A larger discussion is looming about the role of CHIP in the age of Obamacare, but for now — in Pennsylvania — the federal government is letting certain low-income kids continue their health coverage through the Children’s Health Insurance Program.
Starting in this year, a new group of children became eligible to get their health care through Medicaid, under the Affordable Care Act. The law added kids in families earning 100 percent to 133 percent of the poverty level — $23,850 for a family of four.
This week’s decision from the Obama Administration means families don’t have to make the switch until 2015 unless they want to. Gov. Tom Corbett’s team argued that CHIP is very popular and offers families a wider network of doctors, compared with Medicaid.
The new policy affects 30,000 to 40,000 children, according to the state Department of Insurance.
Corbett has said families should be able to decide which plan — CHIP or Medicaid — is best for them. A string of hospitals and health groups across Pennsylvania supported the governor’s bid.
“I see this as a win for children and families,” said pediatrician David Rubin, co-director of The Policy Lab at the Children’s Hospital of Philadelphia.
Children’s Hospital’s CEO was among the institutional leaders who wrote a letter on Corbett’s behalf.
As states have tightened their belts, Medicaid payments to doctors and hospitals have shrunk — along with the number of providers who say they will accept Medicaid insurance.
“There are fewer and fewer choices, particularly for specialty services when a child has a special need,” Rubin said. “It’s harder to get into an office and see someone.”
“Making the reflexive decision that kids will do better in Medicaid, I don’t think is backed up by the data,” he said.
Rubin, who offered his opinions in a recent blog post, said it’s not clear how the shrinking number of Medicaid provider has affected children’s overall care.
Insurance Commissioner Michael Consedine said families will receive letters soon with details on their options as well as information on the differences between Medicaid and CHIP benefits.
So which plan is better?
“For a healthier child, CHIP offers good preventive care, it may be equally good,” Consedine said.
For parents of a child with a serious health problem, the decision may be easy, said Colleen McCauley, health policy director at Public Citizens for Children and Youth.
“CHIP is a very good program, it has very good benefits. Medicaid has better,” McCauley said. “Under Medicaid, children are entitled to all necessary medical services. If their primary care provider — their doctor, their nurse practitioner — prescribes a treatment, the child gets it.”
Pennsylvania’s CHIP benefit package has been hailed as “pretty comprehensive” by all sides and includes vision, dental and mental health care coverage similar to private industry plans. It also requires parents to shoulder some of the costs of care through co-payments, similar to private plans.
“It’s about benefits. Children should have access to the full benefits that they are entitled to,” McCauley said. “Since the governor has made this choice to not automatically shift all these kids over, we think he and his staff should use this time, this year, to build a larger network of Medicaid health care providers in the suburbs.”
Rubin said he and others who want to reduce health care disparities for low-income children are worried that Medicaid coverage carries a stigma that sometimes translates to poorer care.
“I think there is something liberating about saying you can’t look at an insurance plan and tell whether a kid is publicly insured versus commercially insured,” Rubin said. “That’s a value that’s hard to measure in terms of dignity and respect.”
Consedine said his team will track the churn.
“It will be quite telling if they make the choice to stay on CHIP,” Consedine said. “Even in this new world of the Affordable Care Act, we still look at CHIP as safety valve for families.”
Current federal law offers funding for the CHIP program through October 2015. Pundits expect the debate on the program’s future will heat up later this year.