Children’s Health Insurance Program Reauthorization Act  Of 2009 (CHIPRA)

The law is designed to provide health coverage for children in families who are above the Medicaid income level, but whose incomes are too low to purchase private health coverage.

  • Expanded the program formerly known as the State Children’s Health Insurance Program (“CHIP”), now renamed Children’s Health Insurance Program (“CHIP”).
    • Establishes new options for pregnant women.
    • Limits adult coverage options and prohibits new waivers.
    • Requires states to include dental coverage.
    • Allows states to cover more people (up to 300% of poverty level).
    • Allows states to provide premium assistance.
    • Provides for two new “special enrollment” events.
    • Adds new employer notice obligations.
    • Adds duty to respond to state requests for information.
  • Funded by state and federal governments.
  • States determine eligibility, benefits, etc., subject to maximum limits (generally, 300% of poverty level).
  • 60-day special enrollment right (effective April 1, 2009) for employees and their dependents if:
    • they lose eligibility and coverage from Medicaid or CHIP (contrast with 30 days for other loss of coverage or other qualifying events), or
    • they are eligible for a premium subsidy from Medicaid or CHIP.
  • States may subsidize the cost of health coverage for children under an employer’s group health plan.
  • Employers are required to provide notice to each employee, regardless of enrollment status, by the later of: (1) the first day of the first plan year on or after February 4, 2010; or (2) May 1, 2010. 
  • Notice must be sent annually before the start of each plan year. A model notice is available from the Department of Labor atdol.gov/ebsa or by calling EBSA toll-free at 1-866.444.3272.

What do employers and health plans need to do?

  • Amend health and cafeteria plans (effective April 1, 2009) if they conflict with the new HIPAA Special Enrollment Rights under CHIPRA.
  • Update all communications and plan information to reflect the new special enrollment rights.
  • Begin sending required annual notice to employees by the later of: (1) the first day of the first plan year on or after February 4, 2010; or (2) May 1, 2010.