Over the past few years, many states have expanded and improved health coverage for children. During the economic recovery of 2006 and 2007, a number of states advanced ambitious plans to broadly expand coverage to children, and in some cases, adults as well. These efforts led to the enactment of several universal coverage programs for children, as well as significant expansions of Medicaid and Children's Health Insurance Program (CHIP). Even in the face of a severe economic recession, states have continued to expand eligibility for public programs. The reauthorizaton of CHIP in February 2009 has provided states with new incentives to cover more uninsured children. In addition to expanding coverage, states have sought to capture those children who are eligible but not enrolled by improving outreach and simplifying enrollment in Medicaid and CHIP. Since 2006, two-thirds of states have expanded coverage or otherwise improved coverage programs for children.
The following summary of state coverage initiatives is current as of July 10, 2009. The map and summaries will be updated to reflect developments as they occur.
Note: The federal poverty level is $22,050 for a family of four in 2009.
Enacted Expanded Coverage.
On May 15, 2009, the legislature overrode the Governor’s
objections and passed a budget that expands CHIP eligibility from 200% to 300%
FPL.The expansion will go into effect
on October 1, 2009 and is expected to cover an additional 14,000 children.
AK
Enacted Expanded Coverage. On July 12, 2007, Governor Sarah Palin (R) signed legislation that increases Medicaid/CHIP eligibility for children to 175% of the 2007 federal poverty level. Eligibility had been set at 175% of the 2003 federal poverty level, which is equivalent to 154% of the 2007 federal poverty level. On April 1, 2009, Alaska moved to 12-month continuous eligibility for children.*
Improved Outreach and Enrollment. The FY 2007-2008 state budget, signed by Arizona Governor Janet Napolitano (D) on June 25, 2007, lifts the “gag rule” in CHIP that prohibited schools from participating in outreach and enrollment efforts. *
Enacted Expanded Coverage. On March 18, 2009, Governor Mike Beebe (D) signed legislation that expands eligibility for ArKids First (CHIP), from 200% to 250% FPL. The expansion is funded with a 56 cent increase in the state's tobacco tax.*
Proposed Universal Coverage. In January 2007, Governor Arnold Schwarzenegger (R) announced a proposal to provide universal coverage for all state residents. Modeled after the Massachusetts reform plan, the proposal would expand eligibility for the state’s CHIP program to 300% of the federal poverty level for all children, including immigrant children. The proposal mandated that all adults purchase health insurance coverage and that parents ensure coverage for their children. Compromise legislation was passed by the General Assembly in December 2007, but ultimately failed in the state Senate. *
Enacted Expanded Coverage. On May 31, 2007, Governor Bill Ritter (D) signed legislation that would provide coverage to all low-income children by 2010. On April 21, 2009, Governor Ritter signed legislation that expands CHIP for children and pregnant women to 250% FPL and provides 12-month continuous eligibility for children. It also expands Medicaid eligibility for parents to 100% FPL.*
Enacted Universal Coverage. On June 26, 2007, Governor Jodi Rell (R) signed into law the FY 2008-2009 state budget that calls for the automatic enrollment of all uninsured newborns into either Medicaid or CHIP, based on income. For newborns enrolled in CHIP, premiums are waived for 4 months. The law also creates a single point of entry for children applying for Medicaid or CHIP and provides additional funding for outreach. Children in families with income above 300% of the federal poverty level can buy-in to SCHIP at full-cost.*
Enacted Expanded Coverage. In January 2007, the DC City Council approved a budget that would expand Medicaid/CHIP eligibility up to 300% of the federal poverty level. The expansion was implemented in June 2007. *
Improved Outreach and Enrollment. On May 2, 2008, as part of Governor Charlie Crist’s (R) Cover Florida Plan, the cap on the number of children who could buy-in to the KidCare (CHIP) program was removed. By removing this cap, more children will be able to purchase health care coverage through the KidCare program.*
Enacted Expanded Coverage. In 2006, the state’s CHIP program, QUEST, expanded coverage to children up to 300% of the federal poverty level. On June 30, 2007, Governor Linda Lingle (R) signed legislation creating a three-year pilot program to cover all uninsured children not eligible for Medicaid or CHIP through a partnership with the Hawaii Medical Service Association. This program was stopped seven months later due to budget concerns. *
Enacted Universal Coverage. In November 2005, Governor Rod Blagojevich (D) signed into law the Illinois All Kids program, which provides coverage to all uninsured children in Illinois, regardless of income, health status, or citizenship. Implemented in July 2006, the program builds on the state’s Medicaid and CHIP programs though it is funded entirely with state dollars. Families with incomes above 150% of the federal poverty level (FPL) are required to pay premiums on a sliding scale based on income, up to $300 per child per month for families with incomes at or above 800% FPL. *
* Personal communication with Anne Marie Murphy, Office of Governor Rod Blagojevich. April 13, 2007. For more information on the All Kids program, see: http://www.allkidscovered.com/.
