: The provider network in PeachCare for Kids is the same as Medicaid. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in PeachCare for Kids, 2016

Family Income Level Premiums* Office Visits Inpatient Services Prescription Drugs

0-138% FPL None $0.50-$3 $12.50 $0.50-$3

139-158% FPL $11/1 child; $16/2+ children $0.50-$3 $12.50 $0.50-$3





232-247% FPL $36/1 child; $72/2+ children $0.50-$3 $12.50 $0.50-$3 *There are no premiums for children under 6 years old or children in foster care.

Strategies to Simplify Enrollment and Renewals Implemented in Georgia

Strategy Used



Use of express lane eligibility No4


Other Program Characteristics: Below are some other key program characteristics of PeachCare for Kids.

Does Georgia…

Require a waiting period?5 No6





Quality Measures: States may report on a "core set" of quality measures for children. Georgia reported on 22 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Georgia 94.7% 86.7% 88.3% 84.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 Express Lane Eligibility was ended 4/1/16. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 Information from the state; as of 8/1/16, the waiting period was eliminated. 7 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 8 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 9 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Hawaii 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 95.2% of eligible children in Hawaii participated in either Medicaid/CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Hawaii (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

191-308% FPL 139-308% FPL >133-308% FPL

Source for Ages 0-1 and Ages 1-5: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Source for Ages 6-18: Information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Hawaii’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Hawaii operates a Medicaid expansion CHIP program.

Number of Children Covered: In FY2014, 30,505 children were covered by Hawaii’s CHIP program.*


*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats .report.





Hawaii 2016 CHIP Fact Sheet

Delivery System: The provider network in CHIP uses managed care.


Hawaii’s CHIP program has no premiums or cost sharing

Strategies to Simplify Enrollment and Renewals Implemented in Hawaii

Strategy Used





Other Program Characteristics: Some states have taken additional steps to facilitate access to CHIP coverage. Below are some other key program characteristics of Hawaii’s CHIP program.

Does Hawaii…



Cover dependents of public employees?6 Yes7



Quality Measures: States may report on a "core set" of quality measures for children. Hawaii reported on 18 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Hawaii 96.5% 88.6% 89.1% 87.3% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 Information provided by the state. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 Information provided by the state.





Idaho 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 90.6% of eligible children in Idaho participated in either Medicaid or Idaho Health Plan in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Idaho (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18


Separate CHIP Program 143-185% FPL 143-185% FPL 134-185% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Idaho’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Idaho operates a combination CHIP program, called Idaho Health Plan for Children.

Number of Children Covered: In FY2014, 30,615 children were covered by Idaho Health Plan for Children.*






Idaho 2016 CHIP Fact Sheet


Delivery System: The provider network in Idaho Health Plan is the same as Medicaid. All children are enrolled in primary care case management. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Idaho Health Plan, 2016


142-150% FPL $10 $3.65 None None

150-185% FPL $15 $3.65 None None

Strategies to Simplify Enrollment and Renewals Implemented in Idaho

Strategy Used




Premium assistance Yes The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of Idaho Health Plan.

Does Idaho…






Quality Measures: States may report on a "core set" of quality measures for children. Idaho reported on 13 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Idaho 93.7% 79.3% 66.9% 66.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Illinois 2016 CHIP Fact Sheet


Participation Rate: 93.3% of eligible children in Illinois participated in either Medicaid or All Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Illinois (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18



Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Note: Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Illinois’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Illinois operates a combination CHIP program, called All Kids.

Number of Children Covered: In FY2014, 295,844 children were covered by All Kids.*






Illinois 2016 CHIP Fact Sheet


Delivery System: The provider network in All Kids is the same as Medicaid. Most children are required to enroll in either primary care case management or managed care. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in All Kids, 2016


>142-157% FPL None $3.90 $3.90 $2-$3.90

>157-209% FPL $15/$40 max $5 $5 (per day) $3-$5

>210-313% FPL $40/$80 max $10 $100 (per admission) $3-$7 For families between 157-209% FPL, premiums are $15 for one child; $25 for two children; $30 for three; $35 for four; $40 for five or more.

Strategies to Simplify Enrollment and Renewals Implemented in Illinois

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of All Kids.

Does Illinois…

Require a waiting period?4 Yes5





Quality Measures: States may report on a "core set" of quality measures for children. Illinois reported on 20 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Illinois 90.1% 82.9% 85.0% 85.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 Information on waiting periods verified by state. All Kids has a three-month waiting period for children between 142-209% FPL, although the state funds coverage during this period. There is currently a 90 day waiting period for children between 210-313%. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 Information provided by the state. 9 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 10 Illinois covers income-eligible children who do not meet immigration status requirements using state-only funds.





Indiana 2016 CHIP Fact Sheet


Participation Rate: 86.9% of eligible children in Indiana participated in either Medicaid or Hoosier Healthwise in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Indiana (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

Medicaid Expansion 158-208% FPL 141-158% FPL 106-158% FPL



Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Indiana’s CHIP program include (but are not necessarily limited to):




1 The increased federal CHIP matching rate began in FY2016; states’ federal matching rates currently range from 88 to 100 percent. 2 Information in this fact sheet has not been reviewed by the state. 3 Genevieve Kenney et al., Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA. May 2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf

Key Highlights

Program Type: Indiana operates a combination CHIP program, called Hoosier Healthwise.

Number of Children Covered: In FY2014, 153,523 children were covered by Hoosier Healthwise.*






Indiana 2016 CHIP Fact Sheet


Delivery System: Hoosier Healthwise is a managed care delivery system. A small number of CHIP participants are served by the fee-for-service program.


Premiums and Selected Cost Sharing in Hoosier Healthwise, 2013


>158-175% FPL $22/$33 max None None $3-$10

>175-200% FPL $33/$50 max None None $3-$10

>200-225% FPL $42/$53 max None None $3-$10

>225-250% FPL $53/$70 max None None $3-$10 Note: MAGI-adjusted income levels for premiums and cost sharing were not available at the time of publication.

Strategies to Simplify Enrollment and Renewals Implemented in Indiana

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Hoosier Healthwise.

Does Indiana…






Quality Measures: States may report on a "core set" of quality measures for children. Indiana reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Indiana 96.4% 88.1% 91.1% 90.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Iowa 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 94% of eligible children in Iowa participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Iowa (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Iowa’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Iowa operates a combination CHIP program.

