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Take a Bow: 23 States Get Bonuses for CHIP, Medicaid Programs

By Jane Norman, CQ HealthBeat Associate Editor

December 19, 2012 – The Department of Health and Human Services recently announced that 23 states qualified for $306 million in performance bonuses for their gains in signing up low-income children for health coverage, including Utah for the first time.

The bonuses come as states and the federal government work on setting up health insurance exchanges that will begin operation in 2014 and are intended to make enrollment in public programs even smoother. According to an Urban Institute study published earlier this month, 86 percent of eligible children were signed up for CHIP and Medicaid in 2010, an increase from 81.7 percent in 2008.

The bonuses were created under the 2009 reauthorization of CHIP (PL 111-3) and reward states for improving their CHIP and Medicaid programs' access to low-income children and also for increasing enrollment. This year marks the fourth fiscal year bonuses have been handed out. The amount of the payments is tied to increases in enrollment—the bigger the increase, the bigger the bonus.

Cindy Mann, director of Medicaid at the Centers for Medicare and Medicaid Services, said in a telebriefing that one of the agency's top priorities is making sure children get the medical care they need, and children's enrollment has been on the upswing in contrast to trends among adults.

The 23 states receiving bonuses are Alabama, Alaska, Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Kansas, Maryland, Michigan, Montana, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Utah, Virginia, Washington, and Wisconsin. The largest bonus went to Colorado, at $43 million.

Medicaid and CHIP programs vary from state to state. According to CMS officials, states receiving bonuses upped their child enrollments above a baseline figure and also put in place at least five of eight specific program features. For example, to qualify, states could eliminate requirements for in-person interviews, use the same application and renewal forms for Medicaid and CHIP, allow health care providers to enroll children right away contingent on a review of eligibility and allow full-year enrollment regardless of parents' income changes.

Utah qualified for the first time because it eliminated the in-person interview and coordinated application and renewal procedures, among other changes, officials said.

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