CHIP Executive Summary
HCS 550
June 30, 2014
CHIP Executive Summary The process of implementing a health care policy involves important steps of legislation formulation before execution and monitoring for progression and improvements. Committees and subcommittees on levels of the government, state, and local legislation are inclusive in ensuring the policy is enacted both efficiently and effectively. To accomplish these goals and objectives legislators must develop rules and regulations that align with goals and objectives, and take precautions to form the proper language to explain the actions suitable toward a successful operation. Some steps in the process are repeated each time a modification in the policy occurs. Examination of the Children’s Health Insurance Program (CHIP), justification of the policy, the responsibility of legislative committees appropriated to the policy, the implementation process, and the impact on the community, are addressed in the contents of this paper. CHIP Policy Description The Children’s Health Insurance Program (CHIP) provides low-income families with health coverage because they are not eligible for Medicaid. Funds for this program derive from state tax collections, and are matched by the federal government. Individuals under the age of 19 may receive coverage for immunizations, routine examinations, office visits, hospitalization, diagnostics, prescriptions, emergency room services, vision, and dental care. CHIP coverage varies in each state therefore, the aforementioned services may not be available in every state (NCSL, 2014). Each state identifies the CHIP program with its own title. To illustrate, in Florida the program title is KidCare (Florida KidCare, 2014) whereas, in the state of Georgia the program’s title is PeachCare for Kids (HIF, 2014). The eligibility of coverage extends to pregnant women, parents, seniors, and those with disabilities. These candidates are a part of the mandatory group requirements, and each state has the flexibility to decide to include other population groups in their programs. If any state wishes to include additional groups for CHIP coverage they must apply for a waiver of the federal law through the Centers for Medicaid and Medicare Services (CMS) (Medicaid.gov, 2014). The program’s eligibility standards allow for families with income levels of 200% of the Federal Poverty Level (FPL). Some state’s standards are income levels of 250% of FPL and others can be 300%. Under the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states are permitted to provide prenatal care, delivery services, and postpartum health care services to uninsured and low-income women as of 2009 (Medicaid.gov, 2014). Policy Justification In 1997 factors of the vast amounts of American families living at poverty levels, preventing them from Medicaid eligibility and not enough to afford to pay for health care coverage, fueled the need to formulate legislation for provisions of children’s health insurance. The purpose of Title XXI is to distribute funds to states for initiation and expansion of health care assistance to uninsured low-income families with children (NCSL, 2014). This issue is ongoing and according to the United States Census Bureau, in 2012 the statistics for family incomes were basically the same as 2011 where 46.5 million Americans were at or below the poverty line. After two years of annual declines, the rate of poverty was 15.0 percent. From 2007 to 2012 the percentage rate had increased 2.5 percent. The implementation of the ACA in 2010 resulted in the percentage of children under 18 without insurance decreasing to 8.9 percent from the 9.4 percent in 2011, a reduction of 6.6 million from the 7.0 million ("US Census Bureau," 2014). The poverty guidelines chart for 2014 indicates a family of four with an income of $23,550, in contiguous states including D.C., $29,440 in Alaska, and $27,090 in Hawaii are at the poverty levels of CHIP eligibility (WhiteHouse.gov, 2014). Evidence supports ongoing issues with uninsured children in America. The CHIP program’s existence is justifiably sound and will need both government and state’s continuous attention for modifications and funding. Legislative Committees and Responsibilities for CHIP Legislation of CHIP and committee assignments began with amending the Social Security Act to include Title XXI. The Balanced Budget Act passed in 1997 assigned appropriation to the U.S. Department of Health and Human Services (HHS) where general rules and regulations were established. State funding quantities, distributions, requirements, budget authority, general eligibility of families, the process of identifying and enrollment of candidates, outreach activities, and monitoring methods are some duties performed by this top committee (HHS, 2014). The state legislation is also inclusive of its HHS and responsible for collecting taxes to cover CHIP programs, individual rules, and regulations for effective and efficient operations. Although each state is given authority to operate their CHIP programs, general guidelines from the government level must be followed to receive federal funding to match state contributions. The local levels of the programs, such as community clinics