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Kids and Health Care: The Various State Programs

The details of how various states run their CHIP programs can be instructive about how these benefits work, generally.

California's program, called Healthy Families, is a program separate from traditional Medicaid (which itself is called Medi-Cal in California). It offers medical coverage to children from birth to 19 years old.

For a child to be eligible for Healthy Families, at least one parent must be working and household income must be between $11,000 and $21,000 a year for a family of two or $32,000 a year for a family of four. Households with incomes below this range are eligible for Medi-Cal.

Parents don't have to work to qualify for Healthy Families; a family can get income from sources other than employment -- such as alimony, unemployment or interest income. These types of income can keep a child off Medi-Cal.

However, children must not have been covered by an employer-sponsored plan for the three months prior to the time of application, and must be either legal immigrants or U.S. citizens.

Healthy Families benefits are essentially the same as those given to state employees -- and include medical, dental and vision care. To enroll a child in Healthy Families, parents or guardians must complete an application that includes personal financial information; once eligibility is determined, the family receives a letter asking it to choose from a list of certified health plans. The child's name is then forwarded to the chosen health plan. Monthly premiums range from $4 to $9 per child, depending on family income and the plan selected.

Families can get applications and assistance through the county Social Services offices or designated community centers, such as Head Start programs, public health clinics and other certified agencies.

Some child-welfare advocacy groups in California complain that Healthy Families doesn't do enough. They point to state estimates of 1.8 million uninsured children and sneer at fewer than 200,000 kids enrolled in the program (as of early 2004). The advocacy groups say that numerous problems -- including an application that's long and complicated, insufficient outreach efforts and fears of illegal immigrant parents about enrolling their eligible children -- keep the numbers down. But, most emphatically, the groups complain that Healthy Families should include more families -- including those with household income of up to 300 percent of the FPL.

State administrators counter that 300 percent of the FPL is a household income of nearly $56,550 for a family of four. It's hard to characterize such a family as "poor."

The advocacy groups counter by pointing to New Jersey's KidCare Program (its combined Medicaid and CHIP) that is available to children in families with incomes up to 350 percent of the FPL.

Arizona's CHIP program, called KidsCare, is separate of its Medicaid program. But the state administers both its CHIP and Medicaid programs through a managed care system, the Arizona Health Care Cost Containment System (AHCCCS).

In Massachusetts, the state combines its CHIP and Medicaid programs into one entity called MassHealth, which is run through the Massachusetts Division of Medical Assistance (DMA). MassHealth operates a managed care plan with participating MDs and hospitals throughout the state.

From an administrative perspective, there is some distinction within MassHealth between standard Medicaid recipients and CHIP families; ordinary Medicaid recipients are administered by one department (MassHealth Standard) and CHIP applicants and enrollees by another (MassHealth Family Assistance). Because the CHIP law allows somewhat more flexible rules, its administrators can respond accordingly.

MassHealth is aggressive about reaching as many potential members as it can. It has enrollment centers in hard-to-reach communities and organizes outreach campaigns to homeless and immigrant populations. It focuses its application assistance efforts during evenings and weekends, so that working parents can more easily seek out the help.

MassHealth -- like CHIPs in a number of states with combination programs -- extends important Medicaid protections to CHIP families. Most importantly, it provides for presumptive eligibility, which means that applicants are treated as though they're eligible for CHIP coverage once they apply for the program. (CHIPs in Michigan, New York and New Jersey do the same.)

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