Examining Substitution: State Strategies to Limit "Crowd Out" in the Era of Children's Health Insurance Expansions. New York Child Health Plus

12/09/1997

HISTORY:

The Child Health Plus program was passed by the New York State legislature in 1990, and by August of 1991, children began receiving coverage under the program. New York’s Child Health Plus is the largest of 13 non-Medicaid, taxpayer-funded child health insurance programs in the country. As of July 1, 1997, the program was providing coverage to over 135,000 children. The program has estimated target enrollment over the next few years to total 250,000; this number may increase significantly due to recent federal legislation. The overall intent of the Child Health Plus Program is the following:

  • To improve the health status of children participating in the program by providing a "medical home"
  • To provide primary, preventive, outpatient and inpatient health insurance coverage to low income children by removing financial barriers to purchasing such coverage through an individual subsidy program
  • To increase children’s access to primary comprehensive, preventive and inpatient health care services
  • To reduce and more effectively target bad debt and charity care expenditures in the state of New York

TARGET POPULATION:

Children considered eligible for the program must be either uninsured or underinsured, residents of New York State, under the age of 19, and not eligible for state Medicaid benefits. Children under age 19 in families with an income below 222% FPL are eligible for an income-variable premium subsidy. Children in families above 222% FPL are permitted to buy into the program without any premium subsidy.

BENEFIT PACKAGE:

The program began providing coverage to children in August of 1991, initially providing subsidized primary and preventive outpatient care to children under age 13. In 1997, the program extended benefits to include inpatient care (excluding inpatient services for mental health and substance abuse) and extended coverage to include children through age 18.

PROVIDER NETWORK AND REIMBURSEMENT:

The provider network currently consists of 15 insurance plans contracted to provide health services to enrollees, of which 11 are MCOs and 4 are traditional indemnity plans. As of October 1, 1997, 24 insurance plans, with almost all providing a managed care product, will participate in Child Health Plus. Additionally, a marketing and outreach organization has been contracted to promote the plan throughout the state. This will be complemented by an in-house statewide marketing effort.

FINANCING:

The program is financed through a provider surcharge established under the New York Health Care Reform Act of 1996. The premium contribution from families participating in the program is an additional funding source.