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Pennsylvania Upgrades Kids' Mental Health and Vision Coverage

Gov. Wolf on Thursday announced a series of small benefits upgrades for all families with coverage though the Children's Health Insurance Program, effective Dec. 1.

By Don Sapatkin

Gov. Wolf on Thursday announced a series of small benefits upgrades for all families with coverage though the Children's Health Insurance Program, effective Dec. 1.

Changes include removal of limits on inpatient and outpatient stays for mental health and substance abuse treatment, and the end of outpatient copays for mental health services. Vision care was broadened to cover more types of prescription lenses and tinting.

CHIP has long been considered excellent insurance, and many of the changes will apply to small portions of the 148,000 children on the program. For example, few would normally exceed the current limit of 50 outpatient visits a year, which will be removed. But some kids with chronic conditions had maxed out, said Colleen McCauley, health policy director for the nonprofit Public Citizens for Children and Youth.

At a news conference at Penn State Hershey Children's Hospital, Wolf said the changes were prompted by the Affordable Care Act, which mandated minimum essential benefits for policies sold on the individual market.

Most CHIP policies are subsidized on a sliding scale according to income, and they were grandfathered in under pre-Obamacare rules. But Pennsylvania allows families who earn too much for subsidies to buy CHIP at cost, and those were subject to the new rules. The Wolf administration told insurers several months ago to upgrade policies for those 3,600 unsubsidized children without raising the price.

That solved the problem but left the vast majority of CHIP families with lesser coverage. In an interview after the news conference, Insurance Commissioner Teresa Miller said the state wanted to upgrade the rest of the policies but was concerned about cost. It asked insurers to price out the added benefits for next year.

The rate proposals came in recently. "The impact will minimal. Probably a couple dollars a month," Miller said. Much of the cost for subsidized policies is paid by the federal government.

Pennsylvania's CHIP predates the popular national program, which works differently from state to state.

In New Jersey, households that earn too much to qualify for subsidized coverage cannot buy CHIP at full cost, a spokeswoman for the Department of Human Services said. On the other hand, subsidized CHIP in New Jersey already met the minimum coverage requirements in the Affordable Care Act and did not need to be upgraded, she said.

(c)2015 The Philadelphia Inquirer

Caroline Cournoyer is GOVERNING's senior web editor.
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