Health Care Reform

Medicaid and CHIP

Medicaid and CHIP are designed to provide health care coverage to low-income Americans, primarily children. States run these programs within guidelines set by the federal government, but have the ability to expand coverage. While the federal government only requires certain dental coverage for children, several states have expanded dental coverage for individuals covered by Medicaid and CHIP. Medicaid currently covers over 50 million people and CHIP covers approximately six million children.

To a large degree, the Affordable Care Act uses Medicaid and CHIP as the way to expand care to those who are unable to afford it. Prior to the ACA, Medicaid required those covered to meet two criteria:

    1. They must earn less than that of the defined federal poverty level; and
    2. They had to be part of a "group" such as pregnant women, blind, disabled, etc.
Medicaid coverage expanded under the ACA does away with "group" assignment and increases the income level from the Federal Poverty Guideline to 133 percent of the Federal Poverty Guideline. This is expected to expand Medicaid enrollees by about 15 million people and CHIP by about five million children. Of the 15 million possible additional enrollees for Medicaid and CHIP, around 10 million may already be eligible, but haven't enrolled.

Many states outsource the administration of their Medicaid and/or CHIP programs to private health insurance companies. Though the two programs' features are distinct from one another in significant ways and can differ from state to state, Delta Dental, because of its state-based member company structure, is well-positioned to serve local state administrative needs as Medicaid and CHIP enrollment increases in the coming years. Currently, Delta Dental handles the dental portion of Medicaid and/or CHIP in several states, and stands ready to administer coverage in others. We believe that we are uniquely qualified to administer the dental portion due to our expertise in dental claims administration, dental science and dentist relations.