State Children's Insurance Program (93.767)

Program

93.767 State Children's Insurance Program

Federal Agency

Agency: Department of Health and Human Services
Office: Centers For Medicare And Medicaid Services

Authorization

Children's Health Insurance Program Reauthorization Act of 2009.

Program Number

93.767

Last Known Status

Active

Objectives

To provide funds to States to enable them to maintain and expand child health assistance to uninsured, low-income children, and at a state option, low-income pregnant women and legal immigrants, primarily by three methods: (1) obtain health insurance coverage that meets the requirements in Section 2103 relating to the amount, duration, and scope of benefits; (2) expand eligibility for children under the State's Medicaid program; or 3) a combination of the two.

Types of Assistance

FORMULA GRANTS

Uses and Use Restrictions

No State is eligible for payments for child health assistance for coverage provided prior to October 1, 1997. Standards used to determine eligibility may include those related to geographic areas to be served by the plan. Age, income and resources, residency, disability status (as long as the standard does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility are factors. Standards may not discriminate on the basis of diagnosis. Eligibility standards must not cover higher-income children without covering lower-income children, and must not deny eligibility based on a child having a preexisting medical condition. The State must ensure that only targeted low-income children are furnished child health assistance under the plan. Children found through screening to be eligible for Medicaid are to be enrolled in Medicaid. The insurance provided under the State plan does not substitute for coverage under group health plans. Coordination with other public and private programs providing creditable coverage for low-income children should occur. Child Health Assistance (other than Medicaid), must consist of any of the following: Benchmark coverage; benchmark equivalent coverage (which can be FEHBP-equivalent coverage); State employee coverage or coverage offered through the HMO with the largest insured commercial non-Medicaid enrollment in the State; existing comprehensive State-based coverage; or Secretary-approved coverage. A State child health plan must include a description of the amount (if any) of cost-sharing and must be in accordance with a public schedule. Cost-sharing may be varied in a way that does not favor higher-income children over lower-income children. No cost-sharing is permitted for well-baby and well-child care, including age-appropriate immunizations. Cost-sharing for children at 150 percent of poverty must be consistent with Medicaid; Cost-sharing for children at 150 percent of poverty and above must be based on an income-related sliding scale.

The aggregate for all children in a family cannot exceed 5 percent of the family's income. The State child health plan may not impose pre-existing condition exclusions for covered benefits. States that provide for benefits through a group health plan or group health insurance coverage may permit pre-existing condition exclusions as allowed under the applicable Section of the Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). Funds provided to a State under this Title may only be used to carry out the purposes of this Title. Health insurance coverage provided may include coverage of abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. States may spend up to 10 percent of their total CHIP expenditures (Federal and State) on non-benefit activities, including: outreach conducted to identify and enroll eligible children in CHIP; administration costs; health services initiatives; and other child health assistance. These expenditures are matched at the enhanced CHIP matching rate and counted against both the 10 percent limit and the allotment. Monetary amounts provided by the Federal government or services assisted or subsidized to any significant extent by the Federal government, may not be included in determining the amount of nonfederal contributions required for State matching purposes.

Eligibility Requirements

Applicant Eligibility

All States and Territories may apply.

Beneficiary Eligibility

Targeted low-income children will benefit. These children are defined (for the purposes of Title XXI) as children who have been determined eligible by the State for child health assistance under their State plan; are low-income children; or are children whose family income exceeds the Medicaid applicable income level but does not exceed 50 percentage points above the Medicaid applicable income level; and are not found to be eligible for medical assistance under Title XIX or covered under a group health plan or under health insurance coverage. This term does not include a child that is a member of a family that is eligible for health benefits coverage under a State health benefits plan on the basis of a family member's employment with a public agency in the State.

Credentials/Documentation

States and Territories must submit and have approved by the Secretary of DHHS, a State Child Health Plan. Individuals must meet State requirements. OMB Circular No. A-87 applies to this program.

Application and Award Process

Preapplication Coordination

Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Title XXI plans and amendments are submitted by the State Governor, or designee, to the CMS Center for Medicaid and State Operations; Families and Children Health Program Group (CMSO/FCHPG). The Title XXI plan should be a stand alone document that fully addresses each relevant Section of the statutory requirements.

Award Procedure

The CMS Administrator exercises delegated authority to approve Title XXI plans and amendments. Letters of approval will be signed by the CMS Administrator.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time

Section 2106 of the Law, specifies that a State plan is considered approved unless the Secretary notifies the State in writing, within 90 days after receipt of the plan, that the plan is disapproved (and the reasons for disapproval) or that specific additional information is needed. Informal clarification and discussion between the State and the DHHS review team is permitted and encouraged during the review period. This does not stop the "90-day clock." The 90-day review period may be stopped by formal written requests for additional information and clarification. The 90-day review period may be stopped as many times as necessary to obtain completed information necessary to disapprove or approve the plan. The 90-day period will resume when the finalized additional information is received by CMS.

Appeals

If a State wishes to appeal a disapproval, it may petition for a reconsideration of this decision within 60 days after the date of receipt of the disapproval letter, by submitting a written request for reconsideration to the project officer and the regional office. States also have the option to submit a new application following the disapproval, starting a new 90-day review clock.

Renewals

An approved State child health plan shall continue in effect unless the State amends that plan or the Secretary finds substantial noncompliance of the plan in accordance with the requirements of Title XXI.

