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20 Years of CHIP: Past Successes. Future Challenges
2017 Annual Research Meeting June 27, 2017
Debbie I. Chang, MPH
Senior Vice President, Policy & Prevention Nemours Children’s Health System
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Past Successes. Future Challenges 2017 Annual Research Meeting - - PowerPoint PPT Presentation
Past Successes. Future Challenges 2017 Annual Research Meeting - - PowerPoint PPT Presentation
20 Years of CHIP: Past Successes. Future Challenges 2017 Annual Research Meeting June 27, 2017 Debbie I. Chang, MPH Senior Vice President, Policy & Prevention Nemours Childrens Health System 1 Nemours Integrated Child Health System
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Top 5 CHIP Accomplishments: #1 Bipartisan support for a public program
- CHIP is a finely crafted compromise
– It was created as part of a budget deal (BBA) between a Republican Congress and a Democratic President in 1997. – It represents a partnership between states and the federal government. – It brought together advocates of a Medicaid expansion and those who favored a private insurance approach. – It balances the politics of conservatives and liberals by including elements of a block grant and an entitlement program:
- Federal CHIP funds are capped with each state receiving an
annual allotment
- No individual entitlement under separate CHIP programs
- States can choose to expand through Medicaid (in this case
there is an entitlement)
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Top 5 CHIP Accomplishments: #2 Coverage gains for children
- CHIP extended insurance coverage to millions of uninsured
kids.
– CHIP and Medicaid are credited with reducing the number of uninsured children from 10 million in 1997 to 3.3 million in 2015. – The percentage of uninsured children is at a historic low of 5 percent. – Medicaid and CHIP play a particularly critical role in covering children in low income families and children of color.
- More than ¾ of children in families with incomes below the
poverty level are enrolled in Medicaid and CHIP.
- CHIP and Medicaid cover more than half of all Black, Hispanic
and American Indian and Alaska Native children. – CHIP made covering a “moderate income” population acceptable
- Over half (56%) of children in families with incomes between
100% and 199% are enrolled in CHIP.
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Top 5 CHIP Accomplishments: #3 Improved access for children
- Enrollment in CHIP improves access to health care
services.
- Some studies have found that Medicaid and CHIP
coverage contribute to improved health outcomes
– Reductions in avoidable hospitalizations and mortality
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Top 5 CHIP Accomplishments: #4 Innovations and spillover to Medicaid
- CHIP flexibility led to innovations in enrollment,
- utreach and program design
- CHIP has had a positive spillover effect on Medicaid
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Top 5 CHIP Accomplishments: #5 States and Parents embraced CHIP
- After enactment, states moved quickly to adopt
programs.
- Parents are satisfied with the coverage that CHIP is
providing their children.
- Most new CHIP enrollees stayed enrolled in public
coverage for at least 28 months and the vast majority exited because they were no longer eligible.
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Current Challenges for CHIP
- Proposed changes to Medicaid and ACA have created
much uncertainty around children’s coverage.
- CHIP Funding levels and financing policy unknown.
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What is next for CHIP?
- CHIP funding is set to expire on September 30, 2017.
- In order for CHIP to continue, Congress must act very soon
to extend federal funding.
- If no legislative action is taken, the health of millions of
children will be at risk and it will increase the financial pressures for states.
– States will be responsible for maintaining coverage for children in CHIP-funded Medicaid expansions under the ACA MOE requirement.
- MACPAC recently recommended a 5-year extension of CHIP
with the current CHIP maintenance-of-effort. More information can be found here: https://www.macpac.gov/publication/recommendations-for- the-future-of-chip-and-childrens-coverage-2/
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Moving to a Prevention-Oriented Health System
- CHIP (and Medicaid) should focus on prevention and
population health
- There are many existing authorities for CHIP and Medicaid to
finance prevention (e.g., CHIP Health Services Initiative)
- See Nemours toolkit for many more examples at:
http://movinghelathcareupstream.org/innovations/pathways- through-medicaid-to-prevention
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A Roadmap of Medicaid Prevention Pathways: Framework
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A Roadmap of Medicaid Prevention Pathways: Examples
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