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Title V Technical Assistance Meeting

 View from Washington

CHIP, CYSHCN, Transitions and Transformations

By Brent Ewig, MHS
Director, Public Policy & Government Affairs, AMCHP

As this Pulse issue on CYSHCN and transitions goes to press, the future of the Children's Health Insurance Program remains unresolved. While a two-year extension of CHIP – as well as Maternal, Infant and Early Childhood Home Visiting (MIECHV) program; the Personal Responsibility Education Program (PREP) and Family to Family Health Information Centers (F2Fs) – passed the House of Representative by a solid bipartisan vote of 392-37 on Mar. 26, the Senate put off its vote until the week of Apr. 13. Additional details are available in the most recent AMCHP Legislative Alert.

[Editors Note: On Apr. 15 the U.S. Senate gave final approval to this legislation with a vote of 92-8. Additional details are available here. It will now go to the president to be signed into law.]

The CHIP program plays a key role in reducing the number of uninsured children and, in fact, helped to cut the uninsured rate in half since its inception in 1997. Additionally, the protections CHIP provides both in benefits and cost sharing are two of the most important feature supporting children and youth with special health care needs.

Over the past year, congressional leaders sought input on the future of CHIP from a range of stakeholders, including all governors. A summary of this input by the United States Senate Finance and House Energy and Commerce Committees notes, "Governors reported that CHIP is more affordable to consumers than exchange or employer-sponsored coverage and generally has a richer benefit package. All 34 governors that mentioned the cost of care to consumers indicated that CHIP coverage is more affordable than private coverage, such as that offered on the exchanges or by employers."

Perhaps one of the most important features CHIP offers in support of CYSHCN is the out of pocket cost protection provided to families. A study commissioned by colleagues at First Focus and conducted by Wakely Consulting included this key finding:

The financial impact of CHIP enrollees transitioning to QHPs [qualifying health plans] is especially pronounced for children with special health care needs (those with a large number of medical claims) who will likely reach the out of pocket maximum for cost sharing in a year. In some states, children with special health care needs could go from paying $0 in CHIP to over $5,000 in annual out of pocket expenditures in QHPs. All states included in the analysis had lower maximum out of pocket costs in CHIP compared to QHPs.

These tenets formed the central messages that AMCHP promoted in our advocacy for extending CHIP. Our hope is that the Senate will act quickly the week of Apr. 13 to provide at least two years of additional funding for CHIP.

In the meantime, the transformation of the Title V Maternal and Child Health Services Block Grant is gaining momentum. The revised guidance released in January has galvanized state action to activate needs assessments and revise state plans, with applications reflecting the new framework due this July.

In particular, the new performance measurement framework confirms that CYSHCN remains a central focus of Title V services, with prominent measures on medical home, adequacy of insurance, and transition to adult care systems included - as well as stratification of other measures to help delineate potential disparities. More on the transformation is available from the Maternal and Child Health Bureau here.

As always, we value your feedback on AMCHP policy and advocacy activities. Please direct any comments or suggestions to Brent Ewig, Director of Policy, at