Waiting Periods in CHIP
Section 2102(b)(3)(C) of the Social Security Act requires states to include in their state plan a description of how the state ensures that CHIP coverage does not substitute for coverage under group health plans. Prior to January 1, 2014, 36 states elected to institute a period of uninsurance (“waiting period”) ranging from one month to 12 months to address this requirement.
Effective January 1, 2014, CHIP regulations at 42 CFR 457.805 provide that a waiting period imposed under the state plan cannot exceed 90 days. Section 457.805(b)(3) of the regulations also requires states to adopt certain exemptions to any waiting period. States have the option to adopt additional exemptions. Regulations at 42 CFR 457.340(d)(3) and 457.350(i) require states to implement processes ensuring a smooth and seamless transition to other insurance affordability programs for which children may be eligible during a waiting period.
As of November 2016, only 15 states had a waiting period. The 21 states that eliminated their waiting period protect against substitution of coverage by using various procedures to monitor for substitution, including use of survey data, and private insurance database checks. Fifteen states have elected to continue to have a waiting period. Of these, 12 have a 90 day waiting period, 1 state has a two month waiting period, and 2 states have a one month waiting period.
The following table provides a summary of state policies in this area prior to, and subsequent to January 1, 2014.
State |
Waiting Period prior to January 1, 2014 |
Waiting Period as of November 2016 |
Exemptions to the Waiting Period (In Addition to Federally Mandated Exemptions under 42 CFR §457.805(b)(3)) |
---|---|---|---|
Alabama |
3 months |
None |
N/A |
Arizona |
3 months |
90 days |
|
Arkansas |
6 months |
90 days |
|
California |
3 months |
None |
N/A |
Colorado |
3 months |
None |
N/A |
Connecticut |
2 months |
None |
N/A |
Delaware |
6 months |
None |
N/A |
Florida |
2 months |
2 months |
|
Georgia |
60 days |
None |
N/A |
Idaho |
6 months |
None |
N/A |
Illinois |
12 months |
90 days |
|
Indiana |
3 months |
90 days |
|
Iowa |
1 month |
1 month |
|
Kansas |
8 months |
90 days |
|
Kentucky |
6 months |
None |
N/A |
Louisiana |
12 months |
90 days |
|
Maine |
3 months |
90 days |
None |
Massachusetts |
6 months |
None |
N/A |
Michigan |
6 months |
None |
N/A |
Minnesota |
None |
None |
N/A |
Mississippi |
None |
None |
N/A |
Missouri |
6 months |
None |
N/A |
Montana |
3 months |
None |
N/A |
Nevada |
6 months |
None |
N/A |
New Jersey |
3 months |
90 days |
|
New York |
6 months |
None |
N/A |
North Carolina |
None |
None |
N/A |
North Dakota |
6 months |
90 days |
|
Oklahoma |
None |
None |
N/A |
Oregon |
2 months |
None |
N/A |
Pennsylvania |
6 months |
None |
N/A |
Rhode Island |
None |
None |
N/A |
South Dakota |
3 months |
90 days |
None |
Tennessee |
3 months |
None |
N/A |
Texas |
90 days |
90 days |
|
Utah |
90 days |
90 days |
|
Virginia |
4 months |
None |
N/A |
Washington |
4 months |
None |
N/A |
West Virginia |
3 months |
None |
N/A |
Wisconsin |
3 months |
None |
N/A |
Wyoming |
1 month |
1 month |
None |
Totals |
36 states |
15 states |
N/A |