CHILDREN HEALTH INSURANCE PROGRAM (CHIP)

Overview: Proposed by President Clinton and passed as part of the historic, bipartisan Balanced Budget Act of 1997, the Children's Health Insurance Program (CHIP) is the largest single expansion of health insurance coverage for children in more than 30 years. Today, nearly 11 million American children -- one in seven -- are uninsured. This initiative was designed to reach these children, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance. This new initiative set aside $24 billion over five years for states to provide new health coverage for millions of children -- the largest children's health care investment since the creation of Medicaid in 1965. States will be able to use part of their federal funds to expand outreach and ensure that all children eligible for Medicaid and the new CHIP program are enrolled. More than 4 million uninsured children are eligible but not signed up for Medicaid. To improve the health of our nation's children, the President has challenged the public and private sectors to work together to educate families and help them enroll their children in Medicaid or CHIP.

The initiative is a partnership between the federal and state governments that will help provide children with the health coverage they need to grow up healthy and strong. At President Clinton's insistence, the CHIP program requires that states use this new money to cover uninsured children -- and not replace existing health coverage. The program also includes important cost-sharing protections so that families will not be burdened with heavy out-of-pocket expenses.

Funds for the program became available to the states on October 1, 1997. States will receive federal matching funds only for actual expenditures to insure children.

HHS has now approved all 56 state and territorial CHIP plans. In addition, to date, 21 states have had amendments approved to expand their CHIP plans. According to states' estimates, more than 2.6 million children will be covered by September 2000.

EXPANDING CHILDREN'S ACCESS TO HEALTH COVERAGE

The federal-state Children's Health Insurance Program (CHIP), created under Title XXI of the Social Security Act, expands health coverage to uninsured children whose families earn too much for Medicaid but too little to afford private coverage. It builds on Medicaid, the federal-state health insurance program that covers approximately 36 million low-income individuals, including 18 million children. Because Medicaid allows states flexibility in determining eligibility, states currently cover children whose family incomes range generally from below the federal poverty level (FPL) to as high as 300 percent FPL. (Note: One state, Tennessee, has no 300 percent cap.) The majority of states cover children in families between 100 and 150 percent of the FPL. The FPL for a family of four was $16,450 1998. In the new CHIP program, states may either cover children in families whose incomes are above the Medicaid eligibility threshold but less than 200 percent of poverty, or up to 50 percentage points over the state's current Medicaid income limit for children.

Ensuring Meaningful Health Benefits. Under the new program, states have flexibility in targeting eligible uninsured children. States may choose to expand their Medicaid programs, design new child health insurance programs, or create a combination of both. States choosing a new children's health insurance program may offer one of the following benchmark plans: the standard Blue Cross/Blue Shield Preferred Provider Option offered by the Federal Employees Health Benefit Program; a health benefit plan offered by the state to its employees; or the HMO benefit plan with the largest commercial enrollment in the state. A state may also choose to offer the "equivalent" of one of the benchmark plans. If a state chooses this option, its plan's value must be at least equal to the benchmark plan's and it must include: inpatient and outpatient hospital services; physicians' surgical and medical services; laboratory and X-ray services; and well baby/child care services including immunizations. In addition, a benchmark-equivalent plan must include benefits similar to the benchmark plan coverage of prescription drugs, mental health services, visions care, and hearing-related care. Under the law, New York, Pennsylvania and Florida can continue to offer the benefit plans under their existing state programs for uninsured children (with some modifications to comply with the law's cost-sharing protections). States choosing the Medicaid option must offer the full Medicaid benefit package.

Limiting Patient Costs. Patient out-of-pocket costs for this program are allowed but limited. If a state expands its Medicaid program, then existing Medicaid limits apply to the newly enrolled children. If a new health plan is developed, premiums for families whose income are under 150 percent of the poverty level cannot exceed $19 per family per month and copayments must be nominal. Cost sharing is not permitted for well-child, well-baby visits. For families with incomes above 150 percent of poverty, cost-sharing may be based on an income-related sliding scale with an annual total out of pocket maximum for all children not to exceed five percent of the family's income.

Preventing Cost Shifting. To prevent states from shifting children from the traditional Medicaid program to this new program, states must not tighten the Medicaid eligibility standards for children that were in place on March 31, 1997. In addition, states must screen all applicants, and must enroll in the Medicaid program those who meet the Medicaid eligibility rules, instead of enrolling those children in the new CHIP plan. For states that expand their existing Medicaid programs, children who would have been eligible under Medicaid eligibility rules in effect on March 31, 1997 cannot be counted in the scope of the CHIP-related expansion. All states must design their programs to prevent private cost shifting as well. In their child health plans, states will describe methods they will use to prevent "crowd out" or the shifting of children from private insurance to CHIP.

ACCESSING FEDERAL FUNDING

Under the new law, states are eligible to receive an enhanced federal matching rate drawn from an "allotment" for state programs approved by the Secretary of Health and Human Services that expands access to targeted, low-income children under the new CHIP program. Funds are allotted to each participating state according to their number of uninsured low-income children, accounting for regional cost differences. Available state allotments for fiscal year 1998, which were published in the Federal Register in September 1997, ranged from $3.5 million for Vermont's relatively small population to a high of $855 million for California.

Under current law, the calculation of CHIP funds for U.S. territories is separate than that used for states, resulting in a lower subsidy than is given to states. In order to provide more equitable funding for children's health care in U.S. territories, the President's fiscal year 2000 budget request asks Congress for an additional $34 million in additional CHIP funds to further aid American Samoa, Guam, Puerto Rico and other U.S. territories providing care to uninsured children.

States and U.S. territories may use up to 10 percent of the CHIP benefit expenditures for outreach efforts, additional services other than the standard benefit package for low income children, and administrative costs. To access the fiscal year 1998 allotment totaling $4.3 billion, states and territories must have their CHIP plans approved by the Secretary of Health and Human Services by Sept. 30, 1999. The fiscal year 1999 budget includes $4.247 billion for fiscal year 1999 state allotments. This includes $32 million for U.S. territories. Allotments for fiscal year 1999 funds were announced in February 1999 and are similar to the amounts for fiscal year 1998. However, states and territories will receive federal matching funds only for actual expenditures used to insure children.

