Issues in Developing Programs for Uninsured Children: A Resource Book for States. C. Referral to Medicaid or Other Programs for Inpatient Care or Other Benefits Not Provided by the Program


Some children's health insurance plans offer a more limited benefit package with the intent of keeping costs low and insuring as many children as possible. In these cases, plans may find it helpful to coordinate services with the state Medicaid program so that children who become severely ill and in need of comprehensive benefits (perhaps not offered by the separate children's health insurance program) have access to Medicaid.

  • CaliforniaKids does not offer inpatient care so they established a coordinated effort between CaliforniaKids and the Medicaid agency (MediCal) for inpatient care. Although the relationship is not formal, coordination with Medicaid is conducted on a case-by-case basis. When a child requires inpatient care, CaliforniaKids contacts and coordinates with MediCal to assist families in obtaining necessary services. However, CaliforniaKids has needed to coordinate the care of children with MediCal in only seven cases since the establishment of the program.
  • In Pennsylvania, Caring Programs provide coverage to "wrap-around" the CHIP program. [The Children's Health Insurance Program provides coverage to children up to age 16 whose families are below 185% of the poverty level. These children receive free coverage. Children under age 6 up to 235% of the poverty level are eligible for subsidized coverage. Applicants must be residents of Pennsylvania for at least 30 days (except newborns) and cannot have access to any other private insurance or the Medicaid program.] The Caring Programs subsidize coverage for children ages 6-18 between 185-235% of poverty and offer free coverage for 17- and 18-year-olds under 185% FPL who are too old to be eligible for the CHIP program. In addition, Blue Cross/Blue Shield allows families on the CHIP waiting list to "buy-in" to the program while they wait for an open spot. The Caring Foundation will often subsidize their coverage until a spot in CHIP is available.