The Children's Health Plan originally limited program eligibility to children ages 1 through 8 in families with incomes below 185 percent of the federal poverty level and provided a restricted benefit package of ambulatory, preventive, and primary care services. The intent of the program was to ensure that the greatest possible number of children had at least some kind of basic coverage (Hill et al., 1993). After various Medicaid eligibility expansions, the Children's Health Plan raised its upper age limit. In January 1991, the program began to cover all children under age 18 in families with incomes below 185 percent of the federal poverty level.
Minnesota Care funding comes from a 2 percent excise tax on hospitals and health care providers and from monthly enrollee premiums, which are based on a sliding scale. Families with incomes greater than 275 percent of the federal poverty level are not eligible for a subsidy, on the assumption that other policies will be available to these families in the private market (Call et al., 1997). The program pays a monthly capitation to contracted health plans for a comprehensive array of services, and enrollees choose their health plan at the time of enrollment. There are no copayments for children. The program's one-page, mail-in application forms are available from schools and health and social services agencies, and applications can also be completed by telephone.
In addition to meeting the income guidelines, there is a 4-month waiting period after losing insurance coverage from another source. This provision is intended to discourage those who seek to replace private coverage with the state-subsidized plan. The Minnesota Department of Health estimates that Minnesota Care saves the state and federal government $1.8 million each month by meeting the state's cost-containment goals and growth limits (Minnesota Health Information Clearinghouse, 1996).
The programs have different benefit packages. Most of the programs have started out with a prevention and primary care program, i.e., not a lot of mental health coverage, not a lot of inpatient coverage. As these programs become more popular and as people understand what they are paying for and what the insurance risks are, the programs have been expanding.
National Academy for State Health Policy, Portland, ME
Public Workshop, June 2, 1997
In September 1991, the state of New York introduced Child Health Plus, a plan that uses state funds to purchase private health insurance for eligible low-income children. Child Health Plus is financed through the state's system of reserving funds for uncompensated hospital care, supplemented by enrollment fees and premium payments. With an enrollment approaching 160,000 by the end of 1997, Child Health Plus is the largest of state children's insurance programs. New York still has one of the highest rates of uninsured children: about 557,200 children still have no coverage, and state officials plan to double the number of children enrolled in Child Health Plus over the next 3 years (Johnson and McDonough, 1998).
Based on legislation that was enacted in 1996, all children aged 2 to 19 whose family income is below 120 percent of the federal poverty level are eligible for comprehensive benefits, and those with incomes from 120 to 222 percent of the federal poverty level are eligible with a sliding scale. Families with incomes above 222 percent of the federal poverty level pay the full cost of the premium. Premiums range from $477 to $656 per year depending on the region and specific health plan (Hill et al., 1993).
The Child Health Plus benefit package covers a wide array of ambulatory, preventive, and primary