Funding for the Children's Health Insurance Program (CHIP) is set to expire Sept. 30. If that happens, states will need to screen children no longer covered by CHIP for Medicaid eligibility. Those found ineligible for Medicaid may be enrolled in an Affordable Care Act qualified health plan (QHP) that compares to CHIP.
To see just how CHIP plans compare to QHPs, the Government Accountability Office (GAO) examined data from five states. The report reviewed coverage and costs to consumers for one CHIP plan and one QHP in Colorado, Illinois, Kansas, New York and Utah. For the most part, CHIP serves consumers better than QHPs, GAO found. Here are two reasons why.
CHIP plans cover more value-added services
While most plans were comparable, GAO did find exceptions during their review. For instance, certain enabling services, care coordination or case management were offered by all selected CHIP plans but by only one selected QHP. Routine transportation to and from medical appointments was covered by two CHIP plans but none of the selected QHPs. The QHP in New York was the only selected QHP that covered pediatric dental services.
Additionally, the CHIP plans and QHPs examined typically did not place day, visit or dollar limits on office visits, emergency care or prescription drugs. One notable difference between these selected CHIP plans and QHPs, though, was the frequency by which they limited home-and community based healthcare.
CHIP plans cost consumers less
The GAO found that costs to consumers were almost always less in the selected CHIP plans than in the selected QHPs. In four of the five states, CHIP plans did not include any deductible--consumers in those states were not required to pay a specified amount before the plan began paying for services. On the flip side, the selected QHPs required annual deductibles--some as high as $500 for an individual and $1,500 for a family.
What's more, premiums were found always to be less in the CHIP plans than in the QHPs. The GAO concluded that all selected CHIP plans and QHPs limited the total potential costs to consumers by imposing out-of-pocket maximum costs--however, these costs were usually less in the CHIP plans.
The GAO findings support the argument of CHIP advocates who say that the program deserves long-term stability and not the two-year fix that the House proposed in March.
- here's the report (.pdf)