The Children's Health Insurance Program now enrolls more than 7 million children, but it began as a collaboration between neighbors in Western Pennsylvania.
After the collapse of the steel industry in the early 1980s, churches, unions and other community organizations began raising money to fund medical coverage for children left uninsured. Highmark Health — then Blue Cross Blue Shield of Western Pennsylvania — matched these funds and administered the first health insurance program for at-risk children.
Highmark is celebrating 30 years of CHIP, the federal program designed to cover children whose families do not qualify for Medicaid but do not have other forms of insurance, in 2023. Pennsylvania created a state version of the program in 1992 that enrolled its first members in 1993, and the federal program was created in 1997.
Diana Kobus, CHIP program director at Highmark Inc., sat down with Becker's to discuss the organization's connection to the program and CHIP's role to play in Medicaid redeterminations.
Question: Highmark is connected to the origin of the CHIP program — how does that inform the work you do today?
Diana Kobus: It truly is the mission of Highmark that we've been pushing that we've had since 1984, to give healthcare to everyone who needs it. It's an awesome program that really transformed healthcare in our region, at the state level in 1992, when it was signed into law, and nationally in 1997. It's a public-private partnership that found a need in the community, worked together to figure out how we're going to fill that need, and brought care to those kids and families that didn't have it.
Q: Medicaid redeterminations are underway. How is CHIP impacted?
DK: We are separate from Medicaid — they are separate contracts and a separate department that overlooks it — but we are very much connected. It's an interesting partnership between Medicaid and CHIP in Pennsylvania.
For a lot of those children who are losing Medicaid coverage due to redeterminations, CHIP is here for them. It doesn't matter how much money your family makes. You could make $10 million a year, and your child could still qualify for CHIP in Pennsylvania because we don't have an income ceiling. For folks coming off of Medicaid, after the public health emergency, after redeterminations, CHIP is a really great option for a lot of families. Depending on what your income is, you might get CHIP completely free, or you pay a small premium to be covered for all of your primary care needs, preventive care needs, hospital, emergency, telehealth, behavioral health — it's such a robust benefit that is really needed right now as we all come out of this.
Q: Are you preparing for more CHIP enrollees as a result of redeterminations, and what does your outreach strategy look like?
DK: Pennsylvania as a whole is expecting to see a large number of children get back into the program. Because of our strange relationship, enrollment in the CHIP program in Pennsylvania has dipped. Our enrollment is down between 50,000 and 60,000 across the state, not just at Highmark. We are expecting to see at least that many return. I've also seen [Pennsylvania] DHS quote somewhere between 80,000 to 100,000 children who will be eligible for CHIP coming off of Medicaid.
We really are partnering with our friends over at Highmark Wholecare as they are communicating to their membership who is going through this, letting them know that we have plans that are available for them. CHIP is here for them. We're also doing a number of community events, we are working on different tools and resources that we'll put out on our website helping families understand what you need to enroll in CHIP, and how do you renew your CHIP coverage.
Not only are Medicaid families going through redeterminations, CHIP also had a continuous coverage requirement as well. … We kept them on the books, and now they have to complete the renewal so they don't also lose coverage. We're seeing in a number of places, so we want to make sure all of our families have the tools at their disposal, know how to enroll, who to call, who can help them as they're going through this.
Q: Do you expect there to be more uninsured children after continuous coverage requirements unwind?
DK: I hope to not see more uninsured children. I hope that all the outreach, the engagement, the different tools that everyone in Pennsylvania is putting out, I'm hopeful we don't see an influx in uninsured children. It's probably inevitable in some cases, as they're working through the system, a parent might not get something in the mail, they miss something. If we do see that, I think everyone in Pennsylvania, all of the managed care organizations, CHIP, especially Highmark, is focused on ensuring those kids get coverage, remain covered and don't lose that care.
Primary care is so important. Throughout COVID, a lot of children got behind on their necessary shots, they haven't been able to get their developmental screenings. … A primary care doctor is truly that quarterback of your care, especially as a child, to see how the child is growing, changing, and ensuring they are remaining healthy, both mentally and physically.
Q: Is there any advice or best practices you would share with other organizations managing CHIP and Medicaid redeterminations?
DK: I'm not sure I have any best practices, since this is truly something that is new to all of us. We've never really seen this kind of unwind being needed. It's hopefully a once-in-a-century event. Really what we're going for is persistence and options. We want to have many options to make it easy for our families to get in contact with us, to find the information they need, as well as continue to do that outreach, continue to stay top of mind, so they can ensure they're getting their renewals done, they're getting their redeterminations done, they're not going to lose healthcare coverage.