Number of Children Covered: In FY2014, 83,411 children were covered by Iowa’s CHIP program.*


* Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.





Iowa 2016 CHIP Fact Sheet

Delivery System: The state contracts with managed care organizations, which provide services through a per member per month capitation payment managed care network. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Iowa’s CHIP Program, 2016


181-242% FPL $10/20 max None None None


Strategies to Simplify Enrollment and Renewals Implemented in Iowa

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Iowa’s CHIP program.

Does Iowa…

Require a waiting period?4 Yes, 1 month only if >181% FPL5





Quality Measures: States may report on a "core set" of quality measures for children. Iowa reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Iowa 100.0% 95.0% 95.0% 96.4% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 Information provided by the state. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Kansas 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 88.2% of eligible children in Kansas participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Kansas (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Kansas’s CHIP program include (but are not necessarily limited to):



Key Highlights

Program Type: Kansas operates a combination* CHIP program as part of KanCare.

Number of Children Covered: In FY2014, 73,574 children were covered by CHIP.**






Kansas 2016 CHIP Fact Sheet




Delivery System: Both Medicaid and CHIP use a managed care and primary care case management system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Kansas’ CHIP Program, 2016





Strategies to Simplify Enrollment and Renewals Implemented in Kansas

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Kansas’s CHIP program.

Does Kansas…

Require a waiting period?4 Yes, 3 months only if >200% FPL





Quality Measures: States may report on a "core set" of quality measures for children. Kansas reported on 8 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below. Percentage of Eligibles Receiving Preventive Dental Services and Dental Treatment Services (FFY2014)


Kansas 48.5% 20.1% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.






Kentucky 2016 CHIP Fact Sheet


Participation Rate: 94% of eligible children in Kentucky participated in either Medicaid or KCHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Kentucky (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

Medicaid Expansion N/A 142-159% FPL 109-159% FPL



Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Kentucky’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Kentucky operates a combination CHIP program, called KCHIP.

Number of Children Covered: In FY2014, 61,473 children were covered by KCHIP.*


*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment system challenges, some CHIP-funded Medicaid enrollees were included in Medicaid enrollment counts, rather than CHIP.)




Kentucky 2016 CHIP Fact Sheet


Delivery System: KCHIP uses the Medicaid service delivery system of managed care, with few exceptions.


Premiums and Selected Cost Sharing in KCHIP, 2016


≤213% FPL None $3 $50 $1-$8 There is a $225 out-of-pocket maximum per year for prescription drugs, and a separate $225 out-of-pocket maximum per year for other benefits.

Strategies to Simplify Enrollment and Renewals Implemented in Kentucky

Strategy Used

Use of presumptive eligibility No4




Other Program Characteristics: Below are some other key program characteristics of KCHIP.

Does Kentucky…






Quality Measures: States may report on a "core set" of quality measures for children. Kentucky reported on 19 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Kentucky 97.2% 92.2% 96.8% 95.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 The state only conducts hospital presumptive eligibility. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Louisiana 2016 CHIP Fact Sheet


Participation Rate: 92.6% of eligible children in Louisiana participated in either Medicaid or LaCHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Louisiana (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Louisiana’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Louisiana operates a combination CHIP program, called LaCHIP.

Number of Children Covered: In FY2014, 136,263 children were covered by LaCHIP.*






Louisiana 2016 CHIP Fact Sheet


Delivery System: The delivery system and provider network is the same in LaCHIP and Medicaid for all children. It is a managed care system called Healthy Louisiana. Enrollees choose coverage from one of five participating plans. These plans differ in their provider networks, referral policies, health management programs and extra services and incentives offered.


Premiums and Selected Cost Sharing in LaCHIP, 2016



Strategies to Simplify Enrollment and Renewals Implemented in Louisiana

Strategy Used




Premium assistance No4 The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of LaCHIP.

Does Louisiana…

Require a waiting period?5 Yes, 3 months only if >212% FPL


Cover dependents of public employees?7 No8



Quality Measures: States may report on a "core set" of quality measures for children. Louisiana reported on 18 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Louisiana 92.4% 80.9% 83.5% 81.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 Louisiana terminated its premium assistance program effective 11/30/15; however the state is considering reestablishing it in 2017. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 The state indicated that dependent coverage for public employees is available through Medicaid expansion LaCHIP but not the separate CHIP program. 9 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Maine 2016 CHIP Fact Sheet


Participation Rate: 93.7% of eligible children in Maine participated in either Medicaid or MaineCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Maine (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Maine’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Maine operates a combination CHIP program, called MaineCare.

Number of Children Covered: In FY2014, 27,461 children were covered by MaineCare.*






Maine 2016 CHIP Fact Sheet


Delivery System: Both Medicaid and CHIP programs use primary care case management (PCCM) and fee-for-service. All children are enrolled in PCCM unless they qualify for an exemption or exclusion. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in MaineCare, 2016


157.1-166% FPL $8/$16 max None None None




Strategies to Simplify Enrollment and Renewals Implemented in Maine

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of MaineCare.

Does Maine…






Quality Measures: States may report on a "core set" of quality measures for children. Maine reported on 12 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Maine 96.7% 88.0% 92.7% 91.0% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 Maine has a buy-in program that is limited to those who had been previously enrolled in CHIP; a child can participate for up to 18 months. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Maryland 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 94.1% of eligible children in Maryland participated in either Medicaid or MCHP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Maryland (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

194-317% FPL 138-317% FPL 109-317% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Maryland’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Maryland operates a Medicaid expansion CHIP program, called Maryland Children’s Health Program (MCHP).

Number of Children Covered: In FY2014, 137,192 children were covered by MCHP.






Maryland 2016 CHIP Fact Sheet


Delivery System: The state uses a managed care delivery system.


Premiums and Selected Cost Sharing in MCHP, 2016


211-264% FPL $53/month max None None None

264-317% FPL $66/month max None None None

Strategies to Simplify Enrollment and Renewals Implemented in Maryland

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of MCHP.

