The Children’s Health Insurance Program (CHIP) was established under the Balanced Budget Act of 1997, and most recently extended through federal fiscal year 2027 under the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act (HEALTHY KIDS Act) and the Advancing Chronic Care, Extenders and Social Services Act (ACCESS Act). CHIP is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage.
Under the Federal Law, states are provided with the option to cover targeted low-income children and targeted low-income pregnant women under a separate CHIP. Guidelines indicate that in order to be eligible for CHIP, a child must meet the following:
- Under 19 years of age;
- Uninsured (determined ineligible for Medicaid, and not covered through a group health plan or creditable health insurance);
- A citizen or meet immigration requirements;
- A resident of the state; and
- Eligible within the state’s CHIP income range, based on family income, and any other state specified rules in the CHIP state plan.
Based on the above parameters, the following are deemed not eligible for the CHIP coverage:
- Inmates of a public institution;
- Patients in an institution for mental diseases; and
- Children who are eligible for health benefits coverage under a State health benefits plan due to a family member’s employment with a public agency (unless a state qualifies for either the maintenance of agency contribution, or hardship exception described below).
An amendment to the law, the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), requires that employers issue an annual notice requirement that offers group health plan coverage within states providing premium assistance subsidies under a Medicaid plan or a Children’s Health Insurance Plan (CHIP). An employer can choose to provide the notice on its own or concurrent with the furnishing of:
- Materials notifying the employee of health plan eligibility;
- Materials provided to the employee in connection with an open season or election process conducted under the plan; or
- The summary plan description (SPD).
On July 31, 2020, the Department of Labor revised the required model notice that employers are to use for such notification. Employers should be sure to update their files with the revised notice.
Contact your Cowden representative for more information on this or other compliance issues.