NHeLP In-Depth Analysis of the Children’s Health Insurance Program Reauthorization Act

Compiled by the National Health Law Program

On February 5, President Obama signed into law the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Pub. L. No. 111-3. The bill reauthorizesthe Children’s Health Insurance Program (CHIP) for another four and a half years, from April 1, 2009 to September 30, 2013. While the CHIP program, Title XXI of the Social Security Act, is at the heart of the legislation, Medicaid, Title XIX, is also affected. The purpose of the legislation is to “provide dependable and stable funding for children’s health insurance” under CHIP and Medicaid. CHIPRA, § 2. The goal is to enroll “all six million uninsured children who are eligible, but not enrolled, for coverage today” under CHIP or Medicaid. Id. Compare CHIPRA, § 622 (stating an intent to enact legislation this year that improves access to affordable, meaningful health insurance coverage for employees of small businesses and individuals). The legislation is funded in large part by increases in excises taxes on tobacco products. See CHIPRA, Title VII, § 701.

Effective Dates

Most of the CHIPRA amendments become effective on April 1, 2009, regardless of whether regulations have been issued to implement the amendments. CHIPRA, § 3. However, if the Secretary of the Department of Health and Human Services (DHHS) determines that a state will need to enact legislation to bring the state’s CHIP or Medicaid plan into compliance with “one or more of the additional requirements” imposed by CHIPRA, the state will be given some leeway. Id. at § 3(b). In these cases, a state’s CHIP/Medicaid plan will not be regarded as out of compliance with CHIPRA until after the first day of the first calendar quarter beginning after the close of the first regular session of the state legislature that begins after the date of CHIPRA enactment. Id. For example, if State A must authorize a new CHIPRA requirement legislatively and State A holds its next regular legislative session from July to December 2009, then State A will not be considered out of compliance until January 1, 2010.

Effective upon its enactment, CHIPRA repealed a 1999 law that required the Secretary of DHHS or any other federal officer or employee to use the term “SCHIP” instead of “CHIP” and the phrase “State Children’s Health Insurance Program” instead of “Children’s Health Insurance Program.” See CHIPRA, § 612 (repealing § 704 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999).

In this analysis, we use “SCHIP” to refer to provisions under the original legislation and “CHIP” when discussing the recently enacted CHIPRA.

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