FY 2016 Appropriation

The Children's Health Insurance Program (CHIP) provides health insurance coverage to uninsured children up to age 19 living in families whose income is between 139 and 200 percent of the Federal Poverty Level (FPL). Additionally, eligible children must: (1) not have access to affordable 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.

Funding History

Funding Issues

New Federal Surplus Property Resale Program

New federal surplus resale program where state agencies can receive dedicated credits from the sale of property/equipment.
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $79,360,700 from all sources for Children's Health Insurance Program. This is a 4.3 percent reduction from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $1,579,200 from the General/Education Funds, a reduction of 76.4 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time CHIP Caseload Growth ($3,369,400) ($12,108,000)
OngoingOne-TimeFinancing Source
($700,000)$0General Fund
$0 ($2,500,000)General Fund, One-time
($2,669,400) ($9,608,000)Federal Funds
The consensus team estimates an average monthly enrollment of 15,700 for FY 2015. This is lower caseloads than prior forecasts. For FY 2016 the forecast projects enrollment growth of 1.4% or 200 Inflation increases - the Department contracts with two managed care organizations to provide all CHIP medical services. These contracts traditionally have annual increases. For FY 2014 these increases were 0% for one contractor and 9.1% for another contractor. The increase was primarily due to unusually high inpatient mental health expenditures. The forecast has increases in per member per month costs of 1.5% for FY 2015 and 3.0% for FY 2016. Nonlapsing balance - CHIP starts FY 2015 with a $1.4 million in nonlapsing balances which reduces the need for General Fund. The money comes from unspent funds in FY 2014.
Dedicated Credits Increase$100$0
OngoingOne-TimeFinancing Source
$100$0Dedicated Credits Revenue
(1) An increase of $802,200 in dedicated credits in FY 2016 in the Department of Health's Executive Director's Operations line item for $383,700 for potential sales from five new products from the All Payer Claims Database, $250,000 for contract for implementing the Master Person Index, and $168,500 for increased fees in vital records to offset declines in fee quantities. (2) An increase of $10,002,000 in dedicated credits in FY 2016 in the Department of Health's Medicaid Mandatory Services line item which is just a shift from the Medicaid Optional Services line item, but no overall increases for dedicated credits in Medicaid services. (3) $27,500 in ongoing dedicated credits beginning in FY 2016 for the Department of Health for a new federal surplus resale program where state agencies can receive dedicated credits from the sale of property/equipment. (4) For the Department of Health's Disease and Prevention Control line item as dedicated credits - Health: "Grant from the Association of Public Health Laboratories for $148,100. The purpose of this proposal is to establish molecular testing (Severe Combined Immunodeficiency) within the Utah Public Health Laboratory. Through this mechanism we explore and implement a cross-testing section process to advance Newborn Screening and the Infectious Disease group. The grant finances research and development work to implement a mandated test. All future cost will be covered completely through revenue generated through test fees."
Federal Funds Adjustments$0$8,153,400
OngoingOne-TimeFinancing Source
$0$8,153,400Federal Funds
Annual adjustments of federal funds based on agency submission of grant changes.
Medicaid Caseload Growth$0$2,800,000
OngoingOne-TimeFinancing Source
$0$2,800,000General Fund, One-time
The following areas create costs for the state in Medicaid in FY 2016: (1) estimated increase of 1,900 or 1% clients in FY 2016, (2) $3.9 million for a 2% projected increase in accountable care organization contracts starting in January 2016, (3) $3.0 million for a new federal regulation to provide autism spectrum disorder-related services when medically necessary up to age 21, and (4) $3.1 million for cost increases over which the state has no control due to federal regulation or has opted not to exercise more state control. FY 2014 ended and FY 2015 will likely end under budget which reduces the baseline costs for FY 2016. How Measure Success? HEDIS measures (https://health.utah.gov/myhealthcare/reports/hedis) for access to care and how much appropriate care was received.
Staff Analysis

CHIP Performance Measures

As of June 2014 CHIP had 15,600 clients in one of two health plans. Select Health had 60% of clients and Molina had 40% of clients on a full-risk contract. Below are some performance measures from client surveys of FY 2013 CHIP providers as compared to national averages. The full reports can be found at http://health.utah.gov/myhealthcare/report/cahps/2013/. The three charts where clients rated their service are explained by the report with: "The…survey asked members to rate different characteristics of their health plan on a scale of 0 ("worst plan possible") to 10 ("best plan possible"). The charts below show the percentage of members who gave their plan a score of 8, 9, or 10."

Rate Health Plan an 8 to 10

Rate Specialists an 8 to 10

Rate Personal Doctor an 8 to 10

Usually/Always Got Care Quickly

Usually/Always Got Needed Care

Both Select Health and Molina ranked higher than the U.S. average for four of the five measures. Molina ranked higher than Select Health in three of the five measures.

