PaymentAccuracy.gov

An Official Website of the United States Government

Children's Health Insurance Program (CHIP)

Department of Health and Human Services

The Children’s Health Insurance Program (CHIP) is a joint federal/state program, administered by the states, that provides health insurance for qualifying children.

Agency Accountable Official: Ellen Murray, Assistant Secretary for Financial Resources

Program Accountable Official: Shantanu Agrawal, M.D., Deputy Administrator and Director for the Center for Program Integrity, Centers for Medicare & Medicaid Services

Current

$8.6B

Total Payments (Outlays)more info

$0.7B

Improper Paymentsmore info

8.2%

Improper Payment Ratemore info

2013

Not Reported Improper Payment Rate Target more info

All amounts are in billions of dollars

Tabular view for Projected improper payments Tabular View   

 

Note: HHS calculated and is reporting a rolling national error rate that is based on measurements that were conducted in Fiscal Years (FYs) 2013, 2014, and 2015.

Program Comments

Because CHIP payments are susceptible to improper payments, the federal government and states have a strong financial interest in ensuring that claims are paid accurately. HHS has developed a multi-faceted strategy to measure the national improper payment rate for CHIP, through the Payment Error Rate Measurement (PERM) program. CHIP’s Fee-For-Service (FFS) and managed care components are measured by federal contractors. In the past, states led the effort in measuring errors in eligibility. The program is measured using a 17-state, 3-year rotation to produce and report national program improper payment rates. All improper payment rate calculations for the CHIP program are based on the ratio of estimated dollars of improper payments to the estimated dollars of total payments. Individual state improper payment rate components are combined to calculate national component improper payment rates, and individual state CHIP program improper payment component rates are combined to calculate the national CHIP program improper payment rate. For FYs 2015 through 2018, eligibility reviews are on hold while HHS develops a new eligibility review methodology. During this time, the FY 2014 national eligibility improper payment rate (4.2 percent) is used as a proxy in the overall improper payment rate calculation. In place of the FYs 2015 through 2018 PERM eligibility reviews, all states are required to conduct eligibility review pilots. The eligibility review pilots provide more targeted, detailed information on the accuracy of eligibility determinations. The pilots use targeted measurements to: provide state-by-state programmatic assessments of the performance of new processes and systems in adjudicating eligibility, identify strengths and weaknesses in operations and systems leading to errors, and test the effectiveness of corrections and improvements in reducing or eliminating those errors. Read More...