Executive Summary

Issue Area 1: The Realignment of the Children's Health Insurance Program from DHHR to the Department of Administration Creates Important Policy Decisions.

In March, 2000 the West Virginia Legislature passed legislation which moved the Children's Health Insurance Program (CHIP) from within the Department of Health and Human Resources (DHHR) to the Department of Administration. The present computer system being used to determine eligibility for this program is the RAPIDS system, located in DHHR. The Policy Board of the CHIP program must decide whether to continue use of the RAPIDS system to determine eligibility or develop a separate, stand-alone system to determine CHIP eligibility.

However, breaking away from the RAPIDS system is not without consequence. Some of the concerns are as follows:

The magnitude of this potential slippage is shown in Figure 1. Between July of 1998 through December of 1999, 11,855 West Virginia children received either CHIP or Medicaid health insurance through the CHIP initiative. Of this number, 7,200 applied directly using the CHIP application and were found eligible for CHIP. However, 1,735 CHIP recipients did not actually apply to the CHIP program. Their parents applied to DHHR seeking public assistance of another sort, possibly Food Stamps, and they were found to be eligible for the CHIP program. These children were immediately enrolled in CHIP entirely due to the RAPIDS integrated computer system. Conversely, 2,920 children applied for CHIP but were not eligible because their income was too low, but they were eligible for Medicaid instead. They were immediately placed on Medicaid, and began receiving health benefits due to the RAPIDS integrated system.

The Legislative Auditor makes the following recommendation:

If the Children's Health Insurance Agency located within the Department of Administration should decide to develop a stand-alone eligibility computer system, then a cooperative agreement with the Department of Health and Human Resources should be developed whereby information can be exchanged between the two systems to prevent Medicaid eligible children identified by application to CHIP from going any significant length of time without health insurance. The same process should be established for children identified through the RAPIDS system as eligible for CHIP.