Common use of CHIP Clause in Contracts

CHIP. CHIP is HHSC’s program to help Texas families obtain affordable coverage for their uninsured children (from birth through the month of their 19 th birthday). In 1999, the 76th Texas Legislature authorized the state’s participation in the federal CHIP program. The principal objective of the state legislation was to provide primary and preventative health care to low-income, uninsured children of Texas, including Children with Special Health Care Needs (CSHCN) who were not served by or eligible for other state-assisted health insurance programs. HHSC began operating CHIP in 2000. CHIP Members are currently covered through two (2) types of managed care entities – health maintenance organizations (HMOs) licensed by the Texas Department of Insurance (TDI) and exclusive provider organizations (EPOs) with TDI-approved exclusive provider benefit plans (EPBPs). HMOs serve CHIP Members in eight (8), primarily urban Service Areas. EPOs serve the remaining CHIP Members, who reside primarily in the 174-county rural service area (the CHIP RSA). As of September 1, 2010, 523,895 children were enrolled in CHIP. Of these, 400,243 were enrolled in HMOs. The balance of the CHIP enrollment is in the EPOs serving the CHIP RSA. Refer to the Procurement Library for current and projected CHIP enrollment by Service Area. The CHIP Perinatal Program, a subprogram of CHIP, is for unborn children of women who are not eligible for Medicaid. The 2006-07 General Appropriations Act (Article II, Health and Human Services Commission, Rider 70, S.B. 1, 79th Legislature, Regular Session, 2005) authorized HHSC to expend funds to provide unborn children with health benefit coverage under CHIP. The result was the CHIP Perinatal Program, which began in January 2007. This benefit allows pregnant women who are ineligible for Medicaid due to income (whose income is greater than 185 percent and up to 200 percent of FPL) or immigration status (and whose income is below 200 percent of FPL) to receive prenatal care for their unborn children. Upon delivery, newborns in families with incomes at or below 185 percent of the Federal Poverty Level (FPL) move from the CHIP Perinatal Program to Medicaid, where they receive 12-months of continuous Medicaid coverage. CHIP Perinatal newborns in families with incomes above 185 percent FPL up to and including 200 percent FPL remain in the CHIP Perinatal Program and receive CHIP benefits for a 12-month coverage period, beginning on the date of enrollment as an unborn child. CHIP Perinatal Program Members are exempt from the 90-day waiting period, the asset test, and all cost-sharing that applies to traditional CHIP Members, including enrollment fees and co-pays, for the duration of their coverage period. As of September 1, 2010, 33,860 CHIP Perinates (unborn children) and 19,076 CHIP Perinate Newborns were enrolled in this subprogram. Throughout this RFP, references to “CHIP” apply to both the traditional CHIP Program and the CHIP Perinatal subprogram unless the context indicates otherwise.

CHIP. CHIP is HHSC’s program to help Texas families obtain affordable coverage for their uninsured children (from birth through the month of their 19 th 19th birthday). In 1999, the 76th Texas Legislature authorized the state’s participation in the federal CHIP program. The principal objective of the state legislation was to provide primary and preventative health care to low-income, uninsured children of Texas, including Children children with Special Health Care Needs (CSHCN) special health care needs who were not served by or eligible for other state-assisted health insurance programs. HHSC began operating CHIP in 2000. CHIP Members are currently covered through two (2) types of managed care entities – - health maintenance organizations (HMOs) licensed by the Texas Department of Insurance (TDI) and exclusive provider organizations (EPOs) with TDI-approved exclusive provider benefit plans (EPBPs). HMOs serve CHIP Members in eight (8), primarily urban Service Areas. EPOs serve the remaining CHIP Members, who reside primarily in the 174-county rural service area (the CHIP RSA). As of September 1, 2010, 523,895 children were enrolled in CHIP. Of these, 400,243 were enrolled in HMOs. The balance of the CHIP enrollment is in the EPOs serving the CHIP RSA. Refer to the Procurement Library for current and projected CHIP enrollment by Service Area. The CHIP Perinatal Program, a subprogram of CHIP, is for unborn children of women who are not eligible for Medicaid. The 2006-07 General Appropriations Act (Article II, Health and Human Services Commission, Rider 70, S.B. 1, 79th Legislature, Regular Session, 2005) authorized HHSC to expend funds to provide unborn children with health benefit coverage under CHIP. The result was the CHIP Perinatal Program, which began in January 2007. This benefit allows pregnant women who are ineligible for Medicaid due to income (whose income is greater than 185 percent and up to 200 percent of FPLthe Medicaid eligibility threshold) or immigration status (and whose income is also below 200 percent of FPLthe Medicaid eligibility threshold) to receive prenatal care for their unborn children. Upon delivery, newborns in families with incomes income at or below 185 percent of the Federal Poverty Level (FPL) Medicaid eligibility threshold move from the CHIP Perinatal Program to Medicaid, where they receive 12-months of continuous Medicaid coverage. CHIP Perinatal newborns in families with incomes above 185 percent FPL up to and including 200 percent FPL the Medicaid eligibility threshold remain in the CHIP Perinatal Program and receive CHIP benefits for a 12-month coverage period, beginning on the date of enrollment as an unborn child. CHIP Perinatal Program Members are exempt from the 90-day waiting period, the asset test, and all cost-sharing that applies to traditional CHIP Members, including enrollment fees and co-pays, for the duration of their coverage period. As of September 1, 2010, 33,860 CHIP Perinates (unborn children) and 19,076 CHIP Perinate Newborns were enrolled in this subprogram. Throughout this RFP, references to “CHIP” CHIP apply to both the traditional CHIP Program and the CHIP Perinatal subprogram unless the context indicates otherwise.

