Potential Adolescent Reproductive Health Coverage in the Children's Health Insurance Program

According to the Children's Defense Fund, more than 9 million children under the age of 19 in the U.S. have no health insurance. Nearly 90 percent of these uninsured children have at least one parent who works, but for many of these families, affordable health coverage is not offered through their employer (CDF, 2001).

Because an estimated 16 percent of uninsured children are adolescent women aged 13-18 (AGI, 2001) and approximately one out of every six teens ages 15 to 18 lacks health care coverage (CDF, Summer 2001), CHIP — the largest investment by the U.S. government in children's health care since Medicaid was created — could provide a significant funding source for family planning services for these adolescents. It is estimated that by the end of Fiscal Year (FY) 2002, the enrollment of children in CHIP will be 2.9 million (KFF, 2001). Between FY 2000 and FY 2001, enrollment of the 13-18 age group in CHIP increased 32 percent (CMS, 2002).

CHIP is the result of bipartisan efforts to improve the health of America's children by increasing their access to health insurance.

As part of the Balanced Budget Act of 1997 (P.L.105-33, 1997), Congress created CHIP (Title XXI of the Social Security Act) in an effort to provide health insurance coverage for at least half of the uninsured children in the U.S. The program targets the population of uninsured children and adolescents through age 18 in families with incomes at or below 200 percent of the federal poverty level who do not qualify for Medicaid (Deparle, 1999; CDF, 2001).

Congress has allocated more than $40 billion over the next ten years to extend coverage to children in need (KFF, 2001). However, the federal funding level for CHIP is slated to drop from $4.2 billion in fiscal year 2001 to $3 billion in fiscal year 2002, and will remain at this reduced level for three years (KFF, 2001). Funding of CHIP has also been cut at the state level. Although the federal government pays for the bulk of the program, some states have forgone accepting federal money in an effort to lower their own costs (Ornstein, 2002).

While enrollment in CHIP has increased steadily, the dip in funding, coupled with increasing expenditures, is expected to threaten the overall number of children enrolled (KFF, 2001). The estimated impact on enrollment is expected to be delayed as states use unspent funds from previous years or reallocated funds (KFF, 2001). However, some states have already implemented restrictions on CHIP coverage, such as freezing enrollments, limiting coverage for certain services, and instituting premiums and co-payments (Ornstein, 2002).

CHIP enables states to design the program best suited to their needs.

States and territories were given a great deal of flexibility in designing CHIP programs. Currently, 16 have created separate programs, 21 have expanded their existing Medicaid programs (income eligibility levels and/or age limits), and 19 are utilizing a combination of both approaches (HCFA, 2001). Under a Medicaid expansion, children and adolescents are eligible for the same benefits as other Medicaid recipients. However, states are entitled to an enhanced reimbursement rate for expenditures on these newly eligible beneficiaries (65-85 percent of costs versus 50-65 percent for regular Medicaid enrollees) (Gold, 1998). Separate state programs must either utilize one of three benchmarks for coverage (the state employees' plan, the HMO with the largest enrollment in the state, or the Blue Cross/Blue Shield plan offered to federal employees in the area), or design a benefits package that is "actuarially equivalent" to one of the benchmarks, so long as it provides "basic services" (Social Security Act, 42 U.S.C. sec. 1397cc).

Because states are allowed a large amount of flexibility in designing CHIP programs, they can include such beneficial services as prenatal care and family planning services.

Under Medicaid expansions, adolescents covered by CHIP enjoy benefits such as no cost-sharing for family planning services. Where there are separate state CHIP plans, the option to cover family planning services is left up to the states (Silberman, 1999). Overall, states provide relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted infections and pregnancy testing. Fifty-four cover the full range of the most commonly used prescription contraceptive methods, although only 43 cover emergency contraception (Gold, 2001).

Outreach is crucial for the success of CHIP because a total of 8 million children are now income-eligible for coverage through Medicaid or CHIP.

Two out of three of these 8 million children are income-eligible for Medicaid. The other children are eligible for separate CHIP programs. Attention has become more focused on outreach programs and activities. Such activities can inform families about opportunities to obtain health coverage for their children and help identify children likely to qualify for coverage and assist families in getting children enrolled (Cox, 2000).

Planned Parenthood urges health officials to advocate for the extension of adolescent reproductive health coverage in their states and actively participate in outreach efforts that can significantly enhance adolescent access to healthcare.

Additional Information

Access the official CHIP website at http://www.insurekidsnow.gov or call (toll-free) 1-877-KIDSNOW (1-887-543-7669) to be directly connected to the CHIP office in your state.

Additional program descriptions and outreach information is available from the following websites:

Children's Defense Fund
http://www.childrensdefensefund.org/chip/chip.html

Health Care Financing Administration — Children's Health Insurance Program
http://www.hcfa.gov/init/children.htm

National Governor's Association Center for Best Practices — State Children's Health Insurance Programs
http://www.nga.org/CBP/Activities/SCHIP.asp

Cited References

AGI — Alan Guttmacher Institute. (2001, accessed 2002, March 26). Expanding Eligibility and Outreach under CHI. [Online]. http://www.guttmacher.org/pubs/ib_4-01.html

CDF — Children's Defense Fund. (2001, accessed 2001, December 3). What are CHIP and Medicaid? [Online]. http://www.childrensdefense.org/hs_chipmain.php

_____. (Summer 2001, accessed 2002, January). Sign Them Up! [Online]. http://www.childrensdefense.org

CMS — Centers for Medicare & Medicaid Services. (2002, accessed 2002, February 6). The State Children's Health Insurance Program Annual Enrollment Report. [Online]. http://www.hcfa.gov/init/schip01.pdf

Cox, Laura, and Donna Cohen Ross. (April 2000). "Medicaid for Children and CHIP: Income Eligibility Guidelines and Enrollment Procedures." Center on Budget and Policy Priorities, Washington, DC.

Deparle, Nancy-Ann. (1999, accessed 1999, August 13). Testimony on the Children's Health Insurance Program before the Senate Finance Committee, April 29, 1999. [Online]. http://www.hcfa.gov/init/testm429.htm

Gold, Rachel Benson. (1998). "The New Children's Health Insurance Program." Guttmacher Report on Public Policy, 1(2), 6-9.

Gold, Rachel Benson, and Adam Sonfield. (April 2001). "Reproductive Health Services for Adolescents Under the State Children's Health Plan." Family Planning Perspectives, 33(2), 81-7.

HCFA — U.S. Health Care Financing Administration. (2001, accessed 2002, January 3). State Child Health Insurance Program Plan Activity Map. [Online]. http://www.hcfa.gov/init/chip-map.htm

_____. (2002, February 6, accessed 2002, March 26). SCIP Press Release. [Online]. http://www.hcfa.gov/init/20020206.htm

Kaiser Family Foundation. (2001, October 1, accessed 2002). Trends in CHIP Expenditures: State by State Data. [Online]. http://www.kff.org.

Ornstein, Charles. (2002, February 25). "States Cut Back Coverage for Poor Health." Los Angeles Times, A-1.

PL 33, 105th Cong., 1st sess. (August 5, 1997). Balanced Budget Act of 1997.

Silberman, Dayna, et al. (1999). CHIP and Adolescent Reproductive Health. Washington, DC: American College of Nurse-Midwives and Advocates for Youth.

Social Security Act. Vol. 42 U.S. Code. sec. 1397aa-jj. (1998).

Published: 04.01.02 | Updated: 04.01.02

Published by the Katharine Dexter McCormick Library

©2004 Planned Parenthood^® Federation of America, Inc.
All rights reserved.


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