Does Maryland…






Quality Measures: States may report on a "core set" of quality measures for children. Maryland reported on 14 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Maryland 97.2% 91.8% 93.7% 90.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Massachusetts 2016 CHIP Fact Sheet


Participation Rate: 97% of eligible children in Massachusetts participated in either MassHealth Medicaid or MassHealth CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Massachusetts (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 17 Age 18

Medicaid Expansion 185-200% FPL 133-150% FPL 114-150% FPL 0-150% FPL

Separate CHIP Program >200-300% FPL >150-300% FPL >150-300% FPL >150%-300% FPL

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP and data from the state. Note: Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Massachusetts’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Massachusetts operates a combination CHIP program, called MassHealth.

Number of Children Covered: In FY2014, 126,384 children were covered by MassHealth CHIP.*


*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment system challenges, certain members who should have been assigned to CHIP were assigned to Medicaid-funded coverage beginning in the second quarter of 2014.)




Massachusetts 2016 CHIP Fact Sheet


Delivery System: The state’s CHIP program uses the same delivery system as Medicaid. MassHealth uses a managed care delivery system, primary care case management (PCCM), and fee-for-service. Individuals receive fee-for-service until they enroll in managed care or a PCCM. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in MassHealth CHIP, 2016


>150-200% FPL $12/$36 max None None None



Strategies to Simplify Enrollment and Renewals Implemented in Massachusetts

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of MassHealth CHIP.

Does Massachusetts…


Offer a buy-in option?5 Yes6




Quality Measures: States may report on a "core set" of quality measures for children. Massachusetts reported on 20 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Massachusetts 95.8% 93.1% 97.1% 95.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 Information provided by the state. MA has buy-in coverage limited to children with disabilities with no income limit. MA offers more limited state-subsidized coverage to children at any income through its Children's Medical Security Plan Program; premiums vary based on income. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. Massachusetts does not cover these children under CHIP but does cover them under its 1115 Medicaid waiver. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 Massachusetts covers income-eligible children regardless of immigration status using state-only funds.





Michigan 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 94.7% of eligible children in Michigan participated in either Medicaid or MIChild in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Michigan (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6-18

0-212% FPL 143-212% FPL 109-212% FPL

Source: Eligibility level information provided by the state. Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Michigan’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Michigan operates a combination* CHIP program, called MIChild.

Number of Children Covered: In FY2014, 104,127 children were covered by MIChild.**


*Michigan previously operated a separate CHIP program; as of January 2016, all children enrolled in the separate CHIP program were transitioned to the state’s Medicaid expansion CHIP program; however the state is considered a combination CHIP program because conception to birth coverage is offered under the CHIP unborn child option. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.




Michigan 2016 CHIP Fact Sheet


Delivery System: The Medicaid expansion program uses a combination of managed care and fee-for-service. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in MIChild, 2016


160-212% FPL $10 per family/month None None None

Strategies to Simplify Enrollment and Renewals Implemented in Michigan

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of MIChild.

Does Michigan…




Cover lawfully residing children without a five-year period?7 No


Quality Measures: States may report on a "core set" of quality measures for children. Michigan reported on 17 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.


12-24 months 25 months – 6 years 7-11 years 12-19 years

Michigan 96.7% 88.9% 91.7% 90.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include Medicaid only.






Minnesota 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 93% of eligible children in Minnesota participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Minnesota (by Age Group) in 2016

Ages 0 – 2 Ages 2 – 5 Ages 6 – 18

Medicaid Expansion 275-283% FPL N/A N/A

Separate CHIP Program N/A N/A N/A


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, Benefits offered in Minnesota’s CHIP program include (but are not necessarily limited to):




1 The increased federal CHIP matching rate began in FY2016; states’ federal matching rates currently range from 88 to 100 percent. 2 Information in this fact sheet was not reviewed by the state. 3 Genevieve Kenney et al., Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA. May 2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf

Key Highlights

Program Type: Minnesota operates a combination CHIP program called CHIP.

Number of Children Covered: In FY2014, 3,590 children were covered by CHIP.*






Minnesota 2016 CHIP Fact Sheet


Delivery System: Both the state’s CHIP program and Medicaid program use a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Minnesota’s CHIP program has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in Minnesota

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Minnesota’s CHIP program.

Does Minnesota…





Source: Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost Sharing Policies as of January 2016: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families. .

Quality Measures: States may report on a "core set" of quality measures for children. Minnesota reported on 5 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Minnesota 96.3% 89.0% 91.4% 91.2% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Mississippi 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 93.2% of eligible children in Mississippi participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Mississippi (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18



Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; Medicaid expansion information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Mississippi’s CHIP program include (but are not necessarily limited to):




*Key Highlights:

Program Type: Mississippi operates a combination* CHIP program, called CHIP.







Mississippi 2016 CHIP Fact Sheet



Delivery System: The CHIP program has a provider network managed by the plan insurer. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Mississippi’s CHIP Program, 2016


≤175% FPL None $5 None None

176-209% FPL None $5 None None The out-of-pocket maximum for families with incomes ≤175% FPL is $800 and the out-of-pocket maximum for families with incomes between 176-209% FPL is $950.

Strategies to Simplify Enrollment and Renewals Implemented in Mississippi

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Mississippi’s CHIP program.

Does Mississippi…






Quality Measures: States may report on a "core set" of quality measures for children. Mississippi reported on 18 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Mississippi 98.8% 92.0% 94.5% 90.9% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






Missouri 2016 CHIP Fact Sheet


Participation Rate: 86.2% of eligible children in Missouri participated in either Medicaid or HealthNet for Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Missouri (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Missouri’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Missouri operates a combination CHIP program, called HealthNet for Kids.

Number of Children Covered: In FY2014, 86,828 children were covered by HealthNet for Kids.*






Missouri 2016 CHIP Fact Sheet


Delivery System: The provider network in HealthNet for Kids is the same as Medicaid. Both programs use a managed care delivery system and fee-for-service. Children living in 54 Missouri counties receive services through managed care. Children in all other counties receive services through fee-for-service.


Premiums and Selected Cost Sharing in HealthNet for Kids, 2016


>150-185% FPL $14 None None None

>185-225% FPL $46 None None None

>225-300% FPL $111 None None None Premiums are calculated on a sliding scale based on family size and income; these premiums are examples.

Strategies to Simplify Enrollment and Renewals Implemented in Missouri

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of HealthNet for Kids.