EXPANDING OUTREACH

The Clinton/Gore Administration has made significant efforts to reach out to families whose children qualify for CHIP. These efforts include:

The Announcement of an Historic Private Sector Commitment to Provide Outreach. In February 1999, the President announced unprecedented new contributions from the private sector to help ensure that all children who are eligible for health insurance receive it including:

• A new toll-free number, 877-KIDS-NOW, that directs families anywhere in the nation to their state enrollment offices. President Clinton announced that the National Governors' Association (NGA) with a grant from Bell Atlantic established this national toll-free number to help states reach uninsured children. The number, 877-KIDS-NOW, automatically directs callers to their state's enrollment agency.
• A national radio advertising campaign to promote the Insure Kids Now Campaign. From February to June 1999, HHS sponsored a national radio advertising campaign to promote the 877-KIDS-NOW toll-free number and to complement states' outreach efforts. The $1.3 million radio campaign included a four-week paid radio campaign in major markets around the country. In addition, public service announcements in English and Spanish were distributed to an estimated 4,000 radio stations nationwide.
• Supporting the Insure Kids Now Campaign. The committee prepared an outreach training kit for use by workers from all federal departments that will participate in the Insure Kids Now campaign, in concert with the national toll-free number for children's health insurance outreach. The kit contains a presentation outline, posters, and materials that can be used as handouts. In addition, federal departments have promised to distribute more than 140,000 outreach posters to their grantees, field offices, and human services agencies.

Presidential Directive Launched a Government-Wide Effort to Enroll Uninsured Children. In February 1998, as the first step in his public-private children's health outreach campaign, the President directed executive agencies to commit to enrolling uninsured children CHIP. In response, over ten federal agencies developed plans in three areas: how to educate their workforce; how this workforce can help educate families about state health insurance programs; and how to coordinate cross-agency and public-private efforts to identify and enroll children in these programs. In June l998, this Federal Interagency Task Force on Children's Health Insurance Outreach submitted a report to the President, outlining activities that federal agencies would undertake to identify and to help enroll children in Medicaid or other health insurance programs through June l999. The President charged the Secretary of the Department of Health and Human Services with oversight of the implementation of this outreach initiative.

Since then, each of the departments has been actively engaged in the outreach activities they identified in this report. For example, the Department of Agriculture has widely distributed CHIP information to WIC programs in states. In Virginia, the WIC Program has distributed 100,000 CHIP brochures and applications to WIC participants during clinic visits. HUD-sponsored Neighborhood Networks centers, which provide computer training at no cost to residents of more than 400 HUD-assisted multifamily housing developments, have started serving as an access point to download federal and state information about Medicaid and CHIP.

• $45 million in commitments from private foundations across the country. The Robert Wood Johnson Foundation is spending $45 million over the next three years to fund innovative state-local coalitions to design and conduct outreach initiatives, simplify enrollment processes, and coordinate existing coverage programs. The Kaiser Family Foundation will spend up to $10 million over 5 years on studies to help understand why eligible children do not enroll in existing programs and how best to provide insurance coverage for these children. America's Promise, with support from the Robert Wood Johnson Foundation and in collaboration with the American Academy of Pediatrics, is mobilizing corporations such as SmithKline Beecham and Schering Plough and local communities nationwide in children's health outreach efforts.
• New initiatives from corporate and advocacy organizations to reach out to uninsured children. Proctor and Gamble, the manufacturer of Pampers diapers, volunteered to include a letter in its child birth education packages, given to 90 percent of first-time mothers, providing families information about available health insurance options. Grocery stores and chain drug stores across the country committed to providing information about the new toll-free number to their customers. The National Education Association will launch an unprecedented effort to educate teachers on how they can inform children and their families about health insurance, through national newsletters, conferences, and special training sessions. The American Hospital Association's Campaign for Coverage will increase its nationwide initiative to engage hospitals in helping uninsured Americans, including children.

BUILDING ON PREVIOUS CLINTON ADMINISTRATION ACTIONS

Since 1993, HHS has approved Medicaid waivers for 18 states for comprehensive health care reform projects that have allowed states to control costs and expand coverage. In addition, the 1996 welfare reform law provides $14 billion over five years in childcare funding to help more mothers move into jobs. It also guarantees that individuals who meet pre-welfare reform welfare-eligibility criteria continue to be eligible to receive Medicaid, including at least six months of transitional Medicaid when they leave welfare for work.

President Clinton also signed into law the Health Insurance Portability and Accountability Act of 1996 (HIPAA), creating important new protections for an estimated 25 million Americans, approximately 1 in 10, who move from one job to another, who are self-employed, or who have pre-existing medical conditions.

CHIP also builds on the Clinton/Gore administration's long standing commitment to improving health care for children. The President has issued guidelines to eliminate easy access to tobacco products and to prohibit companies from advertising tobacco to children. In addition, President Clinton had announced that over 90 percent of America's toddlers received the most critical doses of each of the routinely recommended vaccines in 1996 -- surpassing the administration's goal set in 1993. And the FDA recently released a rule that requires manufacturers to do studies on pediatric populations for new prescription drugs as well as those currently on the market.

Combined, the Clinton/Gore administration's efforts will help assure that children get the healthy start they need to live long and productive lives.

STATE CHIP PROGRAMS
Descriptions of approved state CHIP programs follow:

Alabama
Alabama could receive over $85 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state is implementing its CHIP plan in two phases. The first phase expands Medicaid eligibility to uninsured children under 19 years of age whose family incomes do not exceed 100 percent of the federal poverty level (FPL). The AL-Kids program, the second phase, is a separate state children's health insurance program that will expand coverage to children up to age 19 whose family income is between 100 and 200 percent of the FPL. AL-KIDS offers coverage comparable to the HMO with the largest insured commercial, non-Medicaid enrollment in the state. With both phases, Alabama expects to insure 36,000 children by September 2000. Alabama will hire extra outreach workers to increase the number of children located and enrolled in Medicaid. Information on the new program will be advertised through newspapers, public service announcements and through the school system. Alabama was the first state approved on January 30, 1998 and its amendment was approved August 18, 1998.

Alaska
Alaska could receive as much as $6.8 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Alaska will use its CHIP allotment to expand its Medicaid program. Currently, the state covers children to age 1 in families with incomes up to 185 percent of the FPL, children 1-6 in families with incomes up to 133 percent of poverty, and children ages 6-19 in families with incomes up to 100 percent of poverty. The state will use its Title XXI funds to expand Medicaid coverage to children in families with incomes up to 200 percent of the FPL. Eligible children will receive the full Medicaid benefit package and there are no cost sharing requirements. To reach eligible children, the state will work with local governments, schools, health care providers, tribal entities, and non-profit corporations serving children. The state plans to implement expanded eligibility on March 1, 1999 and expects to enroll 5,000 children by October 2000. Alaska's plan was approved December 11, 1998.

