ANALYSIS OF

           HOUSE BILL 1301

           Creating the Children=s Health Insurance Program.

                     And

           HOUSE BILL 1469

           Creating the Children=s Health Initiative Program.

Health Care Committee                          February 5, 1999

Washington State House of Representatives

SPONSORS:  (HB 1301) Representatives Edwards and Ruderman.

           (HB 1469) Representatives Parlette and Alexander.

BACKGROUND:

In 1997, Congress established the State Children's Health Insurance Program (CHIP) under the new Title XXI of the Social Security Act.  Authorized for ten years, the program makes federal matching funds available to states at an "enhanced" rate in order to expand health insurance coverage of low-income children.

CHIP matching funds may be used to provide health coverage to children under 19 with family incomes below 200 percent of the federal poverty level (FPL), or 50 percentage points higher than a state's Medicaid eligibility levels.  The funds may not be used to cover any child who was eligible for coverage under an existing state program as of June 1997. 

Since 1993, Washington has provided health insurance coverage through Medicaid and Basic Health Plus for children with family incomes up to 200 percent of FPL.  Thus, Washington may receive CHIP matching funds only for children in families with incomes between 200 and 250 percent of FPL.

The law allows the state to expand its coverage in one of three basic ways:  (1) Medicaid expansion; (2) creating or expanding a separate program that provides coverage through participating insurers, or (3) a combination of both.  Under option (1), the state would be required to follow all Medicaid requirements regarding, for example, the entitlement nature of the program, eligibility, benefits, and cost sharing.  Option (2) would give the state greater flexibility regarding program design, but would require benefits consistent with one of three "benchmark plans" set forth in the federal law.  Option (3) may require that the state apply for waivers of Title XXI provisions through Section 1115 of the Social Security Act.

SUMMARY:  [See attached chart]

HB 1301 creates the Children's Health Insurance Program under the auspices of the  Department of Social and Health Services (DSHS).  The program provides health insurance coverage to persons age 18 and under whose family income is between 200 and 250 percent of the federal poverty level. The DSHS is given general authority to design and implement the program consistent with the requirements of Title XXI of the Social Security Act. 

HB 1469 creates the Children's Health Initiative Program under the auspices of the Health Care Authority (HCA).  The benefits and the poverty levels are the same as in HB 1301; however eligibility is limited to children with special health needs.

         Children=s Health Insurance Program

          COMPARISON OF HB 1301 and HB 1469

Provision	HB 1301 Children=s Health Insurance Program    Reps. Edwards and Ruderman; Gov's request	HB 1469          Children=s Health Initiative Program   Representatives Parlette and Alexander
Age of  Covered Persons	Under the age of nineteen.	Same.
Family Income Eligibility	Between 200% and 250% of the Federal poverty level.	Same.
Other Major Eligibility  Requirements	Child must be uninsured; parent may have coverage.	Same. Enrollee must reside in an area served by a managed health care system participating in the plan. Enrollee must have special health needs which  are chronic health conditions that are expected to last at least one year and have significant sequelae requiring ongoing extensive medical intervention and extensive family management [See section(3)(5) for example]. Eligibility must be reviewed on an annual basis.
Administration	Department of Social and Health Services  through Medical Assistance (Medicaid) statute.	Health Care Authority through the Basic Health Plan statute.
Benefits	Non-entitlement. Comprehensive Medicaid package.	Same. Same.
Services Delivery	Managed care through health carriers or fee-for-service.	Managed care but not necessarily through health carriers. No fee-for-service.
Premium and Other Cost Sharing Requirements	Only for families above 150 percent of poverty and not more than 5 percent of income.	Same.
Estimated Enrollment	10,000	900
Estimated Costs  [99-01]	$4 million:  Health Services Account        (tobacco settlement) $7.6 million:  GF-F	$2.7 million:  GF-S $5.4 million:  GF-F
Effective Date	July 1, 1999.	Same.