Does Missouri…






Quality Measures: States may report on a "core set" of quality measures for children. Missouri reported on 12 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below. Percentage of Eligibles Receiving Preventive Dental Services and Dental Treatment Services (FFY2014)


Missouri 35.1% 16.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.






Montana 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 86.1% of eligible children in Montana participated in either Medicaid or Healthy Montana Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Montana (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Montana’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Montana operates a combination CHIP program, called Healthy Montana Kids.

Number of Children Covered: In FY2014, 49,671 children were covered by Healthy Montana Kids.*






Montana 2016 CHIP Fact Sheet


Delivery System: Both Healthy Montana Kids and Medicaid use a fee-for-service system and provider networks are similar but not identical. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Healthy Montana Kids, 2016


144-261% FPL None $3 $25 None The out-of-pocket maximum for a family is $215 per benefit year, October 1st – September 30th. .

Strategies to Simplify Enrollment and Renewals Implemented in Montana

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Healthy Montana Kids.

Does Montana…






Quality Measures: States may report on a "core set" of quality measures for children. Montana reported on 11 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Montana 87.8% 71.5% 74.9% 76.2% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






Nebraska 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 90.4% of eligible children in Nebraska participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Nebraska (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

162-213% FPL 145-213% FPL 109-213% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Nebraska CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Nebraska operates a combination CHIP program.

Number of Children Covered: In FY2014, 56,476 children were covered in Nebraska’s CHIP program.*







Nebraska 2016 CHIP Fact Sheet

Delivery System: The provider network for CHIP is the same as Medicaid. Managed care is offered state-wide. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Nebraska does not have any premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in Nebraska

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Nebraska’s CHIP program.

Does Nebraska….




Cover lawfully residing children without a five-year waiting period?7 Yes8 Source: Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost Sharing Policies as of January 2016: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families.

Quality Measures: States may report on a "core set" of quality measures for children. Nebraska reported on 2 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below.

Percentage of Eligibles Receiving Preventive Dental Services and Dental Treatment Services (FFY2014)


Nebraska 52.1% 23.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 8 Information provided by the state.





Nevada 2016 CHIP Fact Sheet


Participation Rate: 85.7% of eligible children in Nevada participated in either Medicaid or Check Up in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Nevada (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Nevada’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Nevada operates a combination CHIP program, called Check Up.

Number of Children Covered: In FY2014, 45,870 children were covered by Check Up.*






Nevada 2016 CHIP Fact Sheet


Delivery System: The provider network in Check Up is the same as Medicaid. Managed care is offered in urban areas, while fee-for-service is offered in all other regions. Newborns are enrolled in their mother’s or family’s managed care. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Check Up, 2016


36-150% FPL $25 per quarter, per family None None None



Strategies to Simplify Enrollment and Renewals Implemented in Nevada

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Check Up.

Does Nevada…






Quality Measures: States may report on a "core set" of quality measures for children. Nevada reported on 10 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Nevada 96.7% 92.5% 95.6% 92.1% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 As of January 2016, Nevada began using CHIP funds to cover some dependents of state employees. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





New Hampshire 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 89.8% of eligible children in New Hampshire participated in either Medicaid or Expanded Children’s Medicaid in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in New Hampshire (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

196-318% FPL 196-318% FPL 196-318% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in New Hampshire’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: New Hampshire operates a Medicaid expansion CHIP program, called Expanded Children’s Medicaid.

Number of Children Covered: In FY2014, 16,523 children were covered by Expanded Children’s Medicaid.*






New Hampshire 2016 CHIP Fact Sheet

For more information, www.nashp.org. The David and Lucile Packard Foundation supported the development of this factsheet.

Delivery System: As of December 1, 2013, the Expanded Children’s Medicaid program uses New Hampshire’s Medicaid Care Management managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

New Hampshire’s Expanded Children’s Medicaid has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in New Hampshire

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of New Hampshire’s Expanded Children’s Medicaid program.

Does New Hampshire…






Quality Measures: States may report on a "core set" of quality measures for children. New Hampshire reported on 3 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below. Percentage of Eligibles Receiving Preventive Dental Services and Dental Treatment Services (FFY2014)


New Hampshire 50.4% 21.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.






New Jersey 2016 CHIP Fact Sheet


Participation Rate: 91.4% of eligible children in New Jersey participated in either Medicaid or NJ FamilyCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in New Jersey (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in New Jersey’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: New Jersey operates a combination CHIP program, called NJ FamilyCare.

Number of Children Covered: In FY2014, 211,371 children were covered by NJ FamilyCare.*






New Jersey 2016 CHIP Fact Sheet


Delivery System: The provider network for both Medicaid and CHIP programs use a managed care delivery system. Some services are fee-for-service. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in NJ FamilyCare, 2016


≤200% FPL None $5-$10 None $1-$5

201-250% FPL $43.00 per family $5-$35 None $5-$10



Strategies to Simplify Enrollment and Renewals Implemented in New Jersey

Strategy Used




Premium assistance4 Yes The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of NJ FamilyCare.

Does New Jersey…

Require a waiting period?5 Yes, 3 months if >200% FPL





Quality Measures: States may report on a "core set" of quality measures for children. New Jersey reported on 17 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


New Jersey 97.7% 93.0% 93.7% 91.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4NJ FamilyCare has a Premium Support program for families with employer-sponsored insurance and a Premium Option Program for certain disabled children. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





New Mexico 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 91.2% of eligible children in New Mexico participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in New Mexico (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

200- 300% FPL 200- 300% FPL 138- 240% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in New Mexico’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: New Mexico operates a Medicaid Expansion CHIP program, called CHIP.







New Mexico 2016 CHIP Fact Sheet


Delivery System: The program operates a managed care and fee-for-service delivery system.


Premiums and Selected Cost Sharing in New Mexico’s CHIP Program, 2016


Ages 0-5 240%-300% FPL; Ages 6-18 190%-240% FPL

None $5 $25 $2

Strategies to Simplify Enrollment and Renewals Implemented in New Mexico

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of New Mexico’s CHIP program.

Does New Mexico…






Quality Measures: States may report on a "core set" of quality measures for children. New Mexico reported on 16 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


New Mexico 97.8% 89.0% 91.3% 91.0% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






New York 2016 CHIP Fact Sheet


Participation Rate: 94.5% of eligible children in New York participated in either Medicaid or Child Health Plus in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in New York (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in New York’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: New York operates a combination CHIP program, called Child Health Plus.