American Samoa
American Samoa could receive as much as $128,850 for fiscal year 1998 and $512,250 for fiscal year 1999 for its CHIP plan. The territory will use its allotment to expand Medicaid to children receiving services through a territory-funded program. The local government will not expand income limits, but instead expand the number of children served. Enrollees will receive the benefits package provided through the American Samoa Medicaid program and there is no cost-sharing requirement. American Samoa's CHIP plan was approved April 13, 1999.

Arizona
Arizona could receive as much as $116 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Arizona used its CHIP allotment to create, KidsCare, a new health insurance program that will cover children from birth through age 18. Income eligibility will increase over time, beginning at 150 percent of the FPL and rising to 200 percent FPL effective October 1, 1999. The state expects to insure nearly 50,000 children by September 2000. Enrollees will receive coverage through established Arizona Health Care Cost Containment System plans and state employee health maintenance organizations that elect to participate in the program. American Indians may choose to receive services through the Indian Health Service as well. Participants will pay a $5 copayment for non-emergency use of the emergency room. Premiums will be imposed on families with income between 150 percent and 200 percent FPL, effective October 1, 1999. To assist with outreach, the state has created an Outreach Coordinator position and has sent applications to organizations that serve low-income children. Arizona's plan was approved on September 18, 1998, its first amendment was approved on May 21, 1999 and its second amendment was approved on August 23, 1999.

Arkansas
Arkansas could receive over $47 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its CHIP allotment to expand Medicaid coverage to nearly 3,600 children who would otherwise not have health insurance. It will cover children born after September 30, 1982 and prior to October 1, 1983 whose family income is at or below 100 percent of the FPL. Arkansas is currently considering how to structure the second phase of its Title XXI program to cover even more children. The state currently has a Medicaid section 1115 waiver, ARKids First, that serves children through age 18 with family incomes up to 200 percent of poverty. Outreach activities will include radio and TV ads, a direct mail campaign, a toll-free number, and print advertising. Arkansas' plan was approved on August 6, 1998.

California
California could receive as much as $854.6 million for fiscal year 1998 and $850.6 million for fiscal year 1999 for its CHIP plan. The state will expand its Medicaid program, known as Medi-Cal, by making children under age 19 eligible if they have family incomes at or below 100 percent of the federal poverty level. The state will also expand its current state program, known as Access for Infants and Mothers (AIM), which will cover infants up to age 1 from 200 percent to 250 percent of poverty. Through CHIP, California will also expand its Healthy Families program, which will provide coverage for children age 1-19 with family incomes from 100 percent to 200 percent of the federal poverty level. California expects to insure 500,000 children. As part of its outreach efforts, California will subcontract for a media campaign with private and community based organizations, health brokers and insurance agents to directly identify and assist potential enrollees in filling out the joint application form for the Medi-Cal and Healthy Families program. In addition, California will conduct a provider education campaign to support its outreach effort. California's plan was approved on March 24, 1998 and its amendment was approved on June 29, 1998.

Colorado
Colorado could receive up to $41 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will expand children's access to health coverage by building on its own Colorado Child Health Plan. The state expects to cover a total of 23,000 children under this non-Medicaid managed care plan by September 2000. The benefit package will include services such as hospital and emergency room transport, inpatient services, medical office visits, and prescription drugs. Coverage will be provided to children from birth through age 17 for families whose income is at or below 185 percent of the federal poverty level. The state will publicize the program through press releases, public service announcements, schools, employers, county agencies and regional and social agencies. Colorado's plan was approved on February 18, 1998.

Commonwealth of the Northern Mariana Islands
The Commonwealth of the Northern Mariana Islands could receive $118,000 in federal funds for fiscal year 1998 and $470,000 for fiscal year 1999 for its CHIP plan. The Northern Mariana Islands will use the CHIP allotment to expand Medicaid for children under age 19 who are currently receiving services through a territory-funded program. The local government will not expand income limits, but instead expand the number of children served, an estimated 2,000 by September 2000. Northern Mariana Islands' CHIP plan was approved on August 26, 1999.

Connecticut
Connecticut could receive approximately $35 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its new allotment to both expand its Medicaid population and create a new program based on the state employee's health plan. Under the state's HUSKY program, Medicaid eligibility will be expanded to include children ages 14 through 18 with household incomes of up to 185 percent of the federal poverty level. Previously, the Medicaid program only covered children up to age 13 in families with incomes up to 185 percent of poverty. The new health insurance program, Part B of HUSKY, will be targeted toward children up to age 18 in families with incomes up to 235 percent of poverty. The state will apply an income disregard - setting aside certain types of income the family may have - effectively bringing coverage to 300 percent of poverty. Before income disregards are applied, HUSKY Part B will charge families with incomes above 235 percent of poverty premiums of $30 per child, with an upper limit of $50 per family. The state estimates that an additional 15,000 children will be added to the HUSKY program by June 2000. Children with special physical and behavioral health needs will receive those services under a special third part of the program, HUSKY Plus. Outreach for the state will include radio and TV ads, a direct mail campaign, brochures/flyers, video, a toll-free number, web sites and state presentations and mail-in applications. Connecticut's plan was approved on April 27, 1998.

Delaware
Delaware could receive as much as $8 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Delaware will use its CHIP allotment to create a separate state children's health insurance plan that targets children under age 19 whose family incomes are less than 200 percent of the FPL. Coverage will be provided through the state employee health plan and will include pharmaceutical/prescription drug services, mental health and substance abuse care. Monthly premiums will be charged on a sliding scale based on income. Delaware officials estimate they will insure about 10,500 children by September 2000. Delaware's plan was approved on September 1, 1998.

District of Columbia
The District of Columbia could receive as much as $12 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The District plans to expand its Medicaid program to children from birth to age 19 whose family income is less than 200 percent of the FPL. Enrollees will receive the regular Medicaid benefits package and there will be no cost sharing for families. The District anticipates enrolling nearly 8,400 children in its program, which will be called Healthy DC Kids. As part of its outreach efforts, the District will set up a telephone hotline to handle inquiries and has created a single, two-page, mail-in application for both Medicaid and CHIP. The District of Columbia's CHIP plan was approved September 17, 1998.

Florida
Florida could receive as much as $270 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Phase One of Florida's new CHIP plan expanded Medicaid eligibility to children ages 15 through 18 in families earning up to 100 percent of the FPL and expanded Florida's Healthy Kids program, a comprehensive program that was piloted in 20 counties, to additional counties. Phase Two creates the Florida KidCare Program which consists of: expanding the Healthy Kids program on a state-wide basis and expanding eligibility for the program to children through age 18 in families with incomes up to 200 percent of FPL; creating the MediKids program to provide coverage for children up to age 5; creating the Children's Medical Services Network for children up to 18 with special needs. The state plans to simplify is enrollment form and enrollment process. State officials hope to enroll 175,000 children in the combined Florida plans. Florida's plan was approved on March 6, 1998, and its amendment was approved on September 8, 1998.

