Issues in Developing Programs for Uninsured Children: A Resource Book for States. Colorado Children's Health Plan

03/02/1998

HISTORY:

The Colorado Children’s Health Plan (CCHP) was established in 1992 as a community-based health care reimbursement program for low-income children. CCHP operates as a health maintenance organization that is administered by the University of Colorado Health Sciences Center. The program initially targeted rural counties with a low number of safety net providers, and built its own network of physicians. Recent legislation established the Children’s Basic Health Plan (CBHP), a program which will expand eligibility under CCHP up to age 18 and extend the network into every county in the state. CBHP will be a full benefit program administered by private HMOs. The CBHP will be funded in part by the Title XXI block grant.

TARGET POPULATION:

The target population of CCHP is children age twelve and under with incomes up to 185% of the poverty level who are not eligible for Medicaid. Under CBHP, the target population will expand to include children up to age eighteen. Enrollment in FY1996 was 4,893 children. In FY1997 the target is 6,217 children, and in FY1998 the target is 12,041 children.

BENEFIT PACKAGE:

The benefit package was modeled after the Blue Cross/Blue Shield Caring Programs. Benefits include most preventive services, but do not include inpatient hospital care, eyeglasses, hearing aids or dental care. There is a maximum annual benefit of $10,000 per child. The program expansion will include inpatient and mental health care.

PROVIDER NETWORK AND REIMBURSEMENT:

CCHP is administered by the state of Colorado through the University of Colorado Health Sciences Center. The program has a statewide network of pediatric physicians. Primary care physicians are reimbursed on a capitated basis and bear risk. Medical specialists are reimbursed on a fee-for-service basis.

FINANCING:

Funding is obtained for CCHP through a combination of state appropriations and private donations. Funding comes from several sources: General Fund; public funds consisting of a portion of the Medicaid teaching adjustment paid to University Hospital; cash reserves and interest paid on those reserves; private donations; and enrollment fees. The enrollment fee is a $25 per child yearly payment in lieu of premium contributions. Copayments are required on doctor visits, health screenings, and prescriptions. Blue Cross/Blue Shield HMO donates all claims processing services.