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 State Children's Health Insurance Program We are committed to serving the Transgender community 
August 9, 2007
The State Children's Health Insurance Program (SCHIP). This is Title XXI of the Social Security Act and is jointly financed by the Federal and State governments and administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years (FY) 1998 through 2007. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.
State Children's Health Insurance Program (SCHIP) Waivers and Demonstrations. The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs and SCHIP programs. Each authority has a distinct purpose, and distinct requirements.
Section 1115 Research & Demonstration Projects: This section provides the Secretary of Health and Human Services broad authority to approve projects that test policy innovations likely to further the objectives of the State Children's Health Insurance Program (SCHIP). The download below "Section 1115 Report Approved Under Review" gives a summary of all active and proposed SCHIP demonstrations and waivers.
CMS Administers the State Children's Health Insurance Program (SCHIP). Program benefits became available October 1, 1997 and will provide $24 billion in federal matching funds over 10 years to help states expand health care coverage to over 5 million of the nation's uninsured children.
The State Children's Health Insurance Program (SCHIP) is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years (FY) 1998 through 2007. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.
SCHIP Regulations 42 CFR 457
The regulations are contained in the download below. They are organized in Zip files by Subpart as follows:
Subpart A - Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies.
Subpart B - General Administration; Reviews and Audits; Withholding for Failure to Comply; Deferral and Disallowance of Claims; Reduction of Federal Medical Payments.
Subpart C - State Plan Requirements: Eligibility, Screening, Applications, and Enrollment.
Subpart D - State Plan Requirements: Coverage and Benefits.
Subpart E - State Plan Requirements: Enrollee Financial Responsibilities.
Subpart F - Payment to States.
Subpart G - Strategic Planning, Reporting, and Evaluation.
Subpart H - Substitution of Coverage.
Subpart I - Program Integrity.
Subpart J - Allowable Waivers: General Provisions.
Subpart K - State Plan Requirements: Applicant and Enrollee Protections.
Enrollment in SCHIP
SCHIP national aggregate enrollment from FY 1998 is shown in the download below, "SCHIP Ever Enrolled Year".
SCHIP enrollment report tables are located on the "SCHIP Enrollment Reports" section page.
Governor Gregoire Discusses Children's Health Care
Washington has led the nation to help low-income, working families provide health insurance for their children. Governor Chris Gregoire, in partnership with the Legislature, set a goal to provide access to health care coverage to every child in Washington by 2010. With the additional steps taken this past legislative session, Washington is on track to reach that goal.
Key to reaching this goal is the partnership that the state has with the federal government through the State Children's Health Insurance Program (SCHIP).
SCHIP is scheduled to end September 30, 2007 unless Congress reauthorizes it. Governor Gregoire and forty-three of the nation's governors sent a letter to Senate and House leadership and the President urging them to provide and fully fund coverage for children from lower income families who earn too much to qualify for Medicaid.
"The reauthorization of SCHIP is a priority for all governors; none of us can stomach the idea of children in our states going without the care they need to lead happy, healthy lives," said Governor Gregoire.
Washington's congressional delegation, particularly Senator Cantwell and Congressmen Inslee and McDermott, have looked after our state's interests, ensuring equity for our state while also taking the lead in expanding access to health care to millions of uninsured American children.
President Bush has threatened to veto the current SCHIP reauthorization bills making their way trough Congress.
Overview
Dental services for the State Children's Health Insurance Program (SCHIP) are an optional benefit under Title XXI of the Social Security Act for all children up to age 19. However, nearly all States have opted to provide coverage for dental services. Under Title XXI, States have flexibility in targeting eligible uninsured children. States may choose to expand their Medicaid programs, design separate child health programs, or create a combination of both. States choosing to create a separate child health program may offer one of four benefit options: State may elect to provide benchmark coverage; benchmark equivalent coverage; existing coverage that is substantially equal to coverage under the Federal Employees Health Benefit Plan, the State employee plan or a health maintenance organization that has the largest, uninsured commercial non-Medicaid enrollment in the State. Benchmark equivalent coverage is coverage that, in the determination of the Secretary of Health and Human Services, provides appropriate coverage for the State Children's Health Insurance Program (SCHIP) children.
