Issues in Developing Programs for Uninsured Children: A Resource Book for States. A. Overview


Over the past several years, states have approached the issue of children’s health insurance in many different ways and for a variety of reasons based on the needs of target populations and the basic premise upon which programs were established. Consequently, current eligibility standards and verification processes utilized by children’s health insurance programs differ widely across states.

Some states, such as Minnesota and Tennessee, have chosen to expand coverage for children as part of a larger statewide Medicaid expansion. The use of Medicaid waivers to extend eligibility has allowed many states to reach beyond the scope of "children's-only" initiatives in order to cover families and single adults as well. Eligibility guidelines for these state programs usually expand current Medicaid eligibility requirements, and the processing of applications is often done within the same agency.

Other states have chosen to establish separate children’s health insurance programs independent of the current Medicaid system. Establishing a separate program provides states with added flexibility to design eligibility requirements and a system for program administration.

  • Eligibility for subsidized coverage through the Florida Healthy Kids program is determined by eligibility guidelines already established by the National School Lunch Program. In order to verify eligibility and administer the program, Florida has established the Healthy Kids Corporation, a program separate from Medicaid and other public assistance programs. In contrast, Pennsylvania established their Children’s Health Insurance Program (CHIP) within the Department of Insurance. However, the insurance plans contracting with CHIP, rather than state CHIP staff, are responsible for verifying the eligibility of applicants. The CaliforniaKids program exists as a private organization and therefore, its eligibility requirements are not subject to the same federal and/or state regulations.

This section examines states' approaches to the various aspects of developing and implementing eligibility and verification processes.