NASHP

Massachusetts CHIP Fact Sheet

For more than two decades, the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate incomes. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.

CHIP is currently funded through federal fiscal year (FFY) 2027 (Sept. 30, 2027) by the HEALTHY KIDS and ACCESS Acts. The Acts also extended the maintenance of effort (MOE) provision, which requires states to maintain eligibility standards that were in place in 2010 through FFY 2027. However, beginning in FFY 2020 MOE only applies to children in families with incomes at or below 300 percent of the federal poverty level (FPL).

Eligibility

Modified adjusted gross income (MAGI) eligibility levels for CHIP/Title XXI in Massachusetts (by age)

  Ages 0 – 1  Ages 1 – 5 Ages 6 – 17 Age 18
Medicaid expansion 185 – 200% FPL 133 – 150% FPL 114 – 150% FPL 0 – 150% FPL
Separate CHIP >200 – 300% FPL >150 – 300% FPL >150 – 300% FPL >150 – 300% FPL

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), MACStats: Medicaid and CHIP Data Book, December 2018, Exhibit 35: “Medicaid and CHIP Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State, April 2018,” and information from the state. Note: Eligibility levels do not include the mandatory 5% income disregard.

Coverage for Pregnant Women

Using CHIP funding, states can opt to provide coverage for pregnant women and/or services through the “unborn child” coverage option. Massachusetts provides coverage up to 200% FPL through the CHIP unborn child option.

Benefit Package

States that operate Medicaid expansion CHIP programs must follow Medicaid rules, providing all Medicaid-covered benefits to enrolled children, including the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services benefit. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines.

Delivery System

Massachusetts’ CHIP program uses the same delivery system as Medicaid. MassHealth uses a managed care delivery system (managed care organizations, accountable care organizations, and primary care case management (PCCM)). Individuals receive fee-for-service until they enroll in managed care or a PCCM.

Premiums and Cost Sharing

Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed 5 percent of family income annually.

Key Highlights:

Program type: Massachusetts operates a combination CHIP program called MassHealth.

Number of children covered: In FFY 2018, 227,819 children were covered by MassHealth CHIP. (Data from CHIP Annual Report Template System)

State’s enhanced federal match rate*: For FFY 2020, the federal match is 76.50 percent.

Participation rate: In 2017, 97.8 percent of eligible children in Massachusetts participated in either MassHealth Medicaid or CHIP.  (Urban Institute)

*The Affordable Care Act increased the federal CHIP match rate by 23 percentage points. The HEALTHY KIDS and ACCESS Acts maintained this increase through FFY 2019, and reduced it to 11.5 percentage points in FFY 2020. The federal CHIP match rate returns to states’ regular enhanced match rate in FFY 2021 and beyond.

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