Georgia
Georgia could receive as much as $124 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Georgia will create a separate insurance program for children from age 0-18 whose families have incomes of less than 200 percent of poverty and who are not eligible for Medicaid. Enrollees will receive benefits comparable to the current Medicaid package. There is no cost sharing for children under age 6; for children over age 6 there is a monthly premium of $7.50 for one child and $15 for two or more children. The state expects to insure 58,000 children by September 2000. Georgia's plan was approved September 3, 1998.

Guam
Guam could receive as much as $375,800 for fiscal year 1998 and $1.5 million for fiscal year 1999 for its CHIP plan. Guam opted to use its CHIP allotment to expand its Medicaid program to children receiving services through a territory-funded program. The availability of CHIP funds will help the territory serve more children. The local government will not expand income limits, but instead expand the number of children served. The current categorically needy income level in Guam for a family of four is $17,232--slightly higher than the continental United States. The regular Medicaid benefits package will be provided and there will be no cost to the families participating in the program. Guam's plan was approved on March 29, 1999.

Hawaii
Hawaii could receive as much as $9 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its CHIP allotment to expand Medicaid to cover children between ages 1 and 6 with incomes up to 185 percent of the FPL. Enrollees will receive the state's Medicaid benefit package and there will be no out-of-pocket costs to families participating in the program. Hawaii's CHIP plan builds on its Medicaid demonstration program -- QUEST -- which is attempting to provide universal coverage for residents who are not covered under the state's mandatory employer-sponsored insurance program. Hawaii will launch its CHIP plan in January 2000 and it plans to submit amendments to expand the program to more children. For outreach activities, the state will collaborate with schools to provide Medicaid and CHIP information. Hawaii will also distribute Medicaid and CHIP information through health care providers, the unemployment office, the Office of Youth Services, places of worship, and activity-based organizations such as sports, scouts, and schools of Hula. In addition, the state will establish a toll-free information line, a web site, and a media campaign on the Medicaid/CHIP program. The state expects to insure an additional estimated 500 children by September 2000. Hawaii's plan was approved January 19, 1999.

Idaho
Idaho could receive as much as $15.8 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to insure nearly 5,000 children. Idaho will use its new CHIP allotment to expand Medicaid eligibility to children up to age 19 in families with incomes up to 160 percent of the federal poverty level. Due to state legislation, the income threshold will be 150 percent of the federal poverty level effective, July 1, 1998. The state has formed a task force to study ways of further expanding Idaho's CHIP program. Children in the Medicaid expansion will receive the state's standard Medicaid benefit package, which includes inpatient and outpatient hospital services, inpatient psychiatric care, physician services, dental services, home health services, lab services, and prescription drugs. Outreach activities include mailing postcards to potential enrollees describing Title XXI. The mailing list is comprised of families who have lost cash assistance between April and December 1997. Idaho's was approved on June 15, 1998 and its amendment was approved on December 4, 1998.

Illinois
Illinois could receive over $122 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to insure 40,000 additional children within by September 2000. With its new CHIP allotment, Illinois will expand Medicaid eligibility for children up to age 19 whose families have incomes at or below 133 percent of the federal poverty level. Prior to the CHIP expansion, the income level for Medicaid eligibility varied based on the age of the child. Under the new program, income thresholds have been equalized. State outreach efforts will include reviewing automated records to identify eligible participants followed by the notification of those individuals. In addition, the Illinois Department of Public Aid will send a notice to all non-assistance Child Support families informing them of the program and of locations where families can go to enroll their children. Illinois' plan was approved on April 1, 1998.

Indiana
Under the CHIP program, Indiana could receive as much as $70 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Indiana will use its new allotment to expand its Medicaid program and estimate that they will insure as many as 58,000 more children by September 2000. The program will expand eligibility to children up to age 19 in families with incomes up to 150 percent of the federal poverty level, and the state has formed a task force to study ways to further expand its CHIP program. Children in the Medicaid expansion population will receive the state's standard Medicaid benefit package, which includes inpatient and outpatient hospital services, inpatient psychiatric care, physician services, dental services, home health care, lab services and prescription drugs. To raise awareness about the program, the state will launch a media campaign and conduct outreach through state and local government agencies and community organizations. Indiana's CHIP plan was approved on June 26, 1998.

Iowa
Iowa could receive as much as $32 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Iowa will use its new CHIP allotment to expand Medicaid by raising income eligibility in several different age categories. The Medicaid expansion will allow children from age 6 - 18 in families whose incomes are up to 133 percent of FPL to enroll. The state's current Medicaid program covers infants up to one year of age whose families have incomes of up to 185 percent of FPL. Iowa amended its CHIP plan to add a non-Medicaid component called HAWK-I. HAWK-I provides health care coverage, via contracts with commercial health plans, to children whose family income is less than 185 percent FPL. The benefit package for CHIP will be the same as the current Medicaid package and the state will contract an organization to run an outreach program. This outreach program will work with community and statewide organizations including provider associations, advocacy groups, Native American Tribal Councils, and refugee resettlement programs. Officials expect to insure 55,000 children by September 2000. Iowa's plan was approved September 1, 1998 and its amendment was approved June 16, 1999.

Kansas
Kansas could receive as much as $30 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. With its new CHIP allotment, Kansas will create a separate insurance program called HealthWave for children through age 18 whose families have incomes of less than 200 percent of the FPL. The benefit package for children enrolled in CHIP will be the same as offered to state employees. Families with incomes above 150 percent of FPL must pay a monthly premium. Families with income between 151 and 175 percent of poverty will pay $10 per month per family, and families between 176 and 200 percent of poverty will pay $15 per month per family. The state will target low-income children for outreach through the public schools and will offer a toll free number to access enrollment information. Kansas hopes to enroll 30,000 children by December 1999. Kansas' plan was approved on September 1, 1998.

Kentucky
Kentucky could receive over $49 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Kentucky will use its allotment to both expand its Medicaid program and launch a separate insurance program called K-CHIP. Children through age 18 who are in families with incomes up to 150 percent of the FPL will be enrolled in CHIP as a Medicaid expansion. Children from birth to age 19 in families with incomes up to 200 percent of the FPL, and who are not eligible for Medicaid, will be enrolled in K-CHIP. The K-CHIP benefit plan will be a benchmark equivalent to the Standard High Option HMO plan for state employees. There is some cost sharing, but costs will not exceed 5 percent of family income. Families with incomes between 150 and 200 percent of the FPL will pay a maximum of $120 for a six-month period, and payments can be made at $20 each month or $60 per quarter. To reach eligible children, the state will conduct a media campaign and outreach activities at schools, clinics, community centers, health fairs, health departments, and housing projects. Kentucky expects to enroll nearly 50,000 children by June 2000. Kentucky's plan was approved November 25, 1998 and its amendment was approved on September 3, 1999.

