CMS: CHIP and QHPs offer different levels of financial protection, benefits

Children’s Health Insurance Program plans and qualified health plans sold in the Health Insurance Marketplaces offer beneficiaries different levels of financial protection and benefits, according to a new report by the Centers for Medicare & Medicaid Services. The Social Security Act required the agency to review the benefits and cost sharing in QHPs and CHIP plans to ensure that QHPs are “at least comparable” to CHIP plans. Overall, the report found higher average out-of-pocket spending for the second-lowest cost silver plan sold in the Marketplace in the largest rating area of each state. In addition, the actuarial value of the CHIP plans exceeded the AV of the studied QHP in every state but Utah. However, when premiums were taken into account, average out-of-pocket spending in that state was also higher. The report also found that CHIP benefit packages were generally more comprehensive for “child-specific” services such as dental, vision and habilitative services, and for children with special needs. Based on the report, the Secretary of Health and Human Services will not certify any QHPs as comparable to CHIP coverage at this time. In related news, the Medicaid and CHIP Payment and Access Commission today released its latest data book on CHIP and Medicaid, providing policymakers with the latest trends and data for the CHIP program.