Provider Network Adequacy Standards For CHIP Plans Are Stronger Than For Child-Focused Marketplace Health Plans

A review of network adequacy of selected Children's Health Insurance Program (CHIP) plans and qualified health plans (QHP) sold in five states found variation in the state requirements for inclusion of pediatric specialty provider organizations; those for CHIP plans were stronger than those for QHPs. QHPs are private health plans offered on health insurance marketplaces.

Of the five states (Alabama, Massachusetts, Pennsylvania, Texas, and Washington), two required CHIP plan networks and QHP networks to follow specific provider-to-enrollee ratios. Three required CHIP plan networks and QHP networks to follow provider capacity or availability standards, such as specific limits . . .