DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
CMCS Informational Bulletin 
 
DATE:  December 30, 2013 
 
FROM:  Cindy Mann 
Director 
 
SUBJECT:  FY 2013 CHIPRA Performance Bonuses 
 
Today we are awarding more than $307 million in Fiscal Year (FY) 2013 Childrens Health 
Insurance Reauthorization Act (CHIPRA) Performance Bonuses to 23 states, including:  Alabama, 
Alaska, Colorado, Connecticut, Idaho, Illinois, Iowa, Kansas, Maryland, Michigan, Montana, New 
Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, South Carolina, 
Utah, Virginia, Washington and Wisconsin. All 23 states also received bonuses for FY 2012; nine of 
the states received bonuses each year since 2009.  This year marks the fifth and final year CHIPRA 
bonuses will be awarded. 
 
Many of the simplification options that states adopted to qualify for a CHIPRA performance bonus  
including elimination of in-person interview requirements and a streamlined renewal process  will 
be in place in all states in 2014 and applied consistently across Medicaid, the Childrens Health 
Insurance Program (CHIP) and the Health Insurance Marketplace.  These simplifications have led to 
improved coverage for children and have helped lay the groundwork for outreach efforts aimed at 
enrolling people now eligible for coverage under the Affordable Care Act. 
 
Background on the CHIPRA Performance Bonus 
 
The Childrens Health Insurance Program Reauthorization Act of 2009 established performance 
bonuses to give states an incentive to support the enrollment and retention of eligible children in 
Medicaid and CHIP and to help defray the costs associated with increasing enrollment of the lowest 
income children.  Federal funding for qualifying states has been awarded annually in fiscal years 
2009 through 2013. 
 
To qualify for a performance bonus, states must meet two requirements: (1) States must implement 
at least five out of eight specific program features aimed at streamlining their enrollment and renewal 
procedures. Such improvements include eliminating face-to-face interview requirements so that 
applications can be filed online or through the mail, using electronic data-matching to reduce 
paperwork, and making it easier to renew, thereby minimizing disruptions in coverage and necessary 
treatment. (2) States also must increase childrens enrollment in Medicaid above a baseline level for 
the fiscal year.  States that increase enrollment more than 10 percent above their baseline receive a 
larger (Tier 2) bonus. 
 
By adopting the program features needed to earn a CHIPRA bonus, states have implemented 
sustainable improvements to their programs.  They have helped eligible children gain and retain 
access to health insurance and also have helped achieve administrative efficiencies. 
  CMCS Informational Bulletin  Page 2 
 
FY 2013 CHIPRA Performance Bonus Highlights 
 
This year, states have recognized that the buzz about the availability of health coverage, in general, 
has helped ramp up interest and applications for Medicaid, even in states that have not yet decided to 
expand eligibility.  A number of states continued to fine-tune and build on program features they 
previously adopted and also have taken steps to help make their outreach efforts more effective. 
 
-  Colorado attributes its FY 2013 bump in childrens Medicaid enrollment in large measure to 
the states ambitious systems modernization initiative.  Central to that effort is the 
development of the Colorado Program Eligibility and Application Kit (PEAK), which is 
designed to help applicants apply for a range of public benefits online.  It also allows 
beneficiaries to manage their benefits, increasing self-sufficiency, and enables the state to 
improve customer service and accountability.  There has also been a concerted state effort to 
work with partners across the state to get eligible people covered.  Enhanced outreach and a 
new mind-set that conveys the expectation that Coloradans will have health coverage has 
helped boost Medicaid enrollment.   
-  New Jersey is continually improving upon its presumptive eligibility process for 
children. Since last year, the state has been allowing primary care providers, as well as 
community health centers and hospitals, to make presumptive eligibility determinations, 
meaning they can enroll eligible children and provide benefits while the full application 
process is being completed. The state also has developed a web-based certification tool that 
enables providers to get training online. In anticipation of the new Hospital Presumptive 
Eligibility provision that will become effective in January 2014, New Jersey has revised and 
enriched the online training tool so that more hospitals will be able to become certified 
quickly and easily.   
-  South Carolina attributes its 2013 increase in childrens Medicaid enrollment to the 
increased attention on health care, as well as the states new online application process.  The 
state reports that about 13 percent of applications were submitted electronically in October, 
and it expects that proportion to increase.  In addition, South Carolinas continued efforts to 
improve its Express Lane Eligibility (ELE) process has helped boost enrollment.  South 
Carolina renews childrens Medicaid based on their familys SNAP or TANF data and the 
state also can enroll children into Medicaid when their families are found eligible for SNAP 
or TANF. As of October 2013, approximately 103,000 enrollments and 360,000 renewals had 
been processed via ELE.  Nearly 50 percent of the children enrolled through ELE have either 
selected a managed care plan or have used services, indicating that families want Medicaid 
coverage for their children.   
 
Simplification and outreach efforts have been paying off for children. Recent Census data show that 
uninsurance rates for children declined from 8.6 percent in 2009 to 7.5 percent in 2011.  In addition, 
an analysis by the Urban Institute found that participation rates in Medicaid and CHIP have 
continued to improve over time. In 2011, 87.2 percent of eligible children were enrolled, a 5.5 
percentage point increase from 81.7 percent in 2008.  A map presenting the latest Medicaid/CHIP 
participation rates can be found at http://www.insurekidsnow.gov/professionals/reports/index.html  
 
The full list of FY 2013 performance bonus awardees and details about their efforts, as well as a 
table presenting the history of the CHIPRA performance bonuses can be found at:  
http://www.insurekidsnow.gov/professionals/eligibility/performance_bonuses.html