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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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Section 2. General Background and Description of State Approach to Child Health Coverage and Coordination (Section 2102 (a)(1)-(3)) and (Section 2105)(c)(7)(A)-(B))

2.1. Describe the extent to which, and manner in which, children in the state including targeted low-income children and other classes of children, by income level and other relevant factors, such as race and ethnicity and geographic location, currently have creditable health coverage (as defined in 42 CFR 457.10). To the extent feasible, make a distinction between creditable coverage under public health insurance programs and public-private partnerships (See Section 10 for annual report requirements). (42 CFR 457.80(a))

A. Public-Private Health Insurance Program

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Act, 62 P.S. §§ 5001.101 et seq., as amended by Act 68 of 1998, 40 P.S. §§ 991.2301 et seq. (the Children’s Health Care Act), and Act 136 of 2006, was originally enacted in December 1992 and implemented in May of 1993 (see Appendix A for a copy of the Children’s Health Care Act as amended [the “Act”]). The Program provides Free or Subsidized insurance for children in low-income families who are not eligible for Medicaid or not otherwise insured through private or employer- based insurance. The program also allows those that do not meet the income guidelines to purchase the coverage at the state’s negotiated rate. (See Appendix B, Children’s Health Coverage in Pennsylvania). CHIP is administered by the Pennsylvania Insurance Department through individual contracts with eight health insurance companies (hereinafter referred to as Contractors). Under terms of the contract, Pennsylvania requires the Contractors to:

• Conduct outreach • Utilize CAPS to determine eligibility • Enroll and renew enrollment for eligible children • Provide required in-plan services • Contract with qualified providers to provide primary and preventative health care • Provide parent health education • Perform quality assurance tasks (including but not limited to monitoring of quality of care and health outcomes)

CHIP provides free coverage to children from birth through age 18 whose family income is no greater than 200% of the Federal Poverty Level (FPL). Subsidized coverage is provided to children from birth through age 18 in families whose income is greater than 200% but no greater than 300% of the