Pennsylvania’s Children’s Health Insurance Program now has better benefits for some children in the state. For those families with the highest income – 300 percent of the poverty level — who pay the full cost, CHIP coverage now meets the minimum standards required under the Affordable Care Act.
Before the upgrade, those families faced a tax penalty if they kept their CHIP coverage instead of purchasing coverage in the health insurance marketplace.
The full-cost CHIP program provided some essential services but did not meet the level required by the ACA, said Ron Ruman, spokesman for the state insurance department.
“Some of those preventive care services may have been there, but there may have been a co-payment required, now there’s no co-payment. Some of the essential coverages had limits that are now gone,” said Ruman.
“And many of the plans certainly had mental health and substance abuse coverage, but in some cases it wasn’t on the same level as the medical and surgical benefits.”
The expanded benefits apply only to the 3,600 families covered under the full-cost CHIP plans. Families eligible for federal assistance under CHIP will not receive these additional services because the subsidized plans already qualified as minimal essential coverage.
But the new two-tiered system has caused some backlash.
“We now have two different benefit packages for children who are in CHIP. So if a kid’s family makes more money, your child gets more benefits. If your family makes less money, you get less benefits,” said Colleen McCauley, policy director for Public Citizens for Children and Youth.
State officials say all CHIP plans — whether paid for privately or through the U.S. — now meet the ACA’s minimum essential coverage requirements.
McCauley wants to see the state exceed those minimum requirements and increase benefits to all of the state’s 150,000 CHIP recipients.