The government of the United States has demonstrated its commitment to caring for low income families and children through the public health insurance programs. The significant gap in the privately based insurance programs was filled by the development of the publicly funded health coverage programs for the children. This is because all the children in the United States do not have access to employer based insurance coverage as some of the parents are not in formal employment. Therefore, public coverage plays a vital role in ensuring that the low income children who do not have private coverage access to medical coverage that is publicly funded. Most importantly, both publicly and privately sponsored health insurance play a significant role in ensuring that the children’s access to care is improved. Health insurance coverage in the U.S. enables the children to benefit from primary and early preventive care that contribute to the overall health status of the children in the United States.
For a very long time, the uninsured children have lagged behind those privately or publicly covered on any given measure of access to essential care. Therefore, renewed efforts have been put in place to ensure that such disparities in access to health care among children are considerably reduced (Baicker & Finkelstein, 2011). The Children Health Insurance Program (CHIP) was created in 1997 to offer medical coverage for uninsured low income children who are above the cut off for Medicaid eligibility. The creation of CHIP played a vital role in facilitating access to care by low income children. Moreover, CHIP ushered in an initiative aimed at getting eligible children enrolled into the program by effectively addressing the obstacles to coverage (Blumenthal & Collins, 2014). The complexity and the intrusive nature of the enrollment process were simplified in order to encourage enrolment of children into the program. Moreover, many states designed their own separate CHIP programs which sought to eliminate the barriers to enrollment. Short application forms were developed and limited documentation was required in order to facilitate mass enrollment of eligible low income children through outreach. The Child Health Insurance Program (CHIP) has significantly improved the health status of children, reduced family financial stress and promoted access to care.
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Literature Review
Design and Administration of the CHIP
The creation of CHIP in 1997 demonstrated the government’s commitment to expand health insurance coverage to include low income uninsured children. The program permitted states to design and implement an alternative health insurance program to Medicaid that would provide health insurance coverage that closely resembles what might be provided by the commercial health insurance market (Baicker & Finkelstein, 2011). The Child Health Insurance Program provided new flexibility for the states to develop benefit packages. Moreover, the states were allowed to establish cost sharing and eligibility criteria that are different from those allowed under Medicaid (Volden, 2006).
The options that the law gave to the states regarding the design of the CHIP included expanding the existing Medicaid, creating a separate child health insurance program or using a combination of the two alternatives (Volden, 2006). The states began by expanding the existing Medicaid program. However, over the time, the states have designed and developed separate programs that operate together with Medicaid. Majority of the U.S. states run the CHIP program out of their health and human services agencies whereas others have chosen to run the program under separate agencies. For instance, CHIP is run under the Department of Insurance in Pennsylvania and under the Healthy Kids Corporation not-for-profit organization in New Hampshire.
Eligibility
CHIP was primarily designed to address the health insurance needs of low income and uninsured children. Such children hail from families who qualify for Medicaid but do not have private insurance coverage because their employer does not provide or they are unable to pay for it. Therefore, for low income and uninsured children to be eligible for CHIP, their parents should be eligible for Medicaid cover (Blumenthal & Collins, 2014). The primary objective of the program was to provide health insurance coverage to low income children who lack access to private health insurance. However, the states are at liberty to set eligibility rule for their respective CHIP programs. The state may also further expand the CHIP coverage to families with higher incomes (Baicker & Finkelstein, 2011).
The children who are otherwise eligible for Medicaid and have other health insurance coverage are generally not eligible for CHIP. Therefore, only those applicants who are eligible are enrolled in Medicaid and should not be substituted for private health insurance coverage (Visser et al, 2014). Therefore, the states must have stringent rules in place in order to ensure that uninsured children are targeted rather than already insured children. This will prevent “crowd out” which normally occurs when private coverage substitutes for public coverage. As such, the children should be thoroughly screened for eligibility under Medicaid in order to ensure that they are eligible for the program (Visser et al, 2014).
Financing Structure
The payments for child health assistance under CHIP qualify for federal matching payments just like Medicaid. In order to encourage the states to embrace the voluntary program, the states’ federal matching rates were set at 30 percentage points above the 70% of their Medicaid matching rate (Cohodes et al., 2015). Therefore, state governments pay 30 percent while the federal government pays 70 percent of the program costs. Moreover, the CHIP matching payments are dependent on the annual state based caps (Cohodes et al., 2015).
The number of children and the state cost factor determine the annual allocation of federal limits for CHIP. The sum of the number of uninsured children and the number of low income children constitute the total number of children considered in determining the annual federal limits for CHIP. Moreover, CHIP has a system that facilitates redistribution of federal allotments from states may not have spent the full amount allocated to them for the program. The federal allotments are redistributed to the states that may need higher amounts. The annual allotments that have not been spent within three years from the time of allotment qualify for redistribution to states that require more funds to finance their CHIP programs (Cohodes et al., 2015).
Benefits of CHIP
CHIP has enhanced access to essential medical care by children hence improving the health status of children especially those from low income families who cannot afford private health insurance. The CHIP programs cover the Early Periodic Screening, Diagnosis and Treatment (EPSDT) for children (Szilagyi et al, 2004). Thus, the children health is improved through early preventive care facilitated by EPSDT. EPSDT is a comprehensive package for children that enable them to access not only health services but also developmental services. For instance, the children can get access to habilitation services that help them to attain, maintain and improve skills that assist them to maximize their function (Cohodes et al., 2015).
