Children’s health coverage expands to state workers

November 6, 2011

At least six states have opened their Children’s Health Insurance Program to the kids of low-income state employees, an option that was prohibited until the passage of the 2010 health-care law.

This relatively small step has as its backdrop years of debate over the program, known as CHIP, including concerns that it encourages states — and consumers — to replace private insurance with taxpayer-subsidized coverage.

Now, as a result of the policy change, families of lower-income state workers who have struggled to pay for family coverage can qualify for the program. CHIP, which is jointly financed by the states and the federal government, provides coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.

The federal government had closed that option to most states when CHIP was established in 1997, because of concerns that it might be an easy way for financially strapped states to shift the costs of some public-employee health benefits to the federal government. Federal employees were allowed to enroll their children.

“State employees shouldn’t be the only people in the country who cannot access the program,” said Steven Kreisberg, director of collective bargaining and health-care policy at the American Federation of State, County and Municipal Employees. In an era of frozen wages, pay cuts and furloughs for state employees, the ability to participate in CHIP is critical for families, he said.

States must show that they have not cut their share of employee health insurance costs in an effort to push their workers’ children to CHIP and that the cost of the coverage available to employees is a financial hardship for families.

Tricia Brooks, a senior fellow at the Georgetown University Center for Children and Families, said the federal matching funds that will flow to the states are a plus but are not the primary reason states pursued the policy change.

“I think the intent was much more motivated by the fact that there were children who were being discriminated against,” she said.

Georgia, which is awaiting final federal approval for the program, is the latest state to offer its lower-income workers the CHIP option — known as PeachCare for Kids. The Centers for Medicare and Medicaid Services has given the nod to plans in Alabama, Kentucky, Montana, Pennsylvania and Texas.

Georgia’s open enrollment period began last month, and officials expect 42,000 children to switch to PeachCare, for a total state savings of $32 million in fiscal 2012. That would give Georgia, out of the six states, the highest number of state employees’ children enrolled in CHIP.

Leigha Basini, a program manager at the National Academy for State Health Policy who works with state CHIP directors, said states are enthusiastic about the option because of the potential savings and the chance to expand coverage to more kids.

“It potentially is a win-win for the states and the employees,” she said.

In each state, the number of employees eligible for the coverage will be affected by the income ceiling the state sets — in Georgia, it is $52,500 for a family of four — and how much workers are paid.

And employees’ opinions about the quality of their state-based coverage and CHIP will affect decisions about switching programs.

A spokeswoman for Georgia’s Department of Community Health said the state expects that the new option will benefit state employees through lower out-of-pocket costs, although the exact savings will depend on factors such as the private plan in which the child was enrolled, family income and the child’s age.

Meanwhile, for some states, new cost-sharing requirements for the qualifying state employees sometimes go along with the CHIP change.

Diane Joiner, a single mother who works for Alabama’s health department, enrolled her teenage daughter in All Kids, Alabama’s version of CHIP, when a state-subsidized CHIP look-alike program was canceled because the state prohibition was lifted. (A number of states had such plans in place to aid low-income state employees when they weren’t allowed to participate in CHIP.)

Joiner said she is pleased with the coverage but points out that she now pays a $100 annual premium. Although that amount is more than she paid in the state-subsidized program, it is much less than she would have to pay in regular coverage premiums.

Otherwise, her benefits and copays are the same. “My daughter’s got to be covered, and I can’t afford [the state plan],” she said.

And some state officials say the change is making a real difference for children and families.

Katherine Buckley-Patton, who directs the Healthy Montana Kids program, said some low-income state employees have been struggling to keep their families insured or may not be able to afford coverage for their children. Allowing them to move to CHIP has relieved that pressure and helped to keep some at-risk kids covered.

Here’s how the policy change is playing out in the other states:

● Montana has enrolled 513 children of state employees in its CHIP program in the past year. State officials expect that number to increase as the state does aggressive outreach efforts. Buckley-Patton noted that some employees had questioned why they were excluded when federal workers were not. “The door has been closed on them a number of times in the past,” she said.

● Texas expects to save $16 million over two years, according to a spokeswoman. The state’s CHIP spending is $340 million this year.

● In Kentucky, which had used state dollars to cover its workers’ CHIP-eligible children, the change has saved the state $2 million.

● Pennsylvania officials expect part-time and seasonal workers to be among the beneficiaries of the state’s policy change. They estimate that fewer than 1 percent of state employees qualify for the program.

— Kaiser Health News

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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