Benefits Offered Under Separate CHIP Programs ‘More Limited’ than Those Offered under Medicaid Programs, Brief Says

Separate CHIP programs typically offer "more limited" health benefits than Medicaid programs do and are more likely to give managed care contractors the authority to determine how services will be provided to beneficiaries, a new policy brief from George Washington University's Center for Health Services Research and Policy finds (Center for Health Services Research and Policy release, 12/18). The brief, "Managed Care Purchasing under SCHIP: A Nationwide Analysis of Freestanding SCHIP Contracts," uses information from two nationwide databases, one of all Medicaid managed care contracts and one of all CHIP program managed care contracts in 2000 (Center for Health Services Research and Policy, "Managed Care Purchasing under SCHIP: A Nationwide Analysis of Freestanding SCHIP Contract," December 2001). In particular, the brief focuses on managed care contracts under 15 CHIP programs that are separate from the states' Medicaid programs. The brief finds that separate CHIP programs contracting with managed care organizations offer benefits that are "narrow[er]" than under Medicaid for preventive and chronic care services. For example, of the 15 programs studied, three states do not "clear[ly]" specify coverage of immunization services, which leaves the health plan with the option of providing such a benefit. In addition, only three states with separate CHIP programs specify lead screening as part of their preventive benefit package. Further, only 12 of the 15 programs include standards to assess physical and mental health as part of a basic preventive examination. The brief also examines how children with "serious medical conditions" are covered under separate CHIP programs, finding that all 15 programs require some coverage for medications and inpatient, outpatient and laboratory services, but not all the contracts require coverage of services, such as medical case management, used by children with "complex" health problems. Sara Rosenbaum, the study's author and a professor at George Washington University's Center for Health Services Research and Policy, said, "Without the extensive requirements of Medicaid, states draft their freestanding contracts to parallel those written for the commercial market. Benefits are more limited and the instrument gives more discretion to the contractor in the areas of access, continuity of care, and networks" (Center for Health Services Research and Policy release, 12/18). The study is available online.