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ADEA Advocacy and Government Relations—August 2014

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August 5th marked the 17th anniversary of the Children’s Health Insurance Program (CHIP). Former President Bill Clinton signed CHIP into law August 5, 1997. CHIP is administered by the U.S. Department of Health and Human Services (HHS) and provides matching funds to states for health insurance to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.[1]

In 2009, President Obama signed the Children’s Health Insurance Reauthorization Act (CHIPRA), expanding the healthcare program to an additional 4 million children and pregnant women. CHIPRA also provided states with new programmatic options and new incentives for covering children through Medicaid and CHIP.

Some of the features in CHIPRA that have helped states and communities boost participation rates among eligible children include:

  • A new Express Lane Eligibility option that allows states to enroll children into Medicaid or CHIP based on information available through other programs and data bases.
  • Outreach and enrollment grant funding dedicated to promoting effective enrollment and renewal strategies.
  • An option for states to verify U.S. citizenship through data matches with the Social Security Administration to reduce coverage losses and delays due to paperwork requirements that were difficult for both families and states to manage.

All children covered by Medicaid and CHIP have coverage for dental services.[ 2] In October 2009, the Centers for Medicare and Medicaid Services (CMS) sent State Health Officials a letter detailing dental coverage under CHIP.

According to the Medicaid and CHIP Payment Access Commission (MACPAC), a nonpartisan Congressional advisory commission that provides analytic support and makes policy recommendations to Congress and the HHS Secretary, CHIP is an important source of coverage for 8 million children with low to moderate incomes. Unfortunately, CHIP funding is scheduled to run out shortly after fiscal year (FY) 2015. In its June 2014 Report to the Congress on Medicaid and CHIP (report), MACPAC is recommending that Congress extend CHIP financing for two years through FY17. This short-term recommendation was made by MACPAC, in part, to give the commission time to analyze the impact of the Affordable Care Act and health insurance marketplaces on CHIP. According to MACPAC, since the enactment of CHIP in 1997, the share of children who are uninsured has fallen by half — from 13.9 to 7.1%.

On June 11, Sen. Jay Rockefeller (D-WV) introduced S.2461, the CHIP Extension Act of 2014.

S. 2461 does the following (this list is not exhaustive):

  • Revises and extends CHIP through FY19 at generally increased levels and adjusts CHIP allotment requirements accordingly.
  • Sets forth new requirements for the enrollment and retention of children for fiscal years after FY14.
  • Establishes in the Treasury the CHIP Shortfall Fund, which shall be available without further appropriations for payments to shortfall states whose projected CHIP expenditures for the fiscal year will exceed a specified amount.
  • Provides automatic enrollment under CHIP for newborns.
  • Makes permanent the express lane option as well as the CHIP outreach and enrollment grant program.
  • Limits to 5% of family income the total annual aggregate amount of any premium, enrollment fee, deduction or other cost sharing imposed under a Medicaid plan with respect to individuals and their families.

S.2461 has been sent to the Committee on Finance for further consideration.

For a summary on recent federal legislative and regulatory news about oral health, dental education, and dental research, read our ADEA Washington Update.

Keep up with recent state legislative and regulatory news about oral health, dental education, and dental research in your state with the ADEA State Update.


[1] The legislation that became CHIP (the Balanced Budget Act of 1997, P.L. 105-33) gave states flexibility either to use an expansion of Medicaid or to create CHIP programs separate from Medicaid. States could also use both approaches in which they generally covered lower income children with a Medicaid expansion.

[2] Section 2103(c)(5) of title XXI of the Social Security Act, as added by section 501 of CHIPRA, requires that “child health assistance provided to a targeted low-income child shall include coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function and treat emergency conditions.”