What Was the Impact of States Expanding Eligibility to CHIP?

Evaluating State Health Reforms that Provide Expanded Health Insurance Coverage to Children in Illinois, Pennsylvania, and Washington

Field of Work: Evaluating state expansion of the Children's Health Insurance Program (CHIP).

Problem Synopsis: Before 2006, children of families with incomes above 200 percent of the federal poverty level were not eligible for CHIP. The high cost of private health insurance meant that children in these families often went uninsured.

Synopsis of the Work: Illinois, Pennsylvania, and Washington were among the first states to expand CHIP to children of families who exceeded that income guideline. From 2008 through 2010, researchers at the University of California-Los Angeles and the RAND Corp. evaluated the impact of these eligibility expansions on the coverage and affordability of health insurance for children and families.

The researchers specifically evaluated how states determined how much families had to pay for CHIP coverage, and the percentage of their incomes these payments represented.

Key Findings: Findings were published in an article and issue brief:

  • Although affordability was a key factor in states' decisions regarding premiums for CHIP, officials also considered historical precedent, fiscal viability, premiums paid by public-sector employees, and simplicity. Officials also tried to avoid "crowd-out" of private insurance coverage.
  • The percentage of their incomes families paid for CHIP coverage under the expanded programs varied substantially across the three states.
  • For families earning less than 400 percent of the federal poverty level, family coverage through an exchange—created under the federal Affordable Care Act—is likely to be more affordable than a combination of CHIP and private insurance.
  • Evidence that the states' efforts reduced the number of uninsured children was somewhat ambiguous.

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