20 Years of CHIP: Past Successes. Future Challenges 2017 Annual Research Meeting June 27, 2017 Debbie I. Chang, MPH Senior Vice President, Policy & Prevention Nemours Children’s Health System 1
Nemours Integrated Child Health System 2
Top 5 CHIP Accomplishments: #1 Bipartisan support for a public program CHIP is a finely crafted compromise – It was created as part of a budget deal (BBA) between a Republican Congress and a Democratic President in 1997. – It represents a partnership between states and the federal government. – It brought together advocates of a Medicaid expansion and those who favored a private insurance approach. – It balances the politics of conservatives and liberals by including elements of a block grant and an entitlement program: Federal CHIP funds are capped with each state receiving an annual allotment No individual entitlement under separate CHIP programs States can choose to expand through Medicaid (in this case there is an entitlement) 3
Top 5 CHIP Accomplishments: #2 Coverage gains for children CHIP extended insurance coverage to millions of uninsured kids. – CHIP and Medicaid are credited with reducing the number of uninsured children from 10 million in 1997 to 3.3 million in 2015. – The percentage of uninsured children is at a historic low of 5 percent. – Medicaid and CHIP play a particularly critical role in covering children in low income families and children of color. More than ¾ of children in families with incomes below the poverty level are enrolled in Medicaid and CHIP. CHIP and Medicaid cover more than half of all Black, Hispanic and American Indian and Alaska Native children. – CHIP made covering a “moderate income” population acceptable Over half (56%) of children in families with incomes between 100% and 199% are enrolled in CHIP. 4
Top 5 CHIP Accomplishments: #3 Improved access for children Enrollment in CHIP improves access to health care services. Some studies have found that Medicaid and CHIP coverage contribute to improved health outcomes – Reductions in avoidable hospitalizations and mortality 5
Top 5 CHIP Accomplishments: #4 Innovations and spillover to Medicaid CHIP flexibility led to innovations in enrollment, outreach and program design CHIP has had a positive spillover effect on Medicaid 6
Top 5 CHIP Accomplishments: #5 States and Parents embraced CHIP After enactment, states moved quickly to adopt programs. Parents are satisfied with the coverage that CHIP is providing their children. Most new CHIP enrollees stayed enrolled in public coverage for at least 28 months and the vast majority exited because they were no longer eligible. 7
Current Challenges for CHIP Proposed changes to Medicaid and ACA have created much uncertainty around children’s coverage. CHIP Funding levels and financing policy unknown. 8
What is next for CHIP? CHIP funding is set to expire on September 30, 2017. In order for CHIP to continue, Congress must act very soon to extend federal funding. If no legislative action is taken, the health of millions of children will be at risk and it will increase the financial pressures for states. – States will be responsible for maintaining coverage for children in CHIP-funded Medicaid expansions under the ACA MOE requirement. MACPAC recently recommended a 5-year extension of CHIP with the current CHIP maintenance-of-effort. More information can be found here: https://www.macpac.gov/publication/recommendations-for- the-future-of-chip-and-childrens-coverage-2/ 9
Moving to a Prevention-Oriented Health System CHIP (and Medicaid) should focus on prevention and population health There are many existing authorities for CHIP and Medicaid to finance prevention (e.g., CHIP Health Services Initiative) See Nemours toolkit for many more examples at: http://movinghelathcareupstream.org/innovations/pathways- through-medicaid-to-prevention 10
A Roadmap of Medicaid Prevention Pathways: Framework 11
A Roadmap of Medicaid Prevention Pathways: Examples 12
Debbie I. Chang, MPH Senior Vice President, Nemours Policy and Prevention 1201 15 th Street, NW, Suite 520, Washington, DC 20005 (e) dchang@nemours.org www.nemours.org 13
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