IN
Enacted Expanded Coverage. On May 10, 2007, Governor Mitch Daniels (R) signed legislation that increases CHIP eligibility for children with family incomes up to 300% of the federal poverty level (FPL). The legislation also expands coverage to uninsured adults with incomes up to 200% FPL using POWER accounts, which are structured similarly to health savings accounts. Due to a CMS directive that places new requirements on states seeking to expand coverage above 250% FPL, Indiana limited its expansion to children in families with incomes up to 250% FPL. CMS approved the expansion on May 9, 2008. *
Enacted Universal Coverage. On May 13, 2008, Governor Chet Culver signed legislation calling for coverage of all children in the state by 2011. The legislation expands hawk-I (CHIP) from 200% of the federal poverty level (FPL) to 300% FPL beginning in July 2009. Children in families with incomes between 150% and 300% FPL pay premiums of $10-$40/month per child, with no family paying more than $40/month regardless of the number of children. THe legislation also calls for a plan to be developed to insure children over 300% FPL by January 2010, and provides 12-month continuous eligibility for children. On May 19, 2009, the Governor signed legislation that simplifies enrollment and retention in hawk-I, implements presumptive eligibility, and expands coverage for dental care through hawk-I.*
Enacted Expanded Coverage. On May 18, 2008, Governor Kathleen Sebelius signed legislation to implement 9 of the 21 health care recommendations put forth by the Kansas Health Policy Authority. The legislation expands HealthWave (CHIP) eligibility to 225% of the federal poverty level (FPL) in 2009 and 250% FPL in 2010. On April 13, 2009, Governor Sebelius signed the state budget, which provides funding for the expansion to 250% FPL. Cost-sharing requirements will be developed by The Kansas Health Policy Authority.*
Improved Outreach and Enrollment. On November 3, 2008, Governor Beshear (D) announced an initiative to simplify enrollment into KCHIP. Face-to-face interviews were eliminated, the application was simplified, and a website and toll-free number were launched. The initiative calls for increased staff to process applications and expand outreach, notifying every family with a newborn child about the program, and using other public programs to recruit eligible children. *
Enacted Expanded Coverage. On July 11, 2007, Governor Kathleen Babineaux Blanco (D) signed legislation creating the Louisiana Children and Youth Health Insurance Program, a separate CHIP program that will cover children with family incomes between 200% and 300% of the federal poverty level (FPL). The legislation also provides additional funding for outreach and allows for presumptive eligibility and web-based applications and renewals for Medicaid, LaCHIP, and the new program. On February 27, 2008, CMS approved expanding coverage to children in families with incomes up to 250% FPL with a 12-month waiting period. *
Enacted Universal Coverage. In 2003, the state passed DirigoHealth, which seeks to achieve universal coverage by 2009. The plan expands MaineCare, the state’s Medicaid program, and creates DirigoChoice, a comprehensive insurance plan available to small businesses and individuals. The plan provides premium subsidies for individuals with incomes up to 300% of the federal poverty level. *
Improved Outreach & Enrollment. On May 22, 2008, Governor Martin O’Malley (D) signed legislation that seeks to increase enrollment in the state’s Medicaid and CHIP programs by requiring the state to send a notice to families whose children may be eligible for coverage, including an application and an explanation of how to enroll. Potentially eligible children will be identified through tax returns, where families will be required to indicate whether their child has health care coverage.*
Enacted Universal Coverage. In April 2006, the state enacted legislation that would provide near universal coverage for all state residents. The reform plan includes an expansion of the state’s MassHealth program for children with family incomes up to 300% of the federal poverty level (FPL). It also provides premium subsidies for low-income adults up to 300% FPL. The plan imposes an individual mandate on adults, requiring them to purchase health insurance. *
* General Court of the Commonwealth of Massachusetts, Health Care Access and Affordability Conference Committee Report, http://www.mass.gov/legis/summary.pdf , accessed 4/3/2006. Personal communication with Jim Mongan, President and CEO, Partners Healthcare System, Inc., on March 8, 2007.
