Health Insurance Claims Assessment (HICA) Act

Are SCHIP funds exempt from the Health Insurance Claims Assessment (HICA), like some other sources of federal funding?

With the exceptions of Medicare, Medicare Advantage, and a few other funding sources listed in Section 2(s)(vii) of the statute, the source of funding does not determine whether the HICA assessment applies to a given claim.  In most instances, a carrier’s “paid claim” will be subject to the assessment, regardless of the source of the money that the carrier uses to make that payment.

Currently, Michigan’s MIChild program is administered only by entities that would meet the statutory definition of “carrier” under the HICA Act.  Therefore, the “paid claims” of those entities will be subject to the assessment.  The Medicaid MOMS program is administered as a fee-for-service program directly through the Michigan Department of Community Health (DCH).  Since DCH is not a “carrier” under the HICA Act, these payments are not subject to the assessment.