Number of Children Covered: In FY2014, 604,566 children were covered by Child Health Plus.*






New York 2016 CHIP Fact Sheet


Delivery System: The provider network in Child Health Plus is similar to Medicaid. Both programs use managed care. Most health plans participate in both the Child Health Plus and Medicaid programs. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Child Health Plus, 2013







>400% FPL Full premium; varies by plan None None None

Strategies to Simplify Enrollment and Renewals Implemented in New York

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Child Health Plus.

Does New York…


Offer a buy-in option?6 Yes, >405% FPL




Quality Measures: States may report on a "core set" of quality measures for children. New York reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


New York 96.9% 94.2% 96.6% 93.9% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 The state indicated that the waiting period was eliminated in statute. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 New York covers income-eligible children regardless of immigration status using state-only funds.





North Carolina 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 93.4% of eligible children in North Carolina participated in either Medicaid or Health Choice for Children in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in North Carolina (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18


Separate CHIP Program N/A N/A 134-211% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in North Carolina’s CHIP program include (but are not necessarily limited to):




1 The increased federal CHIP matching rate began in FY2016; states’ federal matching rates currently range from 88 to 100 percent. 2 Information in this fact sheet was verified by state officials. 3 Genevieve Kenney et al., Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA. May 2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000787-Childrens-Coverage-Climb-Continues-Uninsurance-and-Medicaid-CHIP-Eligibility-and-Participation-Under-the-ACA.pdf

Key Highlights

Program Type: North Carolina operates a combination CHIP program, called Health Choice for Children.

Number of Children Covered: In FY2014, 236,893 children were covered by Health Choice for Children.*






North Carolina 2016 CHIP Fact Sheet


Delivery System: The provider network in Health Choice for Children is the same as Medicaid. Most children are required to enroll in a primary care case management system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in North Carolina Health Choice for Children, 2016


≤159% FPL None None None $1-$3

>159% FPL $50/$100 max per year $5 None $1-$10

Strategies to Simplify Enrollment and Renewals Implemented in North Carolina

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Health Choice for Children.

Does North Carolina…


Offer a buy-in option?5 No6




Quality Measures: States may report on a "core set" of quality measures for children. North Carolina reported on 14 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


North Carolina 96.4% 87.6% Not reported Not reported Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 Information from the state. The buy-in program was eliminated through state legislation in September 2015. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





North Dakota 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 86.7% of eligible children in North Dakota participated in either Medicaid or Healthy Steps in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in North Dakota (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in North Dakota’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: North Dakota operates a combination CHIP program, called Healthy Steps.

Number of Children Covered: In FY2014, 5,032 children were covered by Healthy Steps.*






North Dakota 2016 CHIP Fact Sheet


Delivery System: Healthy Steps uses a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Healthy Steps, 2016


≤160% FPL None None $50 $2-$8

Strategies to Simplify Enrollment and Renewals Implemented in North Dakota

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Healthy Steps.

Does North Dakota…

Require a waiting period?4 Yes, 90 days





Quality Measures: States may report on a "core set" of quality measures for children. North Dakota reported on 8 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


North Dakota Not reported 79.9% 81.0% 89.4% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






Ohio 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 92.1% of eligible children in Ohio participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Ohio (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

141-206% FPL 141-206% FPL 107-206% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Ohio’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Ohio operates a Medicaid expansion CHIP program.

Number of Children Covered: In FY2014, 136,169 children were covered by Ohio’s CHIP program.*


*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment challenges, some enrollees who should have been assigned to CHIP were assigned to Medicaid-funded coverage.)




Ohio 2016 CHIP Fact Sheet

For more information, www.nashp.org. The David and Lucile Packard Foundation supported the development of this factsheet.

Delivery System: The provider network in CHIP is the same as Medicaid. Both programs use a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Ohio’s CHIP program has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in Ohio

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Ohio’s CHIP program.

Does Ohio…






Quality Measures: States may report on a "core set" of quality measures for children. Ohio reported on 11 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Ohio 95.5% 85.6% 86.9% 86.2% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Oklahoma 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 87.6% of eligible children in Oklahoma participated in either Medicaid or SoonerCare in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Oklahoma (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 14 Ages 15-18

Medicaid Expansion 169 – 205% FPL 151 – 205% FPL 115 – 205% FPL 65-205% FPL

Separate CHIP Program 211-222% FPL 211-222% FPL 211-222% FPL N/A

Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; also information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Oklahoma’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Oklahoma operates a combination CHIP program, called SoonerCare.

Number of Children Covered: In FY2014, 164,831 children were covered by SoonerCare.*






Oklahoma 2016 CHIP Fact Sheet


Delivery System: SoonerCare uses an enhanced patient-centered medical home primary care case management and fee-for-service.

Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually. Effective January 1, 2014, the Individual Plan portion of OK’s Insure Oklahoma (IO) Premium Assistance Program eliminated coverage for CHIP children. However, the Employer-Sponsored portion of IO continues to provide coverage for CHIP children; this program has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in Oklahoma

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of SoonerCare.

Does Oklahoma…






Quality Measures: States may report on a "core set" of quality measures for children. Oklahoma reported on 20 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Oklahoma 96.2% 89.0% 90.9% 92.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 Effective January 1, 2014, the Individual Plan portion of OK’s Insure Oklahoma (IO) Premium Assistance Program eliminated coverage for CHIP children. However, the Employer-Sponsored portion of IO continues to provide coverage for CHIP children. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Oregon 2016 CHIP Fact Sheet



Participation Rate: 93.5% of eligible children in Oregon participated in either Medicaid or Healthy Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Oregon (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, benefits offered in Oregon’s CHIP program are the same as the Medicaid program, and they include (but are not necessarily limited to):




Key Highlights:

Program Type: Oregon operates a combination* CHIP program, called Healthy Kids.

Number of Children Covered: In FY2014, 109,085 children were covered by The Oregon Health Plan, Healthy Kids.**


* While the state considers the CHIP program to be a separate program, technically it is a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment system challenges, some CHIP-funded enrollees were included in Medicaid enrollment counts rather than CHIP.)




