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SCHIP: increased eligibility in CHP+ for children and pregnant women to 200 percent FPL,removal of the Medicaid asset test, increased children enrolled in the HCBS Waiver Programand the Children’s Extensive Support (CES) Waiver Program, increased Medicaid eligibility forparents up to 75 percent FPL, restoration of Medicaid for legal immigrants, $430,000 for costeffectivemarketing of CHP+, and presumptive eligibility to pregnant women under Medicaid. 340Additionally, it calls for the creation of a reserve fund specifically for the health care expansionfund. The reserve fund will start with FY04-05 revenues ($23 million) and subsequently capture10 percent of the expansion fund revenues every year (10 percent of 46 percent of the totalrevenue) until the total balance in the reserve fund equals half of the annual amount transferredto the health care expansion fund. 341 This money can be accessed only if the appropriationsnecessary to sustain the populations specified in the health care program expansions exceedthe annual transfer of moneys to the health care expansion fund. 342 The sustainability of theseexpansions is a topic of hot debate. Forecasts show that these expansions are sustainable forthe next five years. 343 The question is if all this can be done for approximately $80 million.HIFA Waiver ProposalIn 2003 the state began considering applying for a HIFA waiver to streamline Medicaid, CHP+and the Colorado Indigent Care Program (CICP), with the goal of improving access andcoverage for Colorado’s low-income children and families. The concept of streamlining consistsof merging benefit packages, delivery systems, risk arrangements for vendors and providers,and administrative management of these programs while maintaining budget neutrality andwithout reducing eligibility or benefits. The state obtained a HRSA grant as well as funding fromseveral state foundations to conduct studies and analyses.The comparative analysis of Medicaid and CHIP service utilization among children: Theprincipal finding was that there is comparable utilization. As a result a proposal has beencreated to develop a uniform benefit package. The recommendation is for a “Core” benefitpackage and a “Core Plus” wrap-around benefit package (referred to as the “Core-Core Plus”structure). Based on the finding in the comparative analysis that the current CHIP benefitpackage is comprehensive enough to cover the majority of enrolled children’s health careneeds, the “Core” benefit package for all children on both Medicaid and CHIP would be thecurrent CHIP plan. For children with special health care needs who require expanded services,the “Core Plus” wrap-around benefit package would be added. However, the proposal does notcurrently include several populations of children who require more intensive services than otherMedicaid clients and therefore are much less likely to bounce between Medicaid and CHIP(foster care, adoption, SSI, etc.).The state is hoping the Core-Core Plus structure will allow for multiple purchasing strategies,and will ensure greater efficiency and cost-effectiveness of care. Where possible, the sameprovider networks will be used regardless of whether their reimbursement is from Medicaid orCHIP, in order to create a seamless system from the perspective of the client. It is important tonote that, under this proposal, CHIP and Medicaid would remain separate programs withrespect to federal funding, maintaining their separate matching fund streams. However, fromthe perspective of the client, services would not change with a move from Medicaid to CHIP orvisa versa. It is also important to note that it appears that the HIFA waiver would swing thestate back towards a managed care system. Currently the proposal is waiting to be introducedofficially to the legislature in the current session and therefore has not yet been submitted toCMS.C-24