Louisiana
Louisiana could receive as much as $101 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its allotment to expand Medicaid to children ages 6 through 18 whose family income is at or below 100 percent of the federal poverty level. The benefit package will be the regular state Medicaid program and there will be no cost sharing for families. The state plans to launch a large outreach campaign to educate potential CHIP enrollees. The campaign will include media advertising and mailing to specific target audience groups, including low income working parents, current and former recipients of Families Independence-Temporary Assistance Program, children with special needs, Native Americans, and migrant children. Louisiana also amended its original plan to cover uninsured children through age 19 with family incomes under 150 percent FPL. Louisiana estimates it will enroll more than 39,000 children by September 2000. Louisiana's plan was approved October 20, 1998 and its amendment was approved August 27, 1999.

Maine
Maine could receive as much as $12 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its new funds to expand coverage to 10,400 children by July 2000 by combining both a Medicaid expansion and a statewide children's health insurance program, Cub Care. Through CHIP, Maine will expand coverage to children through age 18 with family incomes up to 185 percent of the federal poverty level. The Medicaid expansion will cover children aged one through 18 in families with incomes up to 150 percent of poverty. The Cub Care program will cover children in families with incomes from 151-185 percent of poverty. State outreach efforts will include a targeted media and direct mail campaign. Maine's plan was approved on August 7, 1998.

Maryland
Maryland could receive over $61 million in federal CHIP funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Maryland will expand its Medicaid program with its new CHIP allotment to an estimated 15,500 uninsured children. Under the CHIP plan, children between birth and age 19 whose family incomes are below 200 percent of poverty will receive coverage. Children covered by CHIP will receive the Medicaid benefits package. To reach families who might be eligible for CHIP, the state will launch a grassroots information dissemination campaign involving state agencies, advocacy and community groups and provider organizations. In addition, the state will launch a public media and advertising campaign to include television, radio, mass transit, and newspaper advertising. Maryland's plan was approved July 29, 1998.

Massachusetts
Massachusetts could receive over $42 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to expand the state Medicaid program and create a separate Family Assistance Plan. With its federal allotment, the state hopes to bring enrollment in the program to 37,000 children. Massachusetts will provide the state's regular Medicaid benefit package to newly-enrolled children. The eligibility level for Medicaid will be increased from the current 133 percent of FPL to children in families with incomes of up to 150 percent of poverty. The state will also use its CHIP funds to create the Family Assistance Plan for children with family incomes between 150 and 200 percent of poverty. Uninsured children with family incomes over 150 percent of poverty will be eligible for either a "direct coverage option" or for financial assistance for families to purchase dependent coverage through their employers, the so-called "premium assistance option." The Family Assistance Plan will provide coverage equivalent to the insurance plan offered to federal employees in the state. These families will pay a monthly premium of $10 per child with a family maximum of $30 per month. Proposed outreach includes school-based campaigns, distribution of promotional materials, and giving mini-grants to community organizations to help locate hard-to-find potentially eligible children. Massachusetts' plan was approved on May 29, 1998.

Michigan
Michigan could receive over $91 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to insure as many as 133,000 new children by September 2000. The state will use its new allotment to implement MIChild. The program will provide comprehensive health care coverage to all children under age 19 whose families have incomes at or below 200 percent of the federal poverty level. Children in families at or below 150 percent FPL will be enrolled in a Medicaid expansion program. Children above 150 percent FPL will enroll in a separate CHIP program. The benefit package will mirror the state employees' plan and will be administered by multiple managed care providers. Some co-payments will apply for families between 151-200 percent of poverty. The state's outreach efforts will include demographically-targeted media campaigns and coordination with relevant community programs and agencies. Michigan's plan was approved on April 7, 1998 and its amendment was approved on June 29, 1998.

Minnesota
Minnesota has been among the most progressive states in the nation in providing health insurance coverage for children and families. The approval of Minnesota's plan enables the state to lay the groundwork for its CHIP program and to secure its CHIP allotment, which could be as much as $28 million for both fiscal year 1998 and fiscal year 1999. Minnesota currently covers approximately 50,000 children who would otherwise be uninsured. The state has accomplished this through a Section 1115 Medicaid waiver amendment, granted in 1995. The MinnesotaCare program provides health coverage to pregnant women and children with family incomes up to 280 percent of the federal poverty level. Minnesota's plan was approved July 17, 1998.

Mississippi
Mississippi could receive as much as $56 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Mississippi will expand Medicaid to cover children ages 15 through 18 in families with incomes up to 100 percent of the federal poverty level. The state estimates that it will enroll 45,000 children by September 2000. Recipients will receive the regular Medicaid benefit package and there are no cost sharing requirements. Mississippi also expanded its CHIP plan with an amendment that will create a new state health insurance program to cover children up to age 19 in families with incomes between 100 and 133 percent of the federal poverty level. The benefit package for the new separate program will be equivalent to that offered to state employees, with the addition of vision, hearing and dental services. There will be no family cost-sharing requirement. As part of an outreach plan, Mississippi will develop a broad based media campaign that will include television, radio and print advertisements. In addition, it will provide information to community health care providers, hospitals, health clinics, Indian reservations and schools. Mississippi's plan was approved October 26, 1998 and its amendment was approved February 10, 1999.

Missouri
Missouri could receive as much as $51 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to insure as many as 90,000 new children. Missouri will use its new allotment to expand insurance coverage to children within the state's existing Medicaid managed care program, known as MC+. The program will expand eligibility to children in families with incomes up to 300 percent of the federal poverty level. Missouri's statewide health care reform demonstration plan was approved through a Section 1115 Medicaid waiver. It will allow the state to slightly alter the Medicaid benefit package and also enroll the CHIP children in Medicaid after the state's CHIP funds are exhausted. This Medicaid waiver will also provide coverage for certain adults, including working parents leaving welfare and mothers who otherwise would have lost their Medicaid following childbirth. Outreach efforts will be coordinated at state offices in every county. Free materials will also be available and distributed to other entities such as social welfare organizations, schools and health care providers. Missouri's plan was approved on April 28, 1998 and its amendment was approved on September 11, 1998.