Oregon 2016 CHIP Fact Sheet



Delivery System: The delivery system for Healthy Kids is the same as Medicaid. Health care services for CHIP clients are primarily provided through the managed care delivery system established in Oregon’s Medicaid 1115 Waiver Demonstration. The State started to transform its delivery system away from a delivery system that has mental and physical health care offered separately, where care is often fragmented and uncoordinated to a Coordinated Care Organization (CCO) model in August 2012. CCOs are accountable for care management and to provide integrated and coordinated health care for each of the organization’s members.


Healthy Kids has no premiums or cost sharing

Strategies to Simplify Enrollment and Renewals Implemented in Oregon

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Healthy Kids.

Does Oregon…






Quality Measures: States may report on a "core set" of quality measures for children. Oregon reported on 17 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Oregon 96.4% 84.3% 87.2% 87.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.






Pennsylvania 2016 CHIP Fact Sheet


Participation Rate: 89.5% of eligible children in Pennsylvania participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Pennsylvania (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Pennsylvania’s CHIP program include (but are not necessarily limited to):




Key Highlights:

Program Type: Pennsylvania operates a combination* CHIP program, called CHIP.



*While the state considers the CHIP program to be a separate program, technically it is considered to be a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that due to eligibility and enrollment system challenges, some CHIP-funded enrollees were included in Medicaid enrollment counts rather than CHIP.)




Pennsylvania 2016 CHIP Fact Sheet



Delivery System: Pennsylvania’s CHIP uses a managed care program statewide, either through a traditional HMO or PPO. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Pennsylvania’s CHIP Program, 2016

Family Income Level Premiums* Office Visits Inpatient Services Prescription Drugs

>208-262% FPL 25% $5-$10 None $6-$9

>262-288% FPL 35% $5-$10 None $6-$9

>288-314% FPL 40% $5-$10 None $6-$9 *Premium amounts are based on a percentage of the state-negotiated rate. Note: In Pennsylvania Children in families with incomes less than 200% FPL do not pay premiums and have no cost sharing responsibilities.

Strategies to Simplify Enrollment and Renewals Implemented in Pennsylvania

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Pennsylvania’s CHIP program.

Does Pennsylvania…






Quality Measures: States may report on a "core set" of quality measures for children. Pennsylvania reported on 18 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Pennsylvania 96.7% 88.6% 92.2% 91.0% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 Information provided by the state. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 This coverage is only available to part-time and seasonal workers who meet the hardship exception. 9 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Rhode Island 2016 CHIP Fact Sheet


Participation Rate: 94.8% of eligible children in Rhode Island participated in either Medicaid or RIte Care in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Rhode Island (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18


Separate CHIP Program N/A N/A N/A Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Note: Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Rhode Island’s CHIP program include (but are not necessarily limited to):




Key Highlights:

Program Type: Rhode Island operates a combination CHIP program, called RIte Care.

Number of Children Covered: In FY2014, 22,136 children were covered by RIte Care.*


*Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report..




Rhode Island 2016 CHIP Fact Sheet


Hearing exams and hearing aids Durable medical equipment Delivery System: RIte Care uses a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

RIte Care has no premiums or cost sharing

Strategies to Simplify Enrollment and Renewals Implemented in Rhode Island

Strategy Used Use of presumptive eligibility No



Premium assistance Yes4 The ACA required states to implement the following strategies beginning January 2014: eliminating in-person interviews, removing asset tests, creating joint application and renewal forms, and adopting automatic/administrative renewals. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter, available at https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho09015.pdf

Other Program Characteristics: Below are some other key program characteristics of RIte Care.

Does Rhode Island… Require a waiting period?5 No Offer a buy-in option?6 No Cover dependents of public employees?7 No Cover lawfully residing children without a five-year waiting period?8 Yes9


Quality Measures: States may report on a "core set" of quality measures for children. Rhode Island reported on 19 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Rhode Island 98.7% 94.1% 97.2% 95.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 The state has a family premium assistance program, RIteShare. 5 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 Information from the state.





South Carolina 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 92.7% of eligible children participated in Medicaid or South Carolina’s CHIP program in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

MAGI-Adjusted Income Eligibility Levels for CHIP/Title XXI in South Carolina (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

194-208% FPL 143-208% FPL 107-208% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in South Carolina’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: South Carolina operates a Medicaid expansion CHIP program as part of the Healthy Connections program.

Number of Children Covered: In FY2014, 79,740 children were covered by South Carolina’s CHIP program.






South Carolina 2016 CHIP Fact Sheet


Delivery System: South Carolina’s CHIP program uses managed care and primary care case management. Individuals can choose from managed care plans that operate in their county of residence. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

South Carolina’s CHIP program has no premiums or cost sharing. Strategies to Simplify Enrollment and Renewals Implemented in South Carolina

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of South Carolina’s CHIP program.

Does South Carolina…






Quality Measures: States may report on a "core set" of quality measures for children. South Carolina reported on 22 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



South Carolina 93.2% 83.1% 87.3% 85.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 Information provided by the state. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





South Dakota 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 87.2% of eligible children in South Dakota participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in South Dakota (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18



Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; also information from the state for the Medicaid expansion program. Note: Eligibility levels do not include the mandatory 5% income disregard.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in South Dakota’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: South Dakota operates a combination CHIP program, called CHIP.







South Dakota 2016 CHIP Fact Sheet


Delivery System: South Dakota's CHIP program uses a fee for service primary care case management model. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

South Dakota’s CHIP program has no premiums or cost sharing.

Strategies to Simplify Enrollment and Renewals Implemented in South Dakota

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of South Dakota’s CHIP program.

Does South Dakota…






Quality Measures: States may report on a "core set" of quality measures for children. South Dakota reported on 2 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below.



South Dakota 39.6% 16.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.






Tennessee 2016 CHIP Fact Sheet


Participation Rate: 92.4% of eligible children in Tennessee participated in either TennCare or CoverKids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Tennessee (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18



Sources: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP; also information from the state. Note: Tennessee’s Medicaid expansion coverage group is only open to children losing Medicaid eligibility (“rollovers”); the separate CHIP program covers all other enrollees. Eligibility levels do not include the mandatory 5% income disregard. Conception to birth coverage is also offered under the CHIP unborn child option.

Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Tennessee’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Tennessee operates a combination CHIP program; the separate CHIP component is called CoverKids.

