Maryland Expands CHIP Eligibility to 300% FPL, Begins Subsidy Program For Job-Based Coverage

Maryland on July 1 entered "uncharted territory," as it became the third state in the nation to offer subsidies to workers to purchase family health coverage, the Baltimore Sun reports. "Studies show that when the whole family gets the same coverage, children access health care more," Maryland Deputy Health Secretary Debbie Chang said. The subsidies are part of a federal waiver to expand Maryland's CHIP program, a Medicaid expansion program. The waiver also approves a $15.2 million CHIP eligibility expansion from 200% of the federal poverty level to 300%, or an annual income of about $53,000 for a family of four. While many of the 14,000 children who gain eligibility under the waiver will enroll in HealthChoice, the state's Medicaid managed care program, some will receive a state subsidy so their parents can purchase employer-sponsored family health coverage. To facilitate this new program, families applying for HealthChoice will be asked whether they have access to employer-sponsored coverage. If the employer-sponsored coverage provides standard benefits and costs less than HealthChoice and if the employer already pays 50% or more of the premiums, the state will likely subsidize the remaining employee cost of the job-based coverage (Salganik, Baltimore Sun, 7/1). Premiums for families with incomes between 200% and 250% FPL will be $38 per month per family, while monthly premiums for families earning between 250% and 300% FPL will be $47. Families enrolled in the premium assistance program will be exempt from copays, coinsurance or deductibles imposed by the employer-sponsored health plan. In addition, cost sharing will not exceed 5% of a family's income, and there are no cost sharing requirements for American Indian/Alaska Native families (HHS release, 11/7/00).

Getting 'Buy-In' for the Buy-In
Nancy Dieter, chief of the child health program division at the state Department of Health and Mental Hygiene, expects that over the next year, more children will enroll in HealthChoice as employers "become familiar" with the subsidy program. While Maryland will promote the employer buy-in program to the public with advertisements and through local health departments, the Sun reports that the state has hired Fidelity Insurance Company to work with insurance brokers to "explain the program" to employers. Patricia Bafford of First Financial Resources, which has worked with Fidelity, said large employers, such as hotels and restaurants, are "interested" in the program because they employ workers in the income eligibility range. She added, "They have many lower-paid employees who aren't insured because they can't pay the premiums." And Sarah Shuptrine, director of Covering Kids, said the buy-in option can help overcome the stigma surrounding government-sponsored programs. "One of the biggest barriers [to enrollment] is that people see the programs as welfare. Many states are trying to frame it as a program for working families, and we think there is better enrollment in states that are projecting a positive image and enrolling families" (Salganik, Baltimore Sun, 7/1).