Montana
Montana could receive over $11 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. Montana expects to insure 9,000 children by June 2000 by creating a statewide children's health insurance program. Children under age 19 whose families have incomes of less than 150 percent of poverty will qualify for the Montana CHIP plan. The benefits package will mirror the state employee health plan, including prescription drugs, emergency room services, and mental health and substance abuse treatment services. For families with incomes at or above 100 percent of poverty, the state will charge an annual enrollment fee of $12 for one child and $15 for families with two or more children enrolled. Copayments for some services will be charged for families whose income is above 100 percent of FPL. Copayments will be capped at $200 per family per year. Montana's plan was approved September 11, 1998.

Nebraska
Nebraska could receive as much as $14.8 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The first phase, Kids Connection Phase I, expanded Medicaid coverage to children age 15 through 18 whose family income is at or below 100 percent of the federal poverty level. Enrollees in Phase I received the state's regular Medicaid benefit package. The amendment, Kids Connection Phase II, expanded Medicaid eligibility to children under age 19 whose family incomes are up to 185 percent of the federal poverty level. Total enrollment for both phases is estimated to be 17,000 by September 2000. To encourage enrollment, the state will work with advocacy agencies in disseminating information as well as distribute pamphlets and brochures. Neither phase has cost-sharing for enrollees. The state's original plan was approved August 7, 1998, and its amendment was approved October 13, 1998.

Nevada
Nevada could receive over $30 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. With its new CHIP allotment, the state will create, Nevada Check Up, a statewide health insurance program which will provide coverage to children up to age 18 in families with incomes at or below 200 percent of poverty. The Nevada Check Up program is estimated to cover 44,000 children. To encourage enrollment, the state has simplified the CHIP eligibility application, which will be available statewide through schools, child care facilities, family resource centers, social service agencies, and other locations where eligible children and/or their parents frequent. The state has also established a toll-free information number, which is listed on posters, marketing brochures, and the application form. Public service announcements are also planned. Nevada's plan was approved on August 13, 1998.

New Hampshire
New Hampshire could receive as much as $11.4 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its CHIP allotment to expand its Medicaid program and create a separate statewide children's health insurance program. Healthy Kids-Gold, or Phase I, will expand Medicaid eligibility for newborns and infants up to age one in families with incomes up to 300 percent of the FPL. Healthy Kids-Silver, or Phase II, will be a separate statewide health insurance plan that will mirror the benefit package offered to federal employees in the state. Healthy Kids-Silver is aimed at children ages 1 to 19 in families with incomes up to 300 percent of poverty. In order to expand its coverage to this level of family income, the state will apply an income disregard setting aside certain types of income the family may have. The state expects to insure 4,000 children by September 2000. New Hampshire's plan was approved September 15, 1998 and its amendment was approved on March 25, 1999.

New Jersey
New Jersey could receive as much as $88 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan, which state officials will use to insure as many as 102,000 new children. The state will use its new allotment to create NJKidCare which will include a Medicaid expansion and a new state CHIP plan. The Medicaid expansion will provide comprehensive health care coverage to all children under age 19 whose families have incomes at or below 133 percent of the federal poverty level. The new CHIP insurance program will be targeted to children in families with incomes above 133 percent to 200 percent of poverty. New Jersey amended its plan to cover children through age 18 whose family incomes are between 200 and 350 percent FPL. The new program will charge families a $15 per month premium. The state will have a fourfold outreach effort which will include: public awareness, targeted outreach, community education, and consumer education. The state is also committed to targeting outreach to special populations such as HIV and homeless populations. New Jersey's plan was approved on April 27, 1998, its first amendment was approved on May 7, 1999, and its second amendment was approved on August 3, 1999.

New Mexico
New Mexico could receive approximately $63 million for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its allotment to expand its Medicaid program for children from birth to age 18 in families with incomes up to 235 percent of the FPL. Enrollees will receive the state's Medicaid benefit package. Families with incomes between 186 and 235 percent of the FPL will pay copayments of $5 for most services, but cost sharing cannot exceed five percent of a family's income. In accordance with the CHIP law, preventive services and prenatal care are exempt from cost sharing. Working with a private contractor, the state will conduct a public awareness campaign to inform potential enrollees. In addition, New Mexico will work with the Indian Health Service to assure CHIP access to American Indians. New Mexico expects to insure 5,000 children by September 2000. New Mexico's CHIP plan was approved January 11, 1999.

New York
New York was one of three states for which existing children's health coverage benefit packages were "grandfathered" into the CHIP legislation. The state could receive as much as $256 million in new funds for fiscal year 1998 and $ 254 million in fiscal year 1999 for its CHIP plan, which state officials will use to insure as many as 360,000 additional children by September 2000. New York will use its new allotment to expand its existing CHPlus program to children up to age 19 whose families have net incomes at or below 192 percent of the federal poverty level. CHPlus is a partnership between the state and private insurers with the state subsidizing private coverage for enrollees. The benefit package includes a full range of inpatient and outpatient services. The state's outreach activities will include a statewide media campaign that will be conducted by the New York State Department of Health. New York's plan was approved on April 1, 1998.

North Carolina
North Carolina could receive over $79 million in new funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. North Carolina will use its CHIP allotment to create a separate state health insurance program to provide coverage to uninsured children whose family income does not exceed 200 percent of the federal poverty level. The state expects to insure 35,000 children. Families whose incomes rise above 200 percent of poverty up to a maximum of 225 percent will be able to buy into the program for one year. The benefit package is equivalent to that offered to state employees, plus Medicaid-equivalent benefits for children with special health care needs. North Carolina plans to improve outreach efforts by simplifying the application forms for both Medicaid and CHIP and by using existing public/private partnerships between local departments of health and social services. North Carolina's plan was approved on July 14, 1998, its first amendment was approved on January 15, 1999, and its second amendment was approved on June 23, 1999.

North Dakota
North Dakota could receive as much as $5 million in new CHIP funds for both fiscal year 1998 and fiscal year 1999. The approval of North Dakota's plan enables the state to lay the groundwork for its CHIP program and to secure its fiscal year 1998 CHIP allotment. The first phase of the state's program will enroll 500 children by expanding its Medicaid program to include 18-year-old children whose family income is at or below 100 percent of the federal poverty level. Currently, North Dakota's Medicaid program covers children age seven through 17 whose families have incomes of 100 percent of poverty or less and children up to age 6 are eligible if their families have incomes at or below 133 percent of poverty. The benefit package is the same as the Medicaid program in the state. North Dakota's plan was approved October 9, 1998.

