Investigate CHIP benefit amount estimates by coverage population, starting with California CCHIP #10155

Purpose

Investigate whether CHIP benefit amount estimates should distinguish children from pregnancy coverage, starting with California CCHIP, and discuss a consistent approach across states.

No replacement amount or methodology has been selected. This is an investigation and discussion issue; implementation should follow agreement on an approach. There is no committed timeline.

Current calculation and concern

per_capita_chip divides each state's separate CHIP spending by its separate CHIP enrollment, without differentiating coverage populations. For California, the FY2024 inputs are:

• Spending: $678,088,532.
• Enrollment: 51,684.
• Result: $13,119.89 per person annually.

California's separate CHIP pool includes CCHIP children, the Unborn Option, MCAP, and MCAIP. Matching MACPAC's aggregate figures does not establish that the pooled average represents CCHIP children appropriately. The model already distinguishes CHILD_CCHIP and PREGNANT_FCEP eligibility categories, but applies the same state per-capita amount.

Medicaid-expansion CHIP is modeled through Medicaid and uses a different valuation calculation; it should remain distinguishable in this investigation.

Alternative estimates raised for discussion

The DHCS November 2025 Medi-Cal Estimate provides:

The broader Title 21 table includes dental and mental-health spending. The completeness of the CCHIP-specific figure, including services paid outside managed care, needs investigation.

One suggestion is to introduce a child-specific estimate while temporarily retaining the pooled amount for the pregnancy pathway. That is an option to assess, not an agreed decision or a validated pregnancy-specific estimate.

Questions for investigation

• Which populations and services should each amount represent, including dental, specialty mental health, CCS, and pregnancy/postpartum services?
• Are spending and enrollment aligned by population, period, and definition? In particular, distinguish enrollment at any time during a year from average monthly enrollment or member-years, and budget forecasts from historical spending.
• What source-selection principles should apply across states? Identify other states where pooled child and pregnancy spending could create the same problem, and determine when a documented proxy is appropriate.
• How would alternative estimates affect net and gross CHIP values, enrolled benefits, federal/state costs, and agreement with aggregate spending benchmarks?
• Confirm annual units in the model and partner-facing descriptions; any monthly presentation should explicitly convert the annual amount.

Intended outcome

Document the evidence, limitations, and alternatives, then discuss a proposed approach before implementation. This issue does not prescribe a California-only override, a particular dollar amount, or an all-state rollout.

Sources

• MACPAC Exhibit 33: CHIP Spending by State, FY2024 — underlying spreadsheet
• MACPAC Exhibit 32: Child Enrollment in CHIP and Medicaid by State, FY2024 — underlying spreadsheet
• DHCS November 2025 Medi-Cal Local Assistance Estimate #page 66,106,115,209-210
• California CHIP State Plan #page 8-10

Related issues

• California CCHIP eligibility varies by county #8522: California CCHIP county-specific eligibility (closed).
• Review Kansas CHIP per-capita denominator for separate CHIP enrollment #8792: Kansas CHIP per-capita spending/enrollment denominator (closed).
• Align CHIP spending, enrollment, and cost-sharing offsets to one fiscal year #8096: Align CHIP spending, enrollment, and offsets to one fiscal year (closed).