MI
No current activity.
MN
Proposed Improvements in Outreach and Enrollment. On May 29, 2007, Minnesota Governor Tim Pawlenty (R) signed into law legislation allocating funds to increase outreach to people who are eligible for public health coverage programs. It called for the implementation of a statewide public awareness and education campaign on the importance and availability of health coverage. The legislation also included measures to simplify application and renewal policies. *
Enacted Expanded Coverage. On May 14, 2007, Governor Brian Schweitzer (D) signed legislation that expands SCHIP eligibility from 150 to 175% of the federal poverty level (FPL). On November 4, 2008, the Healthy Montana Kids Plan was approved by voters through a ballot initiative. The initiative expands SCHIP eligibility from 175% FPL to 250% FPL beginning October 1, 2009, and provides premium assistance to families with access to employer-sponsored coverage. The initiative also creates a single name, Healthy Montana Kids Plan, for the state’s Medicaid and CHIP programs, simplifies transitions between Medicaid and CHIP, and identifies enrollment partners to assist with enrolling eligible children in the program.*
Enacted Expanded Coverage. On May 22, 2009, Governor Heineman (R) signed legislation that expands CHIP from 185% to 200% of the federal poverty level. The bill also provides additional support to children with behavioral health issues.* *L.B. 603, Nebraska Legislature (Nebraska 2009). For bill text see: www.unicam.state.ne.us/FloorDocs/Current/PDF/Slip/LB603.pdf.
NV
No current activity.
NH
Improved Outreach and Enrollment. Through his 2007 Budget, Governor John Lynch (D) provided funding for public education and outreach in order to increase enrollment in Healthy Kids by 10,000 additional children. *
Enacted Universal Coverage. On June 23, 2008, legislation was passed that requires all children to obtain private or public health insurance within a year of the bill’s enactment. In December 2007, Governor Corzine (D) announced an expansion of New Jersey FamilyCare, the state’s CHIP program, which allows children in families with income greater than 350% of the federal poverty level to buy-in to the program at rates that are lower than what they would pay for comparable private insurance. In April 2009, New Jersey simplified their FamilyCare application and began sending applications to families who indicate on their tax returns that their children are eligible but uninsured.*
Enacted Expanded Coverage. New Mexico Governor Bill Richardson (D) dubbed 2006 the “Year of the Child,” calling for universal coverage for all children under five years of age. As part of this effort, the state expanded Medicaid eligibility for children under six by significantly increasing allowable earnings and childcare disregards. In addition, the state created the Premium Assistance for Kids (PAK) program for uninsured children up to age 11 who are ineligible for Medicaid or CHIP. Under the program, the state pays up to one-half of the applicable premiums for enrollment in participating plans. The program is entirely state-funded. *
* Office of the New Mexico Governor (February 7, 2007). Premium Assistance for Kids and Maternity Health Coverage Now *Available in New Mexico. Retrieved April 24, 2007 at http://www.hsd.state.nm.us/pdf/PAK_and_PAM_NR.pdf.
