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MACPAC Report Opens Debate on Children's Health Coverage

By Rebecca Adams, CQ HealthBeat Associate Editor

March 18, 2014 -- The Medicaid and CHIP Payment and Access Commission recommended in its March report that Congress get rid of waiting periods for the Children’s Health Insurance Program and ban any premiums that the poorest children in the program face.

The recommendations are among a handful of suggestions that the commission put forward in the report, which was released Friday.

Eliminating waiting periods would reduce complexity and promote continuous coverage for kids, said the commission, which is known as MACPAC.

The second recommendation called for lawmakers to ensure that children from families with incomes below 150 percent of the federal poverty level would not have to pay CHIP premiums. The commissioners said that this would ensure fairness across the nation. States can choose whether to provide CHIP coverage by establishing separate programs for children’s care or by expanding their current Medicaid programs. States that broaden Medicaid typically do not charge premiums to families with income less than 150 percent of the federal poverty line.

If Congress banned premiums for people in that bracket, it would affect about 110,000 children in eight states.

The commissioners said the change would not significantly affect state spending.

“The CHIP premiums charged in this income range, generally less than $10 per month... are so small that they would not represent a significant revenue loss to states if they were eliminated—especially as this also removes states’ burden in collecting and administering these premiums,” the report states.

However, some states might wind up spending more if a bigger number of families enroll because of the change.

The commission said it would continue to examine the CHIP program, whose federal funding runs out after fiscal year 2015. The panel plans to broaden its analyses of CHIP in a June report to consider aspects including cost sharing, benefits, network adequacy, enrollment, and financing.

“The Commission saw an opportunity to consider a long-term vision for children’s health coverage,” said MACPAC Executive Director Anne L. Schwartz.

The two MACPAC reports examine issues in two growing programs. Medicaid and CHIP combined touch about one-fourth of the U.S. population, the authors noted, with Medicaid covering more than 70 million people for at least part of fiscal year 2013 and CHIP covering more than 8 million. The programs currently account for about 15 percent of total U.S. health care spending.

Rebecca Adams can be reached at [email protected].

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