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Michael Petruzzelli

, National Council for Behavioral Health

CMS Finds Qualified Health Plans, CHIP too Different to Certify as Comparable

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A new analysis from the Centers for Medicare and Medicaid Services finds that coverage through the Children’s Health Insurance Program (CHIP) is more comprehensive and more favorable for kids and families than marketplace exchange plans. The comparison, mandated by the Affordable Care Act, concluded that CHIP plans are more likely to meet the needs of kids and families and therefore could not certify the plans as comparable.

Highlights of the findings from the comparison analysis include:

 

Cost Sharing

CMS found that the average out of-pocket spending in certain marketplace plans was higher than out-of-pocket spending in CHIP for all states reviewed. Additionally, it found that the actuarial value of CHIP exceeds that of marketplace plans in every state reviewed except Utah, where the two are equivalent.

 

Benefit Comparison

While the review found that the coverage of core benefits under CHIP is similar to marketplace plans, the benefits packages under CHIP are generally more comprehensive for “child-specific services”, including dental, vision, and habilitation services.