Design Considerations for the Future of Children’s Coverage: Focus on Affordability

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March 2016

Chapter 5 of the March 2016 Report to Congress on Medicaid and CHIP continues MACPAC’s effort to consider how best to provide adequate affordable coverage to low- and moderate-income children, with an analysis of out-of-pocket spending for children in exchange coverage compared to out-of-pocket spending for children in separate CHIP in 36 states that offer this coverage.

The Commission finds that in no state are out-of-pocket protections in exchange coverage comparable to CHIP. However, whether low- and moderate-income children receive CHIP’s cost-sharing protections depends on CHIP eligibility levels in the state where they reside.

The chapter further notes that while children with chronic conditions make up the majority of children with high out-of-pocket spending in exchange coverage, otherwise healthy children who need treatment for an unexpected acute episode can also incur substantial out-of-pocket costs.

The chapter ends with some key policy issues raised by these findings, which the Commission will consider as it develops recommendations on the future of children’s coverage for release by the end of 2016.

Publication Type: Reports to Congress

From: March 2016 Report to Congress on Medicaid and CHIP

Tags: Affordable Care Act, children, CHIP, comparisons with other sources of coverage, cost sharing, exchanges, premiums