Patient out-of-pocket costs for this program are allowed but limited. If a State expands its Medicaid program, then existing Medicaid cost-sharing limits apply. For all SCHIP enrollees, cost sharing cannot be charged for well-child and well-baby visits. This includes routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants and x-rays) as described in the most recent guidelines issued by the American Academy of Pediatric Dentistry. In addition, States cannot impose cost-sharing charges that, in the aggregate, exceed five percent of a family's total income for the length of child's eligibility period in the State.
States may also use Title XXI funds for oral health services initiatives. For example, California has opted to increase dental service utilization among low-income, uninsured children ages birth to five years by creating a health service initiative. California's oral health service initiative includes case management.
New Bush Policies Limit Reach of Child Insurance Plan
August 21, 2007
The Bush administration, engaged in a battle with Congress over whether a popular children's health insurance program should be expanded, has announced new policies that will make it harder for states to insure all but the lowest-income children.
New administrative hurdles, which state health officials were told about late last week, are aimed at preventing parents with private insurance for their children from availing of the government-subsidized State Children's Health Insurance Program. But Democrats and children's advocates said that the announcement will jeopardize coverage for children whose parents work at jobs that do not provide employer-paid insurance.
Under the new policy, a state seeking to enroll a child whose family earns more than 250 percent of the poverty level -- or $51,625 for a family of four -- must first ensure that the child is uninsured for at least one year. The state must also demonstrate that at least 95 percent of children from families making less than 200 percent of the poverty level have been enrolled in the children's health insurance program or Medicaid -- a sign-up rate that no state has yet managed.
These and other steps must be implemented within a year, Dennis G. Smith, director of the federal Center for Medicaid and State Operations, advised state health officials in a letter on Friday.
"We would not expect any effect on current enrollees from this review strategy," Smith wrote. He added that this focus on "the core uninsured targeted low-income population" will strengthen the program, known as SCHIP.
States had already been taking steps, such as imposing waiting periods, to keep parents from switching from private to government-subsidized insurance. But children's advocates called the new measures overly restrictive.
Cindy Mann, executive director of the Center for Children and Families at Georgetown University, said they "would effectively foreclose the opportunity for states to cover children in families with incomes of about $40,000 to $50,000 a year, depending on the size of family."
The District and 18 states, including Maryland, either cover children in families making more than 250 percent of the poverty level or have recently passed laws to do so, Mann said.
The administrative move, announced while lawmakers are out of town during the August recess, comes after the White House has wrangled with Congress for months over the future of the $5 billion-a-year program.
The Senate and the House have passed legislation that would dramatically increase funding and make it possible to sign up millions of new children for coverage. But President Bush wants to keep the program largely unchanged and has promised to veto either bill, saying they would inappropriately increase the federal role in health care.
SCHIP was created in 1997 to help insure children whose families earned too much to qualify for Medicaid but not enough to afford insurance on their own. It serves about 6.6 million children annually, but will expire at the end of September if Congress does not reauthorize it.
Senate Finance Committee Chairman Max Baucus (D-Mont.) yesterday called the new requirements a "drastic change" that "jeopardizes coverage for tens of thousands of children in low-income, working families. New policies like this warrant greater transparency before changes are made. I hope the administration will reconsider."
Rep. Rahm Emanuel (Ill.), chairman of the House Democratic Caucus, said if the president were serious about enrolling the lowest-income children, the administration would allow states to sign up youngsters for SCHIP when they qualify for school-lunch and other federal programs.
"States want to get these kids enrolled, and they will get them enrolled," said Emanuel, who helped create the program as a staff member in the Clinton administration. "I think states will see the letter for what it is, and that's a political ploy by the president. This is a political attempt by the administration to try to intimidate states." Copyright © 2007-2008 The STHN Group Last modified: August 28, 2007 |
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