House health bill has controversial CHIP provision

"The $894 billion health reform bill working its way toward a House vote this week would repeal the Children's Health Insurance Program, shifting some low-income kids into Medicaid and others into private plans that would both cost more and guarantee fewer benefits," The Washington Independent reports. "Which program the youngsters tumble into hinges, not on need, but on the state where they live - a design some advocates call 'the lottery of geography.'"

Under CHIP, which was designed to cover kids in families that earn too much to qualify for Medicaid, states "were granted broad discretion to fashion the program to fit their needs, with some carving out a separate CHIP program, some using CHIP funds to expand Medicaid eligibility, and still others opting for some combination of the two." The House bill handles the two models differently. "While it expands Medicaid eligibility to 150 percent of poverty and shifts all kids living above that level to private plans contained on a proposed insurance marketplace, or exchange, the proposal also carves out an exception in states which augmented Medicaid in lieu of creating a separate CHIP program. In those cases, the youngsters would remain in Medicaid. The distinction carries both coverage and cost implications." (Lillis, 11/6).

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