Assistance Considerations

Formula and Matching Requirements

Statutory Formula:

Matching Requirements: Section 2105(b), Title XXI, provides for an "enhanced Federal Matching Assistance Percentage (FMAP)" for child health assistance provided under Title XXI that is equal to the current FMAP for the fiscal year in the Medicaid Title XIX program, increased by 30 percent of the difference between 100 and the current FMAP for that fiscal year. The enhanced FMAP may not exceed 85 percent. CHIPRA implemented a limitation on matching rates for states that propose to cover children with effective family income that exceeds 300 percent of the poverty line to FMAP rather than EMAP, unless a waiver or State Plan Amendment or state law was in place to cover this population before the enactment of CHIPRA. The formula for determining the final allotment includes: determining the number of States with approved State Plans as the end of the fiscal year. In order for a State to receive a final allotment for a fiscal year, CMS must approve the CHIP State Plan for that State by the end of the fiscal year. Only States with approved State Plans by the end of the fiscal year will be included in the final allotment calculation. The Children�s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) was enacted on February 4, 2009 and provided appropriations through FY 2013.

The States' FY 2009 final allotments are calculated as 110 percent of the highest of the following three amounts:

� Total Federal payments under title XXI to the State for FY 2008, multiplied by an �allotment increase factor� for FY 2009;
� FY 2008 CHIP allotment multiplied by the �allotment increase factor� for FY 2009; or
� The projected Federal payments under title XXI for FY& 2009 as determined on the basis of the February 2009 estimates submitted and certified by the States no later than March 31, 2009.

The State� FY 2010 allotment will be calculated as the sum of the following four amounts, multiplied by the applicable growth factor for the year.

--the FY 2009 CHIP allotments;
--FY 2006 unspent allotments redistributed to and spent by shortfall states in FY 2009;
--spending of funds provided to shortfall sates in the first half of FY2009; and
--spending of Contingency Fund payments in FY2009, although there may be none.

For FY 2011 and FY 2013 the allotments will be rebased , on prior year spending. This will be done by multiplying the states growth factor for the year by the new base, which will be the prior year�s federal CHIP spending. For FY 2012, the allotment for a state will be calculated as the FY 2011 allotment and any FY 2011 contingency fund spending, multiplied by the states growth factor for the year. The amount of the state allotment for previous fiscal year and the amount of any payments made to the State under subsection (k), (l), or (n) for the previous fiscal year multiplied by the �allotment increase factor� for the current year.

This program has MOE requirements, see funding agency for further details.

Length and Time Phasing of Assistance

Enrolled children receive medical services as necessary. Federal funds are obligated to the States by issuing Title XXI grant awards. To ensure that all of the appropriated funds are available to States, CMS will issue grant awards to all States with Title XXI State plans approved by the end of the fiscal year equaling the national amount available for allotment to the 50 States, the District of Columbia, and the Commonwealths and Territories for that fiscal year. Grant awards must be issued by the time the CMS/HHS accounting system closes with respect to that fiscal year. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements

Reports

No program reports are required. No cash reports are required. Section 2108 of the Law specifies that States must develop annual reports assessing the operation of their State Plan for each fiscal year, including the progress made in reducing the number of uncovered low-income children and report to the Secretary by January 1, of the following year the results of the assessment. By March 31, 2000, each State with a child health plan must submit to the Secretary an evaluation that includes an assessment of the effectiveness of the State Plan in increasing the number of children with creditable health coverage, in increasing the availability of affordable quality individual and family health insurance for children, and in coordinating recommendations for improving the program under this Title. By December 31, 2001, the Secretary must submit to Congress and make available to the public, a report based on the evaluations submitted by the States recommendations and conclusions. No expenditure reports are required. No performance monitoring is required.

Audits

This program is excluded from coverage under OMB Circular No. A-133. A State child health plan under Title XXI must include an assurance that the State will afford the Secretary access to any records or information relating to the plan for the purposes of review or audit.

Records

A State child health plan must include an assurance that the State will collect the data, maintain the records, and furnish the report to the Secretary at the times and in standardized format (as the Secretary requires), in order to enable the Secretary to monitor State program administration and compliance and to evaluate and compare the effectiveness of State Plans under this Title.

Program Accomplishments

Not Applicable.

Financial Information

Account Identification

75-0515-0-1-551.

Obligations

(Formula Grants (Apportionments)) FY 08 $6,900,071,000; FY 09 est $10,562,000,000; FY 10 est $12,520,000,000

Range and Average of Financial Assistance

The range is from $1,221,139 for the smallest territory (Northern Mariana Islands) to $1,552,909,600 for the the States (California).

Regulations, Guidelines and Literature

Regulations and guidance issued related to the Children's Health Insurance Program may be accessed through the World Wide Web at: www.cms.hhs.gov/schip.

Related Programs

93.778 Medical Assistance Program

Information Contacts

Regional or Local Office

See Regional Agency Offices. Contact the Regional Administrator, Centers for Medicare and Medicaid Services. (See Appendix IV of the Catalog for addresses and telephone numbers).

Headquarters Office

Center for Medicaid and State Operations 7500 Security Boulevard, Baltimore, Maryland 21244 Phone: 4107863870

Web Site Address

http://www.cms.hhs.gov.

Examples of Funded Projects

Not Applicable.

Criteria for Selecting Proposals

Not Applicable.