and facilities that accept CHIP funds are subject to state rules and regulations to be compliant for operations (HHS, 2014). CHIP Implementation Process The Senate and House of Representatives meet each year to create new laws, change existing laws, and enact budgets for the state. The legislative process involves a series of regular, extraordinary or special sessions. The legislature may comprise of two houses or chambers, the Senate and the House of Representatives. Members of the House and Senate provide bills for consideration. These bills may have been “born” out of concern (rising death tolls because of drunk driving), or a member wishes to address an issue that is specific to his or her own district. Once a member introduces a bill, the legislative process begins. The legislative process involves a series of steps. 1. Introduction. The bill is introduced to the floor and the referral committee. 2. Committee Action. Committees hold three meetings. These are (1) work sessions (issues are determined and reviewed), (2) public hearings (testimony from interest groups or parties are taken), and (3) executive sessions held (the committee decides how to report the bill to the entire house). 3. Rules Committee. The Rules Committee comprises members of both parties. Members of the committee choose two or three bills that will move forward for consideration. 4. Calendars. The Rules Committee then decides which bills will be scheduled or reviewed for a second reading. Bills which may require a debate are placed on a regular calendar, and those that are not controversial are placed on a suspension calendar in the House and the consent calendar in the Senate. 5. Second Reading. It is here that amendments to the bill can be offered. 6. Third Reading. A roll call vote on the final passage of the bill is taken. If the bill passes the third reading in the second house and the second house does not amend the bill, the bill has passed legislature. 7. Once the bill has passed legislature it is considered to be “enrolled.” The bill is then signed by the Speaker of the House, the Chief Clerk of the House, the President of the Senate, the Secretary of the Senate, and then finally sent to the Governor for his or her action. 8. Governor Action. The Governor then reviews the bill, and may decide to sign it, veto part of it, or veto the entire bill. If the Governor decides to veto part or all of the bill, the legislature may vote to override the veto (Washington State Legislature, n.d). The Impact of CHIP on Communities Medicaid and CHIP provide health coverage for over 30 million low-income children, opening doors to children and their families to affordable preventive, primary, and acute health care services (Ku et. al, 2007). Since the implementation of the CHIP program, the rates of low-income underinsured children has fallen considerably. According to Ku et al. (2007), “The percentage and number of low-income children who are uninsured has fallen by more than one-third since 1997, when CHIP legislation was enacted. The growth in Medicaid and CHIP enrollment of low-income children more than offset the reduction in employer-sponsored coverage that occurred between 1997 and 2005.” Publicly insured children are more likely to have asthma, and health conditions that require regular treatment with prescription medications. Medicaid and CHIP helps to provide access to the medical care that otherwise may not have been accessible to these children. Even though there have been successes since its implementation, there are still challenges ahead such as new federal mandates, and funding. Local community efforts by local social service agencies, health departments and providers, all play a part in ensuring that low-income underinsured children are covered under CHIP. Conclusion The Children’s Health Insurance Program (CHIP) was enacted to provide underinsured children and their families with access to affordable preventive, primary, and acute health care services. Even though statistical data taken from various sources shows the plan has worked, there is still some cause for concern, as new federal mandates and funding may affect the program in the long run. Additional resources are still needed to ensure that low-income children and their families have access to health insurance coverage to help continually improve their health.

References

Florida KidCare. (2014). Retrieved from,

http://www.floridahealth.gov/AlternateSites/KidCare/

HHS.gov. (2014). Retrieved from, http://www.hhs.gov/regulations/

HIF. (2014). Retrieved from,

http://www.healthinsurancefinders.com/healthinsurance/georgia/CHIP.html

Ku et al. (2007). Retrieved from, http://www.cbpp.org/cms/index.cfm?fa=view&id=1296
Medicaid.gov. (2014). Retrieved from, http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html
NCSL. (2014). Retrieved from, http://www.ncsl.org/research/health/childrens-health-insurance-program-overview.aspx
US Census Bureau. (2014). Retrieved from, http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html
Washington State Legislature (n.d). Retrieved from, http://www.leg.wa.gov/legislature/Pages/Overview.aspx
WhiteHouse.gov. (2014). Retrieved from, http://www.direct.ed.gov/RepayCalc/poverty.html