CHIP Generally Provides ‘Broad, Affordable’ Coverage to Special Needs Children, Though Some Changes Suggested, Study Finds

States' CHIP programs seem to provide "relatively broad and affordable coverage to low-income children, including those with special health care needs," and an "encouraging number of states" have "special provisions" that make CHIP "more responsive" to the special needs of some children and their families, a new report from the Urban Institute's Assessing the New Federalism project states. The report examined 18 states, chosen either for their size, population characteristics, geographic location and policies or because they have a particular focus on serving children with special needs. These children, who have either a disability or chronic illness, represent 17% of low-income uninsured children and about 17% of children eligible for the CHIP program. When developing states' programs, however, most policy makers "did not focus particular attention" on children with special needs, but instead concentrated on how to design programs that would enroll the largest number of children, the study says. Thus, except for a small number of states with non-Medicaid CHIP programs, children with special needs in CHIP programs are "subjected ... to the same rules and policies as all other children." The report also notes that none of the states' CHIP program outreach campaigns specifically targeted children with special needs, and few states use "systematic processes" to identify children with special needs. Most states also do not have special CHIP program benefit packages for children with special needs. In fact, many services necessary for children with special needs are "omitted or subject to limits" under CHIP, the study says. However, overall coverage under non-Medicaid CHIP programs is "quite broad" and generally "much better" than what private coverage offers, the report says. Most states use a managed care system to provide services for children in CHIP, and the report found "few or no cases in which [those] delivery systems seemed to be failing to meet the needs of" children with special needs. However, children with special needs and their families are "particularly vulnerable to high out-of-pocket costs" under CHIP programs. Only three of the states the report studied exempt children with special needs from cost sharing. The report also found that the time periods that families must be uninsured before being enrolling in CHIP programs "might disproportionately affect" families of children with special needs. Six states exempt such families from waiting periods if their private health coverage poses a "significant financial burden."

Policy Suggestions
The report suggests two changes in CHIP that would better address special needs children (Hill et al., "Are We Responding to Their Needs? States' Early Experiences Serving Children with Special Health Care Needs Under SCHIP," 6/18). Ian Hill, a health policy expert with the institute, said, "Policymakers should consider permitting SCHIP to 'wrap around' existing private health coverage for children with special needs, and perhaps encourage states to exempt children with special needs from their waiting periods if their private coverage is significantly limited or expensive" (Urban Institute release, 6/18). The report also suggests that the federal government encourage or require states to alter their waiting period policies to allow children with special needs to drop private health coverage if it is "deemed significantly limited or expensive" ("Are We Responding to Their Needs? States' Early Experiences Serving Children with Special Health Care Needs Under SCHIP," 6/18). Click here for the full report. Note: You will need Adobe Acrobat Reader to view the report and this link is only available to Web readers.