Fact Sheets

Children’s Health Insurance Program Reauthorization Act (CHIPRA)
Performance Bonuses for FY 2013

Children’s Health Insurance Program Reauthorization Act (CHIPRA)

Performance Bonuses for FY 2013

About CHIPRA Performance Bonuses

• The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) established performance bonuses to give states an incentive to support enrollment and retention of eligible children in Medicaid and to help defray the costs associated with increasing enrollment of the lowest income children. 

• Federal funding for qualifying states is awarded annually in fiscal years 2009 through 2013.

• To qualify for a performance bonus, states must implement at least five out of eight specific program features aimed at streamlining their enrollment procedures to improve children’s health coverage programs and must increase children’s enrollment in Medicaid above a baseline level for the fiscal year. 

• The eight program features include:
  • 12-month continuous eligibility (Allows full-year enrollment regardless of income or other changes.)
  • Elimination or reduced verification of asset requirements
  • No requirement for an in-person interview
  • Same application and renewal forms for Medicaid and CHIP
  • Automatic/administrative renewal (pre-populated form; electronic verification used to streamline renewal)
  • Presumptive eligibility (allows health care providers and other entities to screen and presumptively enroll children; children have access to needed benefits while the full eligibility process is being completed)
  • Express Lane Eligibility (States can use eligibility findings from other public benefit programs, such as the Supplemental Nutrition Assistance Program (SNAP) to determine eligibility for Medicaid and CHIP.)
  • Premium Assistance

• The amount of a state’s bonus correlates with the increase in Medicaid enrollment: the more children enrolled, the higher the bonus.  States that increase enrollment more than 10 percent above their baseline receive a larger (Tier 2) bonus.

CHIPRA Performance Bonuses Awarded for FY 2013

• CMS is awarding over $307 million in bonus payments for FY 2013 performance to 23 states.  The 23 states awarded performance bonuses include:  Alabama, Alaska, Colorado, Connecticut, Idaho, Illinois, Iowa, Kansas, Maryland, Michigan, Montana, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Utah, Virginia, Washington, and Wisconsin.

• The bonus awards range from just over $1 million for North Dakota to over $58 million for Colorado.

• 15 of the 23 states produced enrollment increases of more than 10 percent above their baselines, earning a larger Tier 2 award.

Nation’s Record on Covering Children Advances

• Studies show that enrollment in Medicaid and CHIP has been driving the nation’s steady progress on increasing the number of children with health insurance coverage.

• A recent analysis by Georgetown University’s Center for Children and Families found that the coverage rate rose to 92.5 percent in 2011. Uninsurance rates for children declined from 8.6 percent in 2009 to 7.5 percent in 2011.

• The Urban Institute found that participation rates in Medicaid and CHIP have continued to improve over time.  In 2011, 87.2 percent of eligible children were enrolled, a 5.5 percentage point increase from 81.7 percent in 2008. In 2011, 19 states and the District of Columbia had participation rates at or above 90 percent.

More information about the CHIPRA Performance Bonuses is available at http://www.insurekidsnow.gov/.

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