For more than two decades, the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate incomes. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.
CHIP is currently funded through federal fiscal year (FFY) 2027 (Sept. 30, 2027) by the HEALTHY KIDS and ACCESS Acts. The Acts also extended the maintenance of effort (MOE) provision, which requires states to maintain eligibility standards that were in place in 2010 through FFY 2027. However, beginning in FFY 2020 MOE only applies to children in families with incomes at or below 300 percent of the federal poverty level (FPL).
Modified adjusted gross income (MAGI) eligibility levels for CHIP/Title XXI in North Carolina (by age)
||Ages 0 – 1
||Ages 1 – 5
||Ages 6 – 18
||194 – 210% FPL
||141 – 210% FPL
||107 – 133% FPL
||134 – 211% FPL
Source: Medicaid and CHIP Payment and Access Commission (MACPAC), MACStats: Medicaid and CHIP Data Book, December 2018, Exhibit 35: “Medicaid and CHIP Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State, April 2018.” Note: Eligibility levels do not include the mandatory 5% income disregard.
Coverage for Pregnant Women
Using CHIP funding, states can opt to provide coverage for pregnant women and/or services through the “unborn child” coverage option. North Carolina does not provide coverage for pregnant women through CHIP.
States that operate Medicaid expansion CHIP programs must follow Medicaid rules, providing all Medicaid-covered benefits to enrolled children, including the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services benefit. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines.
The provider network in Health Choice for Children is the same as Medicaid. Most children are required to enroll in a primary care case management system.
Premiums and Cost Sharing
Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed 5 percent of family income annually.