More evidence why CHIP works for families

By: Colin Reusch

The Centers for Medicare & Medicaid Services (CMS) recently released a background paper that is the foundation of last year’s statutorily-mandated report comparing marketplace coverage to the Children’s Health Insurance Program (CHIP). This background paper cites analysis conducted by the Wakely Group and further underscores the decision by the Secretary of Health and Human Services not to certify any qualified health plans (QHPs) as comparable to CHIP.

Once again, dental benefits were cited as a primary example of why children currently enrolled in CHIP cannot be transitioned into marketplace coverage. The paper noted that while CHIP guarantees all enrolled children have dental coverage, most marketplace QHPs still do not include pediatric dental benefits. Furthermore, it is not a requirement for families in most marketplaces to purchase a stand-alone dental plan in order to ensure that children have adequate dental coverage.

Not surprisingly, the report indicates that cost is the primary factor in concluding that QHPs are not comparable to CHIP, which limits premiums and cost-sharing to 5% of family income. Premiums alone for medical and separate dental coverage can exceed 8% of family income. In addition, the cost-sharing reductions for low-income families established by the Affordable Care Act (ACA) aim to ensure out-of-pocket costs that are comparable to CHIP, but these provisions do not apply to dental coverage purchased separately from a QHP.

Cost is the primary factor in concluding that QHPs are not comparable to CHIP, which limits premiums and cost-sharing to 5% of family income.

For now, families who benefit from CHIP will continue to do so without fear of state-level decisions aimed at transitioning their children into the marketplaces. However, in little more than a year, federal funding for CHIP may come to an end unless Congress acts. Furthermore, without significant changes to the ACA itself, marketplace coverage is unlikely to be comparable to CHIP any time soon. Therefore, it’s imperative that Congress extend funding for CHIP for more than two years this time around and carefully consider the long-term future of children’s coverage.

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Did you know?

75% }
of American Indian/Alaskan Native children have experienced caries by age 5.
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