For over two decades, the Children’s Health Insurance Program (CHIP) has been a vital source of healthcare coverage for children in families with modest incomes across the United States. States have flexibility in how they administer their CHIP programs, choosing to integrate them within Medicaid, operate them separately, or use a combination of both approaches. In Washington state, the program that provides this crucial coverage is known as Washington Apple Health for Kids. But Is Washington Apple Care A Chip Program? Let’s delve into what this means for families in Washington.
CHIP’s funding is secured through the HEALTHY KIDS and ACCESS Acts, currently extending through federal fiscal year (FFY) 2027, ending on September 30, 2027. These acts also maintain the maintenance of effort (MOE) provision, requiring states to uphold the eligibility standards that were in place in 2010, also through FFY 2027. However, it’s important to note that since FFY 2020, this MOE provision applies specifically to children in families with incomes at or below 300 percent of the federal poverty level (FPL).
Eligibility for Washington Apple Health for Kids
Understanding eligibility is key to knowing if your child can benefit from Washington Apple Health for Kids. The program uses Modified Adjusted Gross Income (MAGI) to determine eligibility levels for CHIP/Title XXI in Washington, based on age.
| Ages 0 – 1 | Ages 1 – 5 | Ages 6 – 18 | |
|---|---|---|---|
| Separate CHIP | 211 – 312% FPL | 211 – 312% FPL | 211 – 312% 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.” Note: Eligibility levels do not include the mandatory 5% income disregard.
This table illustrates that for a separate CHIP program in Washington, children across different age groups (0-18 years) are eligible if their family income falls between 211% and 312% of the Federal Poverty Level. This structure ensures that children from families who earn too much to qualify for traditional Medicaid, but still struggle to afford private insurance, can access essential healthcare services.
Coverage for Expectant Mothers
CHIP programs also offer states the option to extend coverage to pregnant women. Washington state has chosen this option, providing coverage for expectant mothers up to 193% FPL through the CHIP unborn child coverage. This ensures that pregnant individuals and their unborn children receive necessary healthcare during this critical period.
Benefit Packages under Washington Apple Health for Kids
For states that operate Medicaid expansion CHIP programs, Medicaid rules apply. This means that all children enrolled receive the full range of Medicaid-covered benefits. This includes the crucial Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, ensuring comprehensive healthcare from a young age. In states with separate CHIP programs, there is greater flexibility in designing benefit packages, though they must still adhere to broad federal guidelines.
How Healthcare is Delivered
The delivery system for Washington Apple Health for Kids with premiums (CHIP) mirrors that of the no-cost Washington Apple Health for Kids (Medicaid). This means families benefit from an established network. Managed Care Organizations (MCOs) are the primary providers for most children within the 211%-312% FPL income bracket. For the unborn population (0 – 193% FPL coverage), healthcare is delivered on a fee-for-service (FFS) basis. Furthermore, Alaskan Native/American Indian children have the choice to receive coverage through FFS, MCO, or primary care case management, offering culturally sensitive and accessible options.
Premiums and Cost Sharing in Washington State
States have the authority to set premium and cost-sharing levels for their CHIP programs within federal guidelines. Importantly, the total family contribution towards coverage costs cannot exceed 5 percent of the family’s annual income. This provision is designed to ensure affordability and prevent financial burden from hindering access to necessary healthcare for children.
In conclusion, Washington Apple Health for Kids is indeed Washington state’s CHIP program. It is designed to provide affordable and comprehensive healthcare coverage to children and pregnant women in families with low to moderate incomes, bridging the gap for those who do not qualify for Medicaid but cannot afford private insurance. Understanding the eligibility, coverage, and delivery systems of Washington Apple Health for Kids is essential for families in Washington to ensure their children receive the healthcare they need to thrive.