Number of Children Covered: In FY2014, 112,826 children were covered by CoverKids.*






6

Tennessee 2016 CHIP Fact Sheet


Delivery System: The Medicaid and the Medicaid expansion CHIP program are managed care programs while the separate CHIP program is a fee-for-service insurance arrangement built around a defined CoverKids provider network of TennCare providers. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in CoverKids, 2016


≤199% FPL None $5 $5 $1-$5

200-250% FPL None $15-20 $100 $5-$40

Strategies to Simplify Enrollment and Renewals Implemented in Tennessee

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of CoverKids.

Does Tennessee…






Quality Measures: States may report on a "core set" of quality measures for children. Tennessee reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Tennessee 98.0% 93.3% 94.6% 91.3% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 6 Information provided by the state; effective 1/1/16, CoverKids elected the option to enroll dependents of public employees into the program if they meet other eligibility requirements.





Texas 2016 CHIP Fact Sheet


Participation Rate: 86% of eligible children in Texas participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Texas (by Age Group) in 2016

Ages 0 up to 1 Ages 1 – 5 Ages 6 – 18


Separate CHIP >198-201% FPL >144-201% FPL >133-201% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Texas’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Texas operates a combination* CHIP program, called CHIP.

Number of Children Covered: In FY2014, 1,041,482 children were covered by CHIP.**






Texas 2016 CHIP Fact Sheet


Delivery System: The CHIP system has managed care organization (MCO) coverage across the state. Many MCOs have contracts in Texas to provide services to both Medicaid and CHIP enrollees. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Texas’ CHIP Program, 2016


<151% FPL None $5 $35 $0-$5

>151-186% FPL $35 per year $20 $75 $10-$35

>186-201% FPL $50 per year $25 $125 $10-$35

Strategies to Simplify Enrollment and Renewals Implemented in Texas

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Texas’ CHIP program.

Does Texas…

Require a waiting period?4 Yes, 3 months5





Quality Measures: States may report on a "core set" of quality measures for children. Texas reported on 20 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Texas 97.5% 89.4% 93.1% 91.0% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 Texas waives the waiting period for children who have lost coverage in certain situations. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Utah 2016 CHIP Fact Sheet


The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 79.8% of eligible children in Utah participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI (by Age Group) in Utah in 2016

Ages 0-1 Ages 1-5 Ages 6-18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Utah’s CHIP program include (but are not necessarily limited to):




Key Highlights:

Program Type: Utah operates a combination* CHIP program, called CHIP.







Utah 2016 CHIP Fact Sheet



Delivery System: CHIP utilizes a managed care delivery system. CHIP does not have a fee-for-service arrangement. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in Utah’s CHIP Program, 2016

Family Income Level Premiums Office Visits Inpatient Services Prescription Drugs 134 --150% FPL $30 per quarter per family $5 $150 after deductible $5-5% of approved

amount

151-200% FPL $75 per quarter per family $25-$40 20% of approved amount after deductible

$15 and 25-50% of approved amount

Strategies to Simplify Enrollment and Renewals Implemented in Utah

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Utah’s CHIP program.

Does Utah…






Quality Measures: States may report on a "core set" of quality measures for children. Utah reported on 15 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Utah 98.9% 86.7% 85.5% 87.7% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






Vermont 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 99.9% of eligible children in Vermont participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Vermont (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

237-312% FPL 237-312% FPL 237- 312% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Vermont’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Vermont operates a Medicaid expansion CHIP program.


State’s Enhanced Federal Match Rate: For FY2017, the federal match is 91.12%. *Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report.




Vermont 2016 CHIP Fact Sheet


Delivery System: Vermont’s CHIP program uses a fee-for-service system until a new enrollee picks a primary care provider when the child is enrolled in primary care case management. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in CHIP, 2016



Strategies to Simplify Enrollment and Renewals Implemented in Vermont

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Vermont’s CHIP program.

Does Vermont…






Quality Measures: States may report on a "core set" of quality measures for children. Vermont reported on 13 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Vermont 98.6% 92.1% 94.5% 93.9% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before s/he can enroll in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 Information from the state. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 9 Information from the state.





Virginia 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 88.3% of eligible children in Virginia participated in either Medicaid or FAMIS in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Virginia (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18



Source: Medicaid and CHIP Payment and Access Commission (MACPAC), “Chapter 5: Design Considerations for the Future of Children’s Coverage: Focus on Affordability,” March 2016 Report to Congress on Medicaid and CHIP. Note: Eligibility levels do not include the mandatory 5% income disregard. Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Virginia’s CHIP program include (but are not necessarily limited to):





Key Highlights

Program Type: Virginia operates a combination CHIP program, called FAMIS.

Number of Children Covered: In FY2014, 186,513 children were covered by FAMIS.*






Virginia 2016 CHIP Fact Sheet


Delivery System: All enrollees start in fee-for-service (FFS) before they are transitioned to a managed care organization. All localities are served by at least two MCOs to assure client choice. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in FAMIS, 2016


≤150% FPL None $2 $15 $2

>150% FPL None $5 $25 $5

Strategies to Simplify Enrollment and Renewals Implemented in Virginia4

Strategy Used


Use of 12-month continuous eligibility Yes5



Other Program Characteristics: Below are some other key program characteristics of FAMIS.

Does Virginia…






Quality Measures: States may report on a "core set" of quality measures for children. Virginia reported on 10 measures for federal fiscal year 2014. Among the measures are access to preventive dental services and dental treatment services, listed below.



Virginia 49.3% 27.6% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.

4 VA also utilized an E-14 waiver to use SNAP enrollment to renew certain cases. 5 12-month continuous eligibility is only used in Virginia’s separate CHIP program. 6 Virginia offers premium assistance through an 1115 HIFA Waiver for CHIP under its FAMIS Select Program. 7 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 8 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 9 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 10 State indicated that this option became effective 7/1/15. 11 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Washington 2016 CHIP Fact Sheet


Participation Rate: 92.7% of eligible children in Washington participated in either Medicaid or Washington Apple Health for Kids in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Washington (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18

211-312% FPL 211-312% FPL 211-312% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Washington’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Washington operates a separate CHIP program, called Washington Apple Health for Kids with premiums.

