Group: Health & Human Services - Department of Health

Agency: Health

Line Item: Children's Health Insurance Program

Function

The 1998 Legislature passed House Bill 137, which established the Children's Health Insurance Program (CHIP) for the State. This program provides health insurance coverage to uninsured children up to age 19 living in families whose income is less than 200 percent of the Federal Poverty Levels. Additionally, eligible children must: (1) not be currently covered by health insurance, (2) not have voluntarily terminated private health insurance within the last 90 days, and (3) be U.S. citizens or legal residents. There is no asset test for CHIP eligibility. For more information please visit http://health.utah.gov/chip/howtoapply.htm.

In November 2006, Utah's Premium Partnership for Health Insurance (UPP) was created to enable families to take CHIP funds as a voucher to purchase their employer's health care coverage. Children on UPP are funded through this line item. Adults on UPP are funded through the Medical Optional Services line item.

During the 1998 Legislative session, the Legislature passed House Bill 137 which established the Children's Health Insurance Program for Utah.

The major portion of the funding for CHIP comes from federal funds. The authorized level of federal funds is tied to the State's Medicaid rate, but at an enriched level. Because the State of Utah has a relatively high Medicaid rate, the CHIP services match rate is also fairly high.

The benefit package for CHIP is based on the benefit package for public employees, but emphasizes prevention. Well-child exams and immunizations are covered at 100 percent. Some services require cost sharing, which varies depending on a family's income level. HB 218 from the 2007 Legislative Session mandated that CHIP cost sharing be changed on July 2008 to make it actuarially equivalent to the cost sharing in private health plans. This change increased co-payments, co-insurance, and deductibles for families. Because of federal limitations on cost sharing for the lowest income families (Plans A & B), the greatest impact of the change was on families with incomes from 151 to 200 percent FPL. Their deductible increased from $250 to $500 per child and many coinsurances increased from 10 percent to 20 percent.

Statutory Authority

The Children's Health Insurance Program is governed by the Utah Health Code in Title 26 of the Utah Code.

• UCA 26-40 details the eligibility qualifications, minimum program benefits, and the funding mechanism for the program.

Funding Detail