CHIP. CHIP is HHSC’s program to help Texas families obtain affordable coverage for their uninsured children (from birth through the month of their 19 th 19th birthday). In 1999, the 76th Texas Legislature authorized the state’s participation in the federal CHIP program. The principal objective of the state legislation was to provide primary and preventative health care to low-income, uninsured children of Texas, including Children with Special Health Care Needs (CSHCN) who were not served by or eligible for other state-assisted health insurance programs. HHSC began operating CHIP in 2000. CHIP Members are currently covered through two (2) types of managed care entities – health maintenance organizations (HMOs) licensed by the Texas Department of Insurance (TDI) and exclusive provider organizations (EPOs) with TDI-approved exclusive provider benefit plans (EPBPs). HMOs serve CHIP Members in eight (8), primarily urban Service Areas. EPOs serve the remaining CHIP Members, who reside primarily in the 174-county rural service area (the CHIP RSA). As of September 1, 2010, 523,895 children were enrolled in CHIP. Of these, 400,243 were enrolled in HMOs. The balance of the CHIP enrollment is in the EPOs serving the CHIP RSA. Refer to the Procurement Library for current and projected CHIP enrollment by Service Area. The CHIP Perinatal Program, a subprogram of CHIP, is for unborn children of women who are not eligible for Medicaid. The 2006-07 General Appropriations Act (Article II, Health and Human Services Commission, Rider 70, S.B. 1, 79th Legislature, Regular Session, 2005) authorized HHSC to expend funds to provide unborn children with health benefit coverage under CHIP. The result was the CHIP Perinatal Program, which began in January 2007. This benefit allows pregnant women who are ineligible for Medicaid due to income (whose income is greater than 185 percent and up to 200 percent of FPL) or immigration status (and whose income is below 200 percent of FPL) to receive prenatal care for their unborn children. Upon delivery, newborns in families with incomes at or below 185 percent of the Federal Poverty Level (FPL) move from the CHIP Perinatal Program to Medicaid, where they receive 12-months of continuous Medicaid coverage. CHIP Perinatal newborns in families with incomes above 185 percent FPL up to and including 200 percent FPL remain in the CHIP Perinatal Program and receive CHIP benefits for a 12-month coverage period, beginning on the date of enrollment as an unborn child. CHIP Perinatal Program Members are exempt from the 90-day waiting period, the asset test, and all cost-sharing that applies to traditional CHIP Members, including enrollment fees and co-pays, for the duration of their coverage period. As of September 1, 2010, 33,860 CHIP Perinates (unborn children) and 19,076 CHIP Perinate Newborns were enrolled in this subprogram. Throughout this RFP, references to “CHIP” apply to both the traditional CHIP Program and the CHIP Perinatal subprogram unless the context indicates otherwise.

CHIP. CHIP is HHSC’s program to help Texas families obtain affordable coverage for their uninsured children (from birth through the month of their 19 th 19th birthday). In 1999, the 76th Texas Legislature authorized the state’s participation in the federal CHIP program. The principal objective of the state legislation was to provide primary and preventative health care to low-income, uninsured children of Texas, including Children with Special Health Care Needs (CSHCN) who were not served by or eligible for other state-assisted health insurance programs. HHSC began operating CHIP in 2000. CHIP Members are currently covered through two (2) types of managed care entities – - health maintenance organizations (HMOs) licensed by the Texas Department of Insurance (TDI) and exclusive provider organizations (EPOs) with TDI-approved exclusive provider benefit plans (EPBPs). HMOs serve CHIP Members in eight (8), primarily urban Service Areas. EPOs serve the remaining CHIP Members, who reside primarily in the 174-county rural service area (the CHIP RSA). As of September 1, 2010, 523,895 children were enrolled in CHIP. Of these, 400,243 were enrolled in HMOs. The balance of the CHIP enrollment is in the EPOs serving the CHIP RSA. Refer to the Procurement Library for current and projected CHIP enrollment by Service Area. The CHIP Perinatal Program, a subprogram of CHIP, is for unborn children of women who are not eligible for Medicaid. The 2006-07 General Appropriations Act (Article II, Health and Human Services Commission, Rider 70, S.B. 1, 79th Legislature, Regular Session, 2005) authorized HHSC to expend funds to provide unborn children with health benefit coverage under CHIP. The result was the CHIP Perinatal Program, which began in January 2007. This benefit allows pregnant women who are ineligible for Medicaid due to income (whose income is greater than 185 percent and up to 200 percent of FPLthe Medicaid eligibility threshold) or immigration status (and whose income is also below 200 percent of FPLthe Medicaid eligibility threshold) to receive prenatal care for their unborn children. Upon delivery, newborns in families with incomes income at or below 185 percent of the Federal Poverty Level (FPL) Medicaid eligibility threshold move from the CHIP Perinatal Program to Medicaid, where they receive 12-months of continuous Medicaid coverage. CHIP Perinatal newborns in families with incomes above 185 percent FPL up to and including 200 percent FPL the Medicaid eligibility threshold remain in the CHIP Perinatal Program and receive CHIP benefits for a 12-month coverage period, beginning on the date of enrollment as an unborn child. CHIP Perinatal Program Members are exempt from the 90-day waiting period, the asset test, and all cost-sharing that applies to traditional CHIP Members, including enrollment fees and co-pays, for the duration of their coverage period. As of September 1, 2010, 33,860 CHIP Perinates (unborn children) and 19,076 CHIP Perinate Newborns were enrolled in this subprogram. Throughout this RFP, references to “CHIP” CHIP apply to both the traditional CHIP Program and the CHIP Perinatal subprogram unless the context indicates otherwise.