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Hey, Texplainer: How much money does Texas spend per child through CHIP?

During the next two fiscal years, Texas is set to spend roughly $200 per child per month through the Children's Health Insurance Program.

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Welcome to The Texas Tribune's "Texplainer" series, where we answer questions from readers like you. 

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Today’s Texplainer is inspired by a question from Texas Tribune reader Adam Miller. 

Hey, Texplainer: With the Children's Health Insurance Program funding in jeopardy, is there a way to see how much money Texas spends per child per month through the health insurance program and how that compares to other states?

The short answer is yes — and no.

But first: Let's talk about why CHIP is back in the headlines. It's because Congress failed to renew the program's authorization before it expired on Sept. 30.

The federal government provides most of the funds used to sustain the Children's Health Insurance Program, which provides low-cost health insurance for children from low- and middle-income families. The state's budget for fiscal years 2018 and 2019 allocates about $200 per child per month to the roughly 400,000 CHIP-eligible Texans. 

Without federal funding, Texas has enough money for CHIP to last until February 2018, according to estimates by the Texas Health and Human Services Commission, the state's health agency.

CHIP, created in 1997 and adopted in Texas in 1999, has cut the percentage of uninsured children nationwide from 15 percent in 1997 to 5 percent in 2015. It also offers prenatal care to about 36,000 pregnant women in Texas.

About 394,000 Texas children who are ineligible for Medicaid – the joint state-federal health insurer of last resort — are covered under CHIP, and another 249,000 Texas children on Medicaid benefit from CHIP.

During the 2016 fiscal year, Texas spent $93 million on CHIP, while the federal government contributed $1.2 billion. 

But it's virtually impossible to know how Texas' CHIP spending compares to other states because there are different ways to operate the program. 

“Some states have CHIP programs that look exactly like their Medicaid program,” said Maureen Hensley-Quinn, senior program director at the National Academy for State Health Policy, a nonpartisan group that advises states on health policy. “Some states require cost-sharing of families in the form of premiums, and some states do not.”

Hensley-Quinn said there are states like Texas that operate two programs: one that uses CHIP funds to expand Medicaid for children up to a certain income level, and another for children in families with slightly higher incomes. The two programs work in concert with one another but are technically different despite both using CHIP funds.

“For the states that use a Medicaid expansion ... how much they spend per child would not be a truly comparable number to a state that uses either a combination program or a separate CHIP program,” said Anne Dunkelberg, an associate director for the Center for Public Policy Priorities, a left-leaning think tank. “By definition, a separate CHIP program is almost never going to offer that same generous guaranteed coverage of all necessary care as a Medicaid program does.”

Together, Medicaid and CHIP cover about 45 percent of all children in the state. The primary difference between the two programs, Garcia said, is that CHIP is like a “gap insurance” program. It is specifically designed for children whose families make too much for them to qualify for Medicaid, but who are less likely to have an employer offer of coverage through their parent. The cap for CHIP is roughly 200 percent above the federal poverty line.

“Medicaid has been around for a long time,” said Mimi Garcia, a spokesperson for the Texas Association of Community Health Centers. “But there was a gap for kids whose families were making too much to get Medicaid, but they were often not in families that had other forms of insurance. This was a way to get those moderate income children covered.”

When it comes to Medicaid, Texas spent more than $40 billion on it in the 2016 fiscal year — a hefty amount, but comparable to most other states when accounting for the state’s size and population. Other large states, like California and New York, spent $81 billion and $62 billion on their programs respectively, according to the Kaiser Family Foundation.

The bottom line: During the next two fiscal years, Texas is set to spend roughly $200 per child per month through the CHIP program. But it’s hard to get a state-by-state comparison on CHIP spending since there are different ways to operate the program.

Disclosure: The Center for Public Policy Priorities has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.

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