The Children’s Health Insurance Program in the US

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Table of Contents

Policy goals
Benefits and/or services provided
Eligibility status
Service delivery system
Financing
References

The Children’s Health Insurance Program (CHIP) is one of the current and robust healthcare policies targeting children in the United States. Children who are below the age of 19 years are covered by the CHIP medical policy. Mostly, these are children whose parents or guardians do not qualify for Medicaid because of their higher-earning brackets. At the same time, they should be unable to cater for private coverage.

It is vital to mention that each state has its own model or system of implementing CHIP. Nonetheless, each state works within the core objectives, spirit, and mandate of the medical policy (Children’s Health Insurance Program, n.d). There are a few exceptional cases where this policy has been extended to young pregnant women and parents.

Policy goals

The main goal of the Children’s Health Insurance Program (CHIP) is to offer medical insurance coverage for children who do not benefit from Medicaid policy and cannot afford private healthcare coverage. There is a growing need to ensure that children who are completely left out of all legible medical policies. The policy aims to provide affordable coverage to the young and growing population, preferably among those who have not clocked 20 years. There are households that earn more than the requirements of Medicaid, and hence, the policy is keen on including them in a comprehensive medical plan (Flores & Lesley, 2014).

The policy goals have also been extended to expectant mothers in some states. The coverage as documented in CHIP’s policy blueprint also collaborates with the Medicaid program in order to provide affordable healthcare programs to children.

Another broad policy goal of CHIP is to assist parents who do not have any form of coverage so that they can also enjoy the benefits of healthcare coverage. Through the policy, children who have no access to doctors can now access individualized healthcare services.

Benefits and/or services provided

The Children’s Health Insurance Program offers a number of healthcare benefits that vary in each state. However, the policy ensures that each state is in a position to provide basic coverage based on the prevailing local and state needs. Comprehensive coverage alongside benefits offered by CHIP includes emergency and ambulatory services, scanning services such as X-ray, laboratory tests and checkups, hospital care for both in-patients and out-patients, dental and vision checkup as well as treatment, drug prescriptions, visits to and by healthcare experts (nurses and doctors), immunization programs and regular screening and tests.

Eligibility status

The policy states that households that are comprised of four members and secure an income of up to $45,000 per annum are eligible for the program. However, eligibility status tends to vary from state to state. For instance, some states may set a higher limit of the threshold income per year than others. Since CHIP’s policy program collaborates with Medicaid, parents are usually encouraged to apply so that their children can be considered. This implies that making a formal application is the initial step before being accepted into the program. Parents who spend more than 50% of their time with children are also eligible to apply for the policy on behalf of such children.

Co-payment is also included as one of the eligibility criteria in some cases when accepted in CHIP’s medical policy. Under CHIP routine checkups are free. A number of states also require monthly premiums from members (Olson, 2013). Nevertheless, the premium is not supposed to go beyond 5 percent of monthly family income. In addition, an ability to pay is the major determining factor when it comes to the required co-pays and enrollment fees.

Eligibility assessment is accepted at any time of the year. The CHIP policy has no ceiling for the enrolment period. After passing the eligibility test, coverage can begin without further delay.

Service delivery system

As already hinted out, the Children’s Health Insurance Program policy model of delivery differs across the states. However, basic healthcare services such as prescriptions and doctor visits are offered in all states. This implies that the delivery system takes place around the various states. Each state administers the policy goals uniquely.

Financing

The respective states and the Federal government jointly fund the Children’s Health Insurance Program (CHIP) policy. Through the FMAP’s formula, the two levels of governance assist each other in pooling funds together to facilitate the healthcare policy. As a boost for individual states to improve healthcare funding policies among children, Congress developed an “accelerated” federal compatibility ratio that would be used in CHIP. The rate is approximately 15 % more than the ratio applied in Medicaid. So far, the CHIP policy has disbursed an estimated $20 billion in one decade to assist children not covered by Medicaid and is also unable to afford private insurance policies. In order to facilitate the process of providing for this coverage, the enhanced federal match is received by each state. The latter amount is higher than the Medicaid match of respective or individual states (Barusch, 2015).

In summary, this policy perceives children as victims because some of them are not covered at all by either Medicaid or CHIP policies. It also explains the reason why the program was initiated: to offer comprehensive medical coverage policy for children who are victims of Medicaid or marginalized family income.

References

Barusch, A. S. (2015). Foundations of social policy: Social justice in human perspective (5^th ed.). Belmont, CA: Thomson Brooks/Cole.

Children’s Health Insurance Program (n.d). Web.

Flores, G. & Lesley, B. (2014). Children and U.S. federal policy on health and health care: seen but not heard. JAMA Pediatr, 168(12), 1155-1163.

Olson, K.L. (2013). The Politics of Medicaid. New York: Columbia University Press.

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