Children's Health Insurance Program

The objective of the Children's Health Insurance Program (CHIP) is 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

CHIP is a federal-state matching program with capped federal funding that provides health care coverage to targeted low-income children. The objective of CHIP is to enable states to maintain and expand child health care coverage to uninsured, low-income children and low-income pregnant women. This program has improved access to health care and quality of life for millions of vulnerable children under 19 years of age. There are currently over seven million children enrolled in CHIP. Under Title XXI of the Act, states have the option to operate a separate CHIP program, expand eligibility for children under their state Medicaid program, or operate a combination of these two options.

CHIP: States, Territories, and Commonwealths CKC grants: The following entities are eligible to apply for the Connecting Kids to Coverage Cooperative Agreements: s: States with an approved child health plan under this title [42 U.S.C. Section1397aa et seq.];local governments; Indian tribes or tribal consortium, tribal organizations, urban Indian organizations receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.), or Indian Health Service providers; federal health safety net organizations; national, state, local, or community-based public or nonprofit private organizations, including organizations that use community health workers or community-based doula programs; faith-based organizations or consortia, to the extent that a cooperative agreement awarded to such an entity is consistent with the requirements of Section 1955 of the Public Health Service Act (42 U.S.C. 300x-65) relating to a grant award to nongovernmental entities; and/or elementary or secondary schools may apply. For eligibility requirements for the Connecting Kids to Coverage Cooperative Agreements, refer to the funding opportunity announcements (Agency Funding Opportunity Numbers: CMS-141-19-001 for the General Outreach and Enrollment Grants and CMS- 2D2-20-001 for the Outreach and Enrollment Grants Focused on Increasing the Enrollment and Retention of American Indian and Alaska Native Children in Medicaid and CHIP).

U.S. Territories, Individual/Family, State, Low Income CHIP: 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 as defined by each state and are not found to be covered under a group health plan or under other health insurance coverage. CKC grants: Children who are eligible but unenrolled in coverage will benefit.

CHIP: 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 pre-existing 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 using Federal funds under the State plan does may 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 cost sharing 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. 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 extent by the Federal government, may not be included in determining the amount of nonfederal contributions required for State matching purposes. CKC grants: All Connecting Kids to Coverage awardees must adhere to all HHS financial and program terms and conditions regarding uses and exclusions of funds. All awardees will receive this information in their award packages.

CHIP: CHIP allotments are obligated to states by issuing grant awards. Under section 2104(e) of the Act, CHIP allotments for a fiscal year are available for expenditure through the end of the succeeding fiscal year. CKC grants: Federal funds are obligated to the Connecting Kids to Coverage grantees by issuing grant awards. To ensure that all of the appropriated funds are available to grantees, CMS will issue cooperative grant awards for one year from the award date to all grantees selected. Awardees must meet all reporting deadlines and demonstrate strong performance to be eligible for a non-competing continuation award for subsequent budget periods. The awards are released as a lump sum into their Payment Management System (PMS) account.

CHIP: Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372. CKC grants: Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372. For the Connecting Kids to Coverage Cooperative Agreement application and award process, refer to the funding opportunity announcement (Funding Opportunity Number CMS-141-19-001 for the General Outreach and Enrollment Grants and Funding Opportunity Number CMS- 2D2-20-001 for the Outreach and Enrollment Grants Focused on Increasing the Enrollment and Retention of American Indian and Alaska Native Children in Medicaid and CHIP) for additional information. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

CHIP: The CMS Administrator exercises delegated authority to approve Title XXI state plans and amendments. Letters of approval will be signed by the CMS Administrator. CKC grants: The cooperative agreements are awarded after the application has gone through a multi-phase review process that consists of at least three expert reviewers. The phases consist of screening applications, panel review of eligible applications, and leadership team review who will make the final recommendations to the CMS approving official.

CHIP: No deadlines CKC grants: Application deadlines for the Connecting Kids to Coverage Cooperative Agreements are dependent on the final release date for the Notice of Funding Opportunity Announcement (NOFO). Refer to the website www.insurekidsnow.gov for the NOFO and application deadline updates.

CHIP: 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. CKC grants: Cooperative agreements are approved within 120 days after the application has been selected through the three-phase review process.

CHIP: 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. CKC grants: The CMS Administrator exercises delegated authority to award cooperative agreements. Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information including the Terms and Conditions. Once an award is made, the funds are posted in recipient accounts established in the Payment Management System (PMS). Grantees may then access their funds by using the PMS funds request process. The funds are then delivered to the recipient via Electronic Funds Transfer.

CHIP: If a State wishes to appeal a disapproval of a state plan amendment, 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 CMS project officer. States also have the option to submit a new state plan amendment following the disapproval, starting a new 90-day review clock. CKC: If an applicant wishes to discuss why their application was denied, they may contact the Office of Acquisitions and Grants Management.