South Dakota 2014 CHIP Fact Sheet
Program Type: South Dakota operates a combination CHIP program, called CHIP.
Number of Children Covered: In FY2013, 17,362 children were covered by CHIP.*
State’s Enhanced Federal Match Rate: For FY2014, the federal match is 67.48%, and for FY2015 it is 66.15%.
*Data from Medicaid and CHIP Payment and Access Commission March 2014 MACStats report.
The Children’s Health Insurance Program (CHIP) was created in 1997 to provide quality health coverage for children under 19 in families that earned too much to qualify for Medicaid but were unable to afford coverage in the private market. Each state has the option to cover its CHIP population under its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 strengthened the program through increased federal funding, new outreach and enrollment opportunities, mental health parity, the requirement to cover dental care, and other provisions. In 2010, the Affordable Care Act (ACA) extended CHIP funding through federal fiscal year 2015 and required states to maintain Medicaid and CHIP eligibility levels and processes for children through 2019.1
Participation Rate: 87.6% of eligible children in South Dakota participated in either Medicaid or CHIP in 2011, the last year for which we have national data. The national average was 87.2% in 2011.2
Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).
|Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP in South Dakota (by Age Group) in 2014|
|Ages 0 – 1||Ages 1 – 5||Ages 6 – 18|
|Medicaid Expansion||178-182% FPL||178-182% FPL||125-182% FPL|
|Separate CHIP Program||183-204% FPL||183-204% FPL||183-204% FPL|
Notes: Under ACA, states must cover all children with incomes up to 133% FPL in Medicaid, but if they had been covered in CHIP (Title XXI) prior to 2014, the state still receives the Title XXI match. Eligibility levels do not include the mandatory 5% income disregard. Medicaid expansion program data from CMS staff; separate CHIP program data from CMS eligibility table.
Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in South Dakota’s CHIP program include (but are not necessarily limited to):
Delivery System: The provider network in CHIP is the same as Medicaid. Both programs use a managed care delivery system.
Premiums & 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 five percent of family income.
South Dakota’s CHIP program has no premiums or cost sharing.
Efforts to Simplify Enrollment and Renewals: CHIPRA established a five-year incentive program to support state efforts to simplify enrollment and renewal of eligible children in Medicaid and CHIP.3 From FY2009 – FY2013, South Dakota did not qualify for incentive payments.4
|Enrollment and Renewal Strategies Implemented in South Dakota, as of December 2013|
|Elimination of in-person interview*||
|Use of presumptive eligibility||
|Elimination of asset test*||
|Use of 12-month continuous eligibility||
|Use of joint application and renewal forms*||
|Use of express lane eligibility||
*ACA requires states to implement this strategy beginning January 2014. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter.
Other Program Characteristics: Below are some other key program characteristics of South Dakota’s CHIP Program.
|Does South Dakota…|
|Require a waiting period?5||Yes, 3 months|
|Offer a buy-in option?6||No|
|Cover dependents of public employees?7||No|
|Cover lawfully residing children without a five-year waiting period?8||No|
Quality Measures: States may report on a “core set” of quality measures for children. South Dakota reported on 2 measures for federal fiscal year 2012.
Source: Department of Health and Human Services, 2013 Annual Report on the Quality of Care for Children in Medicaid and CHIP, September 2013.
2 Genevieve Kenney et al., Medicaid/CHIP Participation Rates Among Children: An Update. September 2013. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407769