Ohio
Ohio could receive over $115 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. With its CHIP allotment, Ohio will expand eligibility within its existing Medicaid program. The state will expand Medicaid eligibility to cover children up to age 19 whose families have incomes at or below 150 percent of the federal poverty level and will expand coverage to as many as 133,000 uninsured children. To encourage enrollment, the state will survey community agencies on how they conduct Medicaid eligibility outreach, and develop media strategies for statewide education provided to Medicaid consumers and providers. Ohio's plan received approval on March 23, 1998.

Oklahoma
Oklahoma could receive over $85 million in new funds for both fiscal year 1998 and fiscal year 1999, which state officials will use to expand its Medicaid program. With its federal allotment, the state hopes to expand coverage to 71,000 children. Oklahoma will provide the state's regular Medicaid benefit package to the newly-enrolled children. Oklahoma plans to use its CHIP allotment to provide Medicaid coverage to children born on or after October 1, 1983, with family incomes up to 185 percent of the federal poverty level. The Oklahoma Health Care Authority is collaborating with other interested agencies in the state to develop a marketing and outreach plan. The plan will consist of posters, public service announcements, fact sheets, press releases and outdoor advertising. Oklahoma's plan was approved on May 27, 1998 and its amendment was approved on March 25, 1999.

Oregon
Oregon could receive as much as $39 million in new funds for both fiscal year 1998 and fiscal year 1999, which state officials estimate they will use to enroll approximately 17,000 children in their CHIP. Oregon will use its new allotment to expand coverage to children from birth to age 6 with incomes between 133 percent and 170 percent of the federal poverty level. Coverage will also be extended to children from age 6 to age 19 with family incomes between 100-170 percent of poverty. Children in the new CHIP program will receive the same benefit package as children currently enrolled in the state's Medicaid section 1115 waiver demonstration. The benefit package includes inpatient and outpatient hospital services, inpatient psychiatric services, physician services, dental services, home health services, lab services, prescription drugs and other medically necessary services. Oregon will convene a task force of public and private partners to develop a consolidated Medicaid and CHIP outreach plan. Oregon's plan was approved on June 12, 1998.

Pennsylvania
Pennsylvania could receive approximately $117 million in new funds for both fiscal year 1998 and fiscal year 1999, which state officials will use to fund its existing Pennsylvania CHIP program. Pennsylvania is one of three states that had the benefit package of their existing state children's health program grand-fathered under CHIP. State officials estimate that with the state's initial plan and amendment, Pennsylvania will be able to insure 109,000 children by September 2000. The first phase provided coverage to children age one through 16 with family incomes at or below 185 percent of poverty. The amendment to Pennsylvania's CHIP plan expands eligibility for children from birth to age 18 in families with incomes up to 200 percent of the federal poverty level. The benefit package includes a full range of inpatient services. Outreach activities in the state include canvassing local businesses, day care centers, school districts, hospitals, religious organizations, social service agencies and civic groups. Pennsylvania's plan was approved on May 28, 1998 and its amendment was approved on October 29, 1998.

Puerto Rico
Puerto Rico could receive as much as $9.8 million in new funds for fiscal year 1998 and $39 million for fiscal year 1999 under the CHIP program. Puerto Rico will use its allotment to expand Medicaid eligibility. Medicaid coverage will be expanded to cover children through age 18 in families with incomes below 200 percent of the commonwealth poverty level ($8,220 for a family of four). Federal CHIP funding will allow Puerto Rico to cover an additional 20,000 children. Puerto Rico's program will also include children currently under its public health system, which receives no federal funding. Puerto Rico will develop a number of outreach efforts, including disseminating brochures, leaflets, and posters with information on the CHIP program; launching a broad-based media campaign; and appealing directly to eligible children and families. Puerto Rico's plan was approved June 26, 1998.

Rhode Island
Rhode Island could receive as much as $10.6 million for both fiscal year 1998 and fiscal year 1999, which state officials will use to insure as many as 4,000 children by September 2000. Under its initial plan, the state is using its allotment to expand its Medicaid program to provide comprehensive health care coverage to children between the ages of 8 and 15 whose family income is between 100 and 250 percent of the federal poverty level. The program will also cover children 15 to 18 whose families have incomes up to 250 percent of poverty. Under its amendment, Rhode Island will expand benefits for uninsured children up to age 19 to 300 percent of the federal poverty level. Beginning at 185 percent of the federal poverty level, or about $30,432 for a family of four, families will begin paying modest premiums or co-payments. In order to effectively reach the target population, various outreach methods will take place. Rhode Island's plan was approved on May 8, 1998 and its amendment was approved February 5, 1999.

South Carolina
South Carolina had already begun to expand its Medicaid program when the new CHIP law was enacted, and could receive over $63 million in new funds for both fiscal year 1998 and fiscal year 1999. The state will use its share of CHIP funds to expand its Medicaid program, and hopes to enroll an additional estimated 75,000 children. Eligibility will be extended to children under age 19 whose family incomes are at or under 150 percent of the federal poverty level. There is no cost-sharing. The state has placed eligibility workers in public schools, hospitals, clinics, pharmacies and other places frequented by families with potentially eligible children. South Carolina's plan was approved on February 18, 1998.

South Dakota
South Dakota could receive as much as $8.5 million for both fiscal year 1998 and fiscal year 1999. The state will use its CHIP allotment to expand its Medicaid program to insure 7,400 children. The state will increase eligibility limits for children ages 6 to 18 from the current limit of 100 percent of FPL to 133 percent of FPL. The benefit package for children enrolled in CHIP will be the same as that offered to other children in the state's Medicaid program. Families will not be charged for medical care under this CHIP program. The state will identify eligible children and mail their families applications. South Dakota's plan was approved on August 25, 1998.

Tennessee
Tennessee could receive as much as $66 million in new funds for both fiscal year 1998 and fiscal year 1999. Tennessee opted to use its CHIP allotment to expand its Medicaid program to children born before October 1, 1983 who are under age 19 in families with incomes at or below 100 percent of the federal poverty level and who could not have been enrolled under the operating rules for the state's Medicaid demonstration program before April 1, 1997. The state expects to cover nearly 10,000 children. The full Medicaid package of benefits will be offered and there will be no family cost-sharing. Tennessee's CHIP plan was approved on September 3, 1999.

Texas
Texas could receive as much as $561 million in new funds for fiscal year 1998 and $558 million for fiscal year 1999, which state officials estimate that they will use to enroll nearly 58,000 children in their CHIP program. Texas will use its allotment to expand Medicaid eligibility to children up to age 19 in families with incomes below 100 percent of the federal poverty level. Texas currently covers children from birth to one in families with incomes up to 185 percent of poverty, ages 1-5 up to 133 percent of poverty, ages 6-14 up to 100 percent of poverty, and ages 15-19 up to 47 percent of poverty. The state also plans to expand coverage to additional low-income children and families by submitting an amendment to their CHIP program in 1999. Outreach activities will include working with the entire network of public health providers to disseminate outreach materials to providers so that they may supply information to families with potentially eligible children. Texas' plan was approved on June 15, 1998.