NY
Enacted Universal Coverage. On April 1, 2007, the state legislature approved the state budget for 2008, which included a proposal to expand Child Health Plus (CHIP) eligibility from 250% FPL to 400% of the federal poverty level. It also included changes to simplify the application and renewal process. The state allows families with incomes above 400% FPL to buy-in to CHIP at full cost. *
Enacted Expanded Coverage. In 2007, North Carolina enacted N.C. Kids' Care, which will expand coverage to children with family incomes above 200% of the federal poverty level (FPL). *
Enacted Expanded Coverage. On April 24, 2007, Governor John Hoeven (R) signed legislation expanding CHIP eligibility for children from 140% to 150% of the federal poverty level. On July 1, 2009, eligibility for CHIP was expanded to 160% of the federal poverty level.*
Proposed Expanded Coverage. On June 30, 2007, Ohio Governor Ted Strickland (D) signed into law the 2008-09 state budget, which includes an expansion of CHIP eligibility for children with family incomes from 200% to 300% of the federal poverty level (FPL). On April 1, 2008, Governor Strickland signed an executive order establishing the Children’s Buy-in Program, which will enable families with incomes above 300% FPL to purchase public coverage for their children. *
Enacted Expanded Coverage. On June 4, 2007, Governor Brad Henry (D) signed into law the All Kids Act, which creates a premium assistance program within Medicaid for children with family incomes between 185% and 300% of the federal poverty level (FPL), to assist them in purchasing private coverage. *
Proposed Universal Coverage. In September 2006, Governor Ted Kulongoski (D) proposed the Healthy Kids initiative, which aims to achieve universal coverage for children in Oregon. His proposal called for expanding Medicaid and CHIP eligibility for children with family incomes up to 350% of the federal poverty level and allowing families with higher incomes to buy-in to public coverage at full cost. The Healthy Kids proposal was part of a larger initiative to provide universal coverage to all state residents. The proposal was contingent upon the passage of a ballot initiative that would increase the tobacco tax by 84 cents. This ballot measure was not approved by Oregon voters. *
Enacted Universal Coverage. On November 2, 2006, Governor Ed Rendell (D) signed into law the Cover All Kids initiative. Cover All Kids expanded CHIP eligibility to 300% of the federal poverty level and permits families with higher incomes to buy-in to SCHIP at full cost. The Centers for Medicare and Medicaid Services approved the state’s SCHIP expansion in February and implementation of Cover All Kids began in March 2007. *
Enacted Expanded Coverage. A provision in the 2007-2008 budget passed by the state legislature in June 2007 created a separate Children’s Health Insurance Program that expands eligibility to children with family incomes up to 200% of the federal poverty level. This provision was vetoed by the Governor, but the legislature overrode the veto. *
Enacted Expanded Coverage. In 2006, Tennessee enacted the CoverKids program, which created the state’s CHIP program and covers children with incomes up to 250% of the federal poverty level with no premiums and limited cost sharing. It also permits higher income families to buy-in to the program for their children. *
Improved Outreach and Enrollment. On June 15, 2007, Governor Rick Perry (R) signed legislation creating a community outreach campaign for CHIP, extending continuous coverage for children from 6 to 12 months, and eliminating a 90-day waiting period, except for certain applicants. Additionally, as a result of a court settlement money will be set aside for Medicaid outreach and enrollment activities to boost enrollment of eligible children. *
Improved Outreach and Enrollment. On March 18, 2008, Governor Jon Huntsman (R) signed legislation that requires the state to keep enrollment open in the state’s CHIP program.*
Enacted Universal Coverage. In May 2006, Governor Jim Douglas (R) signed health care reform legislation aiming to achieve near-universal health coverage for state residents. Referred to as Catamount Health, the plan provides a low-cost private insurance product to the uninsured, and provides sliding scale premium subsidies for individuals with incomes up to 300% of the federal poverty level (FPL). The plan also funded new outreach efforts and reduced premiums for the state’s Medicaid/CHIP program, which provides health care coverage to children with family incomes up to 300% FPL. *
Enacted Universal Coverage. On March 13, 2007, Washington Governor Chris Gregoire (D) signed legislation to cover all children by 2010. The legislation expands SCHIP coverage to children with family incomes up to 300% of the federal poverty level by January 2009, permits families with higher incomes to buy-in to public coverage at full cost, and covers all immigrant children. The CHIP eligibility expansion to 300% FPL was implemented on February 23, 2009. Coverage is retroactive to families who applied since the end of November 2008 but were originally denied coverage. The buy-in option will be available in January 2010. Washington also used options through CHIPRA legislation to simplify enrollment and renewal. *
Enacted Expanded Coverage. On July 31, 2008, the Children's Health Insurance Program Board expanded program eligibility from 220% to 250% of the federal poverty level (FPL), effective January 1, 2009. Children in families with incomes above 200% FPL are required to pay a premium.*
Enacted Universal Coverage. On October 26, 2007, Wisconsin Governor Jim Doyle (D) signed the state budget bill, providing health care coverage to all children. The legislation extends CHIP eligibility to children with family incomes up to 300% of the federal poverty level (FPL). Children in families with incomes above 200% FPL will be required to pay a premium, while those in families above 300% FPL will be able to buy-in to the program at full-cost. *
