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Creating a Seamless Health Insurance System for New York's Children


This new study finds that a lack of integration between New York State's Child Health Plus (CHP) and Medicaid programs has frayed the safety net for low-income children. Creating a Seamless Health Insurance System for New York's Children, by Melinda Dutton, Kimberley Chin, and Cheryl Hunter-Grant of the Children's Defense Fund-New York, examines how the state's two publicly funded health insurance programs for children differ and what can be done to coordinate them better.

With the help of federal dollars, New York has taken several steps in recent years toward creating a seamless child health insurance system-one in which children can easily enroll and remain in a program without experiencing disruptions in care because of changes in family circumstances. Passage of the children's health insurance expansion in 1998 was the first step state lawmakers took to coordinate CHP and Medicaid. More recently, New York brought the two programs together under one umbrella, renaming them Child Health Plus A and Child Health Plus B, respectively.

Still, many disparities remain in public education and outreach efforts, enrollment rules, transfer and recertification processes, and financing and administration. Medicaid and Child Health Plus each have health care providers and health plans that do not participate in the other program. The Child Health Plus benefit package, while improved as part of the 1998 expansion, is still not as generous as Medicaid's. Health services are delivered differently as well: Medicaid benefits are available on a fee-for-service basis or through managed care, while Child Health Plus operates solely through managed care. To help bridge these differences, the authors recommend that New York:

  • Develop educational materials for families explaining the new unified child health program and the benefits and requirements for both components.
  • Eliminate age-based eligibility rules for Medicaid so that all children ages 1 to 18 with incomes below 133 percent of the poverty level are eligible.
  • Allow for immediate Child Health Plus coverage upon birth of a child.
  • Eliminate Medicaid's requirement for a face-to-face interview as part of the application process.
  • Clarify, minimize, and unify documentation requirements across and within the two programs.
  • Halt all new enrollment in Child Health Plus plans not participating in Medicaid managed care, except in counties where no plans participate in both programs.


Facts and Figures





  • Child Health Plus covers more than 539,000 children across New York State; Medicaid covers 1.2 million children.

  • While Child Health Plus has a $4 million mass media budget, Medicaid has no money devoted to advertising.
  • The New York State Department of Health estimates that approximately 30 percent of children enrolled in Child Health Plus-nearly 160,000-may be eligible for Medicaid.




Publication Details



Creating a Seamless Health Insurance System for New York's Children, Melinda Dutton, Kimberley Chin, and Cheryl Hunter-Grant, Children's Defense Fund-New York., The Commonwealth Fund, February 2001