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Sharon Carte: Preserving health coverage for kids means protecting CHIP (Gazette)

By By Sharon Carte

The overwhelmingly popular Children’s Health Insurance Program turns 20 years old this year. We can celebrate the pivotal role that CHIP together with Medicaid has played in increasing health coverage for children in our state — now at 97 percent. It seems like a no-brainer that, after two decades of helping children get the health care they need, either CHIP’s funding or existence would be at question, but it is!

Some members of Congress think that CHIP could go away because kids can get insurance through private coverage in the exchanges. Private coverage, however, does not provide the same protections as CHIP:

1. Comprehensive, child-centered benefits.

2. Affordability of coverage.

Child-centered and comprehensive means the insurance policy provides benefits that address changes over an infant-child-teen developmental span. Johnny may have not needed glasses at 5 years before starting school, but now at 8, he does; Susie may not have had an allergy at 10, but now at 14 she needs ongoing medication, and they both need well visit coverage annually to detect such changes.

The plan must also be comprehensive enough to address dental or mental health needs that will arise for a significant number of children. Most private plans do not offer these benefits.

Affordable means not only the cost of the premium is in reach for lower and middle income families but any added cost sharing must not be a barrier to using services.

In our state’s CHIP program, families whose incomes are more than 200 percent of the Federal Poverty Level, are asked to pay monthly premiums and make modest copayments on some non-preventive services.

By federal regulation, however, all cost sharing in a CHIP benefit plan cannot total more than 5 percent of family income. Families who have children in Exchange plans do not have this protection.

These issues of affordability and benefits were highlighted recently at a roundtable discussion of child health at the West Virginia Osteopathic School of Medicine. A parent of four children in the audience noted that family coverage through her husband’s employer plan had cost-sharing requirements that posed barriers to getting the preventive care her children needed. Some services, she said, were not covered at all.

Was there anything in the way of programs or subsidies that would help her children and families like hers access services like CHIP or Medicaid kids do? This family’s frustration illustrates the need to build a seamless, continuity of coverage system with a minimum standard of coverage for all children.

At the end of this month, CHIP funding to states will expire unless renewed by Congress. Congress may decide to address this issue later in the federal budget or provide for a one- or two-year extension. In January 2017, the Medicaid and CHIP Payment and Access Commission issued its “Recommendations for the Future of CHIP and Children’s Coverage.”

It recommended a five-year extension of CHIP recognizing the complexity surrounding the challenge of further developing a more seamless system of children’s coverage.

The report identifies the need to work towards a longer range vision of “a system that would provide comprehensive and affordable coverage for low- to moderate-income children and remove the gaps in coverage and care that can affect children as they transition among different sources of publicly and privately financed health insurance.”

The report also notes the significant role CHIP plays in the financial security in low-to moderate- income families by decreasing the possibility that a family has unpaid medical bills and faces household bankruptcy.

As we all learned recently in the Great Ongoing Repeal-and-Replace Debate, health care policy is complex, and it is no less true for children’s coverage. CHIP may be relatively small in the picture-puzzle landscape of children’s health coverage, but changes to it are HUGE to the future of children’s health!

Sharon Carte, of Charleston, is retired as director of the West Virginia Children’s Health Insurance Program.

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