Utah
Utah could receive as much as $24 million in new funds for both fiscal year 1998 and fiscal year 1999, which state officials estimate will insure 21,000 children in their CHIP program by September 2000. Utah will use its CHIP allotment to create a separate state health insurance program to provide coverage to uninsured children up to age 19 whose family incomes do not exceed 200 percent of the federal poverty level. The plan does have some cost sharing for services, but no premiums or enrollment fees will be charged. Copayments and out-of-pocket maximums will be determined by income level. The state will use Medicaid eligibility workers already placed in 98 hospitals, community health centers, local health departments, and other allied agencies to determine CHIP eligibility. The state will also do outreach through community presentations, toll-free telephone lines, brochures, flyers and postcards. Utah's plan was approved July 10, 1998.

Vermont
Vermont could receive as much as $3.5 million in funds for both fiscal year 1998 and fiscal year 1999 for its CHIP plan. The state will use its allotment to create a separate health insurance program to cover children up to age 18 in families with incomes between 225 and 300 percent of the FPL. Health services to children will be delivered by the managed care organizations that currently provide services under the Vermont Health Access Plan, a Medicaid section 1115 waiver. An amendment to the Medicaid waiver was also approved, allowing the state to expand coverage to underinsured children up to 300 percent of the FPL. The benefits package for the Vermont CHIP program is the same as provided through the state's Medicaid program. The state will charge beneficiaries a premium of $10 per month per household. Beginning July 1, 1999, providers will be allowed to charge a $10 copayment for office visits. No copayments will be charged for well-baby and well-child visits. Maximum cost sharing will not be allowed to exceed 5 percent of a family's income. The state will integrate its outreach activities with the current outreach campaign for Medicaid, which includes advertising, brochures, flyers, and outreach through community health and social service providers. Vermont also offers a toll-free telephone line with information on Medicaid and CHIP. Vermont expects to insure 1,000 children by September 2000. Its CHIP plan was approved December 15, 1998 and its amendment was approved on November 6, 1998 and its amendment was approved on August 11, 1999.

Virginia
Virginia could receive as much as $68 million in funds for both fiscal year 1998 and fiscal year 1999 to create a separate children's health insurance plan, the Virginia Children's Medical Security Insurance Plan. The plan provides coverage for children under age 19 in families with incomes up to 185 percent of the FPL. Virginia estimates that it will enroll 54,000 children by September 2000. The benefit package will be comprehensive and includes inpatient and outpatient care, laboratory services, and substance abuse treatment. To reach eligible children, the state will create a single mail-in application for both programs. The state will also place eligibility workers in different locations throughout the state, offer a toll-free hotline number, and will coordinate with school districts and local agencies to distribute applications. Virginia's plan was approved October 22, 1998.

Virgin Islands
The Virgin Islands could receive $279,000 in new funds for fiscal year 1998 and about $1.1 million in fiscal year 1999. The territory will use its CHIP allotment to expand its Medicaid program to children receiving services through a territory-funded program. CHIP funds will help strengthen federal support for children's health in the Virgin Islands. The local government will not expand eligibility, but the current income level for a family of four is $8,500 or about half the level of states. The Virgin Islands' plan was approved September 17, 1998.

Washington
Washington could receive over $46 million in new funds for fiscal year 1998 and fiscal year 1999. Washington will use its CHIP allotment to create a separate state CHIP program to cover uninsured children under age 19 in families with incomes between 200 and 250 percent of the federal poverty level. The state expects to insure 3,700 children by July 2000 under its CHIP program. With full implementation by the year 2002, the state expects to be providing health insurance coverage to over 10,000 children. The full Medicaid package of benefits will be offered. Washington will charge $10 per month per child enrolled in CHIP, with a family maximum of $30 per month. Cost sharing will include $5 copayments for physician services and prescription drugs. An emergency room copayment of $25 will be required for each visit that does not result in an inpatient admission. The state will impose a cap on family spending of $300 per child per year or a $900 family maximum cap. Washington's CHIP plan was approved on September 8, 1999.

West Virginia
West Virginia could receive over $23 million in new funds for both fiscal year 1998 and fiscal year 1999. The state will use its CHIP allotment to expand Medicaid eligibility to children between the ages of 1-5 in families with incomes up to 150 percent of FPL. The state currently has an income cutoff for that group of 133 percent of FPL. The newly covered children will receive the regular Medicaid benefit package at no cost to their families. West Virginia's original plan was amended to include coverage for children between the ages of 6 and 18 whose family incomes do not exceed 150 percent FPL. The state estimates that it will enroll 11,000 children by September 2000. As part of their outreach efforts, the state will include Medicaid information in all free or reduced lunch and textbook applications and the state's toll-free 24-hour hotline will include information on the CHIP program. West Virginia's plan was approved on September 15, 1998 and its amendment was approved on March 19, 1999.

Wisconsin
Wisconsin could receive over $40 million in new funds for both fiscal year 1998 and fiscal year 1999, which state officials will use to expand its Medicaid program. Phase One of the state's BadgerCare plan expanded Medicaid eligibility to children ages 15-18 in families with incomes below 100 percent of the federal poverty level. Wisconsin also had a CHIP amendment and a Medicaid waiver approved. While the CHIP expansion will provide health coverage to children through age 18 with family incomes up to 185 percent FPL, the waiver for the state's Medicaid program will allow Wisconsin to enroll the parents of CHIP-eligible children in that program. State officials expect that the two phases combined will enroll an estimated 18,000 children by October 2000. All eligible children will receive the full Medicaid benefit package with no out-of-pocket costs for families. Wisconsin's outreach efforts will include: public health agencies coordinated efforts with schools; the expansion of school-based clinics in twelve Milwaukee public schools; and inclusion of schools as potential outstation sites for Medicaid eligibility workers. Wisconsin's plan was approved May 29, 1998 and its amendment was approved January 22, 1999.

Wyoming
Wyoming could receive over $7 million in new funds for both fiscal year 1998 and fiscal year 1999. Wyoming will use its CHIP allotment to create a separate state CHIP program to cover children age 6-19 in families with incomes at or below 133 percent of the federal poverty level. Wyoming's Medicaid program covers children under age 6 in families with incomes up to 133 percent of poverty. The state expects to insure over 700 children by September 2000 under its CHIP program. The full Medicaid package of benefits will be offered and there will be no family cost-sharing. Wyoming's CHIP plan was approved on September 8, 1999.