CHIP FY 2014 Expenditure and Enrollment Overview

In FY 2014, the average monthly cost per CHIP child was $150. The average monthly cost for CHIP kids now enrolled in Medicaid was $183 (changes mandated by the federal Affordable Care Act). Approximately 72 percent of CHIP children live in Davis, Salt Lake, Weber, and Utah counties. Approximately 57 percent of children eligible for CHIP became eligible for Medicaid in 2014.

Caseloads in Utah's Premium Partnership for Health Insurance

Caseloads for Utah's Premium Partnership for Health Insurance went from 275 children in FY 2013 to 282 children in FY 2014, an increase of 3%. The program has ongoing efforts to encourage people to apply for the program. This program pays monthly up to $120 per child to pay the premiums of qualifying employee-sponsored health insurance. Additionally, another $20 per month per child can be obtained for employee-sponsored dental coverage. About 80% of participating children receive both subsidies. Children who qualify can live in families that make up to 200% of the Federal Poverty Level (a little under $4,000 monthly for a family of 4 in 2014).

In FY 2014 CHIP spent $0.09 of every $1 on administration for the costs of the Departments of Health and Workforce Services. Premiums, shown as dedicated credit revenue, covered about 2% of the program's costs.

Percentage of Children (5 - 11 Years Of Age) With Persistent Asthma who Were Appropriately Prescribed Medication

Percentage of Children (5 - 11 Years Of Age) With Persistent Asthma who Were Appropriately Prescribed Medication

Percentage of Children (Less Than 15 Months Old) That Received at Least Six or More Well-child Visits

Percentage of Children (Less Than 15 Months Old) That Received at Least Six or More Well-child Visits

Percentage of Members (12 - 21 Years of Age) Who Had at Least One Comprehensive Well-care Visit

Percentage of Members (12 - 21 Years of Age) Who Had at Least One Comprehensive Well-care Visit

Statute

The Utah Health Code in Title 26 of the Utah Code governs the Children's Health Insurance Program.

  • UCA 26-40 details the eligibility qualifications, minimum program benefits, and the funding mechanism for the program.
  • UCA 26-40-103 directs the Department of Health to enroll all Children's Health Insurance Program beneficiaries in the electronic exchange of clinical health records unless the individual opts out.

Related Links

For more information on cost sharing please visit: http://health.utah.gov/chip/Adobe%20PDF%20Files/Copaysummary.pdf.

For more information on application criteria please visit: http://health.utah.gov/chip/howtoapply.htm.

Utah's Premium Partnership for Health Insurance (UPP) allows families to receive a partial reimbursement of their health insurance premium using CHIP funds if enrolled in their employer's health care coverage or in COBRA continuation coverage. This line item has the funding for children on UPP. UPP pays monthly up to $120 per child to pay the premiums of qualifying employee-sponsored health insurance and up to $20 monthly for qualifying employee-sponsored dental insurance. Children that do not have access to affordable employee-sponsored dental insurance may enroll in CHIP dental coverage. Children who qualify can live in families that make up to 200% of the Federal Poverty Level. The Medical Optional Services line item has the funding for adults on UPP.

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 as compared to the national average. CHIP clients receive services from one of two managed care plans operating under fully risk-based, capitated contracts.

The benefit package for CHIP emphasizes prevention and is based on the benefit package offered by the health maintenance organization in the State with the largest commercial enrollment. There is no cost to clients for well-child exams and immunizations. Some services require cost sharing, which varies depending on a family's income level. Cost sharing by clients is actuarially equivalent to the cost sharing in private health plans for families with incomes from 151 to 200 percent FPL, but may not exceed 5 percent of the household's gross income in any given year. CHIP provides two cost sharing plans based on income: Plan B between 139% and 150% of FPL and Plan C between 151% and 200% of FPL. The federal government places additional limits on cost sharing for the families on Plans B.

Intent Language

SB0007S01: Item 4

The Legislature intends that the Department of Health report on the following performance measures for the Children's Health Insurance Program line item: (1) percentage of children (less than 15 months old) that received at least six or more well-child visits (Target = 52% or more), (2) percentage of members (12 - 21 years of age) who had at least one comprehensive well-care visit (Target = 39% or more), and (3) percentage of children 5-11 years of age with persistent asthma who were appropriately prescribed medication (Target = 94% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.


SB0007S01: Item 16

The Legislature intends that the Department of Health report on the following performance measures for the Children's Health Insurance Program line item: (1) percentage of children (less than 15 months old) that received at least six or more well-child visits (Target = 52% or more), (2) percentage of members (12 - 21 years of age) who had at least one comprehensive well-care visit (Target = 39% or more), and (3) percentage of children 5-11 years of age with persistent asthma who were appropriately prescribed medication (Target = 94% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.


For analysis of current budget requests and discussion of issues related to this budget click here.

The monthly caseload is the number of children served by the Children's Health Insurance Program.

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COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.