Issues in Developing Programs for Uninsured Children: A Resource Book for States. Pennsylvania Children's Health Insurance Program

03/02/1998

HISTORY:

A 1992 Penn State University study on uninsured children in Pennsylvania precipitated the interest in creating a state-subsidized health insurance program for children. The Pennsylvania Children’s Health Insurance Program was enacted in November 1992 and implementation began in May 1993. The state-sponsored program was initially designed to cover 29,000 uninsured children ages 1-6 whose families were below 100% of the poverty level. In May 1994 the program was expanded to cover children ages 1-13 up to 185% of the poverty level due to excess funds. The Children's Health Insurance Program is currently capped at 53,879 children. There are approximately 3,000 children on the waiting list.

TARGET POPULATION:

The target population of the Children's Health Insurance Program is 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.

BENEFIT PACKAGE:

The focus of the Children's Health Insurance Program is on preventive and primary care services. Primary care, vision and hearing screening, emergency care, outpatient care, mental health treatment and dental care are provided through the benefit package. Inpatient care is covered through the program with a limit of 90 days in-hospitalization.

PROVIDER NETWORK AND REIMBURSEMENT:

The Department of Insurance Office of Special Projects contacts with five HMOs, and each plan insures a different region of the state. Plans are selected through a competitive bidding process. Three of the HMOs are Caring Foundations set up by Pennsylvania Blue Cross/Blue Shield. The State Department of Health approves provider networks, and children have their choice of providers from within the plan.

FINANCING:

The Pennsylvania Children’s Health Insurance Program is supported by a $0.02/pack state cigarette tax, which generates approximately $21.5 million annually. In the 1996 session, the program asked the state legislature to appropriate another $0.01 of the cigarette tax to the program. The cigarette tax fell through, but the legislature appropriated an additional $10 million in general funds to the program.