State Child Health Plan Medical Assistance Administration
Budget Principles
The District’s CHIP Program--Healthy DC Kids--will provide health insurance coverage to all uninsured children who: (a) are under age 19; (b) are District residents; (c) who live in families with income up to 200 percent of the federal poverty level (FPL); (d) who are not Medicaid eligible under current eligibility criteria; and (e) who meet all other statutory eligibility requirements.
It is estimated that approximately 8,401 children will enroll in CHIP. CHIP enrollees will receive the same benefits package as that received by children enrolled in the regular Medicaid Program. In addition, the District plans to provide services to CHIP-enrollees through the same delivery model designed for TANF and TANF-related mothers and children--managed care. As in the regular Medicaid program, behavioral health services and long-term care services will be carved out and reimbursed on a fee-for-service basis.
Using a per-capita cost for covering children under the existing Medicaid managed care plans for AFDC and AFDC-related persons (plus an allowance for mental health services and other costs not included under capitalization), it is estimated that the average per person per month cost of providing coverage to CHIP-enrolled children is $110 per month in fiscal year 1998.
An average annual rate of growth in per-capita costs for this group--3.75 percent--was arrived at based on the estimated average annual rate of growth in per-capita costs for children in the District’s Medicaid Program between 1993 through 1997. Thus total costs over fiscal years 1998 through 2003 will be an estimated $62.7 million, of which, 79 percent ($49.5 million) will be paid by the federal government. The District’s share of program costs are approximately $13.2 million over the same period of time.
The District plans to begin enrolling children in CHIP in early August. Therefore, we expect an average monthly enrollment of 1,063 children in F/Y 1998 at an average per person per month cost of $110. The City plans to spend the full 10 percent (the maximum allowed by federal law) of the total amount of benefits expenditures on some combination of the following: (a) costs associated with operating CHIP; (b) costs associated with making changes in the eligibility determination system; and (c) costs associated with the development and implementation of an outreach and education strategy.
In F/Y 1999 we expect average monthly enrollments of 7,723 children and a per member per month coverage rate of $114. Again, we plan to spend 10 percent of the total amount of benefits expenditures on activities as cited above. In F/Y 2000 we expect average monthly enrollments of 8,346 and a per member per month coverage rate of $118. (See Appendix A Discussion Paper: Coverage and Costs under the Children’s Health Insurance Program, Revised March 16, 1998, prepared by The Lewin Group, Inc. for a complete discussion of costs associated with CHIP and average monthly enrollments for F/Y 2001-2003)