Number of Children Covered: In FY2014, 42,637 children were covered by Washington Apple Health for Kids.*






Washington 2016 CHIP Fact Sheet


Delivery System: The provider network for Washington Apple Health for Kids with premiums (CHIP) is the same as no-cost Washington Apple Health for Kids (Medicaid). Managed Care Organizations (MCO) are used to provide coverage for most children between 211%-312% FPL. The unborn population between 0-185% FPL receive coverage on a fee-for-service (FFS) basis and children residing in counties where only one MCO plan is available may choose FFS or MCO enrollment. Alaskan Native/American Indian children may choose coverage under FFS, MCO, or primary care case management (PCCM).


Premiums and Selected Cost Sharing in Apple Health for Kids, 2016




Strategies to Simplify Enrollment and Renewals Implemented in Washington

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of Apple Health for Kids.

Does Washington…






Quality Measures: States may report on a "core set" of quality measures for children. Washington reported on 16 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



Washington 97.3% 87.5% 91.2% 90.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include both Medicaid and CHIP.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 6 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 7 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children. 8 Washington covers income-eligible children regardless of immigration status using state-only funds.





West Virginia 2016 CHIP Fact Sheet


Participation Rate: 95.9% of eligible children in West Virginia participated in either Medicaid or CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in West Virginia (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in West Virginia’s CHIP program include (but are not necessarily limited to):



Key Highlights:

Program Type: West Virginia operates a combination* CHIP program, called CHIP.



*While the state considers the CHIP program to be a separate program, technically it is a combination program due to the transition required by the ACA of children below 133% FPL from separate CHIP to Medicaid. **Data from Medicaid and CHIP Payment and Access Commission Dec. 2015 MACStats report. (Report notes that children who transitioned between CHIP and Medicaid were reported in both programs rather than the program in which they were last enrolled, resulting in artificially high totals.)




West Virginia 2016 CHIP Fact Sheet




Delivery System: CHIP uses the same fee-for-service provider networks as public employees. For an incentive for the use of medical homes, there are no copays associated with services offered through these networks. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Selected Cost Sharing in West Virginia’s CHIP Program, 2016


<150% FPL None $5 None $0-$5

150-211% FPL None $15-$25* $25 $0-$10

>211% FPL $35/$71 max $20-$25* $25 $0-$15 *Waived when member has a designated medical home.

Strategies to Simplify Enrollment and Renewals Implemented in West Virginia

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of West Virginia’s CHIP program.

Does West Virginia…






Quality Measures: States may report on a "core set" of quality measures for children. West Virginia reported on 21 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below.



West Virginia 97.5% 94.7% 88.5% 91.0% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






Wisconsin 2016 CHIP Fact Sheet

For nearly two decades the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate income. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options. The Affordable Care Act (ACA) extended federal CHIP funding through fiscal year 2015, required states to maintain Medicaid and CHIP eligibility standards for children through 2019, and increased the federal CHIP matching rate by 23 percentage points.1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended federal CHIP funding at its current levels through September 2017.2 Participation Rate: 90.4% of eligible children in Wisconsin participated in either Medicaid or BadgerCare Plus in 2014, the last year for which we have national data. The national average was 91% in 2014.3 Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).

Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Wisconsin (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18


Separate CHIP Program N/A >186-301% FPL >151-301% FPL


Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Wisconsin’s CHIP program include (but are not necessarily limited to):





Key Highlights:

Program Type: Wisconsin operates a combination CHIP program, called BadgerCare Plus.

Number of Children Covered: In FY2014, 183,115 children were covered by BadgerCare Plus.*






Wisconsin 2016 CHIP Fact Sheet


Delivery System: BadgerCare Plus and Medicaid use a managed care delivery system. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Cost Sharing in BadgerCare Plus, 2016


≤201% FPL None $0-$3 $3 per day $1-$3

201-251% FPL $10-$23 $0-$3 $3 per day $1-$3

251-301% FPL $34-$97.53 $0-$3 $3 per day $1-$3

Strategies to Simplify Enrollment and Renewals Implemented in Wisconsin

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of BadgerCare Plus.

Does Wisconsin…






Quality Measures: States may report on a "core set" of quality measures for children. Wisconsin reported on 4 measures for federal fiscal year 2014.



Wisconsin 25.1% 10.8% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016.

4 States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP. 5 The waiting period was eliminated in July 2015. 6 States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP. 7 CHIPRA provided states the option to cover the income-eligible dependents of state employees under CHIP. 8 CHIPRA provided states the option to remove the five-year waiting period for lawfully residing children.





Wyoming 2016 CHIP Fact Sheet



Participation Rate: 82.9% of eligible children in Wyoming participated in either Medicaid or KidCare CHIP in 2014, the last year for which we have national data. The national average was 91% in 2014.3


Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP/Title XXI in Wyoming (by Age Group) in 2016

Ages 0 – 1 Ages 1 – 5 Ages 6 – 18




Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Wyoming’s CHIP program include (but are not necessarily limited to):



Hearing exams Durable medical equipment


Key Highlights:

Program Type: Wyoming operates a combination* CHIP program, called KidCare CHIP.

Number of Children Covered: In FY2014, 9,095 children were covered by KidCare CHIP.**

State’s Enhanced Federal Match Rate: For FY2017, the federal match is 88.0%





Wyoming 2016 CHIP Fact Sheet


Delivery System: The provider networks in KidCare CHIP are maintained separately from Medicaid, however most providers accept both Medicaid and CHIP enrollees. Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income annually.

Premiums and Cost Sharing in KidCare CHIP, 2016


134-150% FPL None $5 $30 $3-$5

151-200% FPL None $10 $50 $5-$10

Strategies to Simplify Enrollment and Renewals Implemented in Wyoming

Strategy Used





Other Program Characteristics: Below are some other key program characteristics of KidsCare CHIP.

Does Wyoming…

Require a waiting period?4 Yes, 1 month





Quality Measures: States may report on a "core set" of quality measures for children. Wyoming reported on 13 measures for federal fiscal year 2014. Among the measures is access to primary care providers, listed below. Percentage of Children and Adolescents Visiting a Primary Care Provider, by Age (FFY 2014)


Wyoming Not reported 74.0% 59.7% 61.5% Source: Department of Health and Human Services, 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, February 2016. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years receiving a visit to a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. Note: These data include CHIP only.






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