Moreover, the CHIP programs cover dental care which is often not available in private health insurance unless purchased separately. Therefore, CHIP programs provide dental coverage, a service that matters so much to children because dental disease is the most common childhood disease that should be effectively covered. In most states, CHIP programs cover inpatient and outpatient mental health services including substance abuse treatment without limits (Szilagyi et al, 2004). Therefore, CHIP programs have facilitated greater access to care among children who would have otherwise remained uninsured. The CHIP programs have helped significantly in eliminating racial and ethnic disparities in access to care among children. The programs have also helped in bridging the primary and preventive care gap between the children under CHIP and those under private health insurance. Moreover, children with chronic and special health care needs have experienced improved access to essential care under CHIP programs (Szilagyi et al, 2004).
Disadvantages of CHIP
As much as CHIP programs have facilitated improved access to early preventive and primary care among children, there are still challenges associated with the programs. For instance, children with CHIP are more likely than privately insured children to be denied appointments with specialists. Furthermore, children with CHIP face longer waits in health facilities if at all they secure appointments with specialist healthcare professionals. Moreover, the dentists are more willing to accept privately insured children as compared to children with CHIP citing referral difficulties, bureaucratic barriers, and payment and billing issues as reasons for avoiding publicly insured children (Koh & Sebelius, 2010). Therefore, CHIP programs are marred with bureaucratic barriers, referral difficulties as well as payment and billing issues which make their effectiveness compromised.
Some of the state practices still limit the enrollment of low income children to CHIP. Waiting lists significantly reduce enrollment beyond their intent as most of the children on the waiting list had been enrolled in Medicaid but no longer eligible because their family’s income had increased or they exceeded the age limit. Moreover, CHIP programs have considerably reduced private coverage through crowding out (Gruber & Simon, 2008). This is because the CHIP programs expand the eligibility for public health insurance programs.
Discussion
CHIP programs have significantly reduced bed days, the acute health conditions, and restricted activity days among children. This signifies that the programs have improved the health status of the children. The programs have enhanced access to essential medical care by children hence improving the health status of children especially those from low income families who cannot afford private health insurance. The CHIP programs cover the Early Periodic Screening, Diagnosis and Treatment (EPSDT) for children. Thus, the children health is improved through early preventive care facilitated by EPSDT (Koh & Sebelius, 2010). EPSDT is a comprehensive package for children that enable them to access not only health services but also developmental services. However, there are various issues associated with the programs such as rising healthcare costs and falling state revenues, barriers to enrollment and retention of children and gaps in coverage.
The rising healthcare costs and the falling state revenues have threatened to stall or even reverse the progress made in enrolling all low income children into the CHIP programs. The downturn in the economy and the rising healthcare costs has made more children to turn to CHIP programs because their families continue to lose income as well as health coverage (Feinberg et al, 2002). The problems in the economy have lowered state revenues making it difficult for states to afford the costs of the CHIP programs. The increasing costs of healthcare may force the sates to cut back on coverage and care. Therefore, the federal government should initiate policies that would avert the challenges associated with the rising costs of healthcare (Koh & Sebelius, 2010).
Gaps still remain in coverage and the fiscal challenges make it difficult to effectively address the existing gaps. Some poor children still do not get coverage as a result of limits on income eligibility in some states. Moreover, immigrant children are barred from CHIP programs despite their income. Therefore, the ban will affect an increasing number of children who are in the country legally hence increasing the number of children who are uninsured in the country. More parents of children who are eligible for CHIP programs remain uninsured despite the fact that family coverage improve the opportunities for enrolling eligible children and ensure that children get access to the necessary care.
Elimination of barriers to coverage, coordination of public and private coverage and creation of seamless coverage systems will help in promoting enrollment and retention of eligible children in the CHIP programs (Ku & Matani, 2001). Access to doctors and proper benefit packages assist in enhancing the children coverage through the CHIP programs.
Conclusion
Amid the challenges associated with CHIP programs, they remain the most important vehicles for providing the essential coverage to many of the nation’s low income children. CHIP has remained an effective program that provides comprehensive coverage and financial protection to millions of American children. The program has increased access to and use of the recommended care and helped reduce disparities in coverage and care that mostly affect the low income children. Therefore, CHIP programs have facilitated greater access to care among children who would have otherwise remained uninsured. The CHIP programs have helped significantly in eliminating racial and ethnic disparities in access to care among children. The programs have also helped in bridging the primary and preventive care gap between the children under CHIP and those under private health insurance.
References
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Szilagyi, P. G., Dick, A. W., Klein, J. D., Shone, L. P., Zwanziger, J., & McInerny, T. (2004). “Improved access and quality of care after enrollment in the New York State Children's Health Insurance Program (SCHIP)”. Pediatrics , 113 (5), e395-e404.
Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., ... & Blumberg, S. J. (2014). “Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011.” Journal of the American Academy of Child & Adolescent Psychiatry , 53 (1), 34-46.
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