State Children's Health Insurance Program



The State Children’s Health Insurance Program (SCHIP) is a national program in the United States that provides health insurance for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance. The program was created to address the growing number of children in the United States without health insurance. At its creation in 1997, SCHIP was the largest expansion of health insurance coverage for children in the United States since Medicaid began in the 1960s. The statutory authority for SCHIP is under title XXI of the Social Security Act. It was initially sponsored by Senator Ted Kennedy in a partnership with the then-First Lady of the United States, Hillary Rodham Clinton.

SCHIP covered 6.9 million children at some point during Federal fiscal year 2006, and every state has an approved plan. States are given flexibility, and an enhanced match is paid to states. Some states have received Section 1115 demonstration authority to use SCHIP funds to cover the parents of children receiving benefits from both SCHIP and Medicaid, pregnant women, and other adults. However, the program is already facing funding shortfalls in several states. Attempts to expand funding for the program have met with political controversy amidst studies that debate the program's fiscal impacts. A proposal recently passed in the Congress to reauthorize and expand SCHIP from an average of $5 billion yearly to approximately $12 billion yearly over the next five years was vetoed by George W. Bush, and an attempt to override the veto failed in the U.S. House of Representatives. Meanwhile, the program was funded at status quo ante levels through a continuing resolution,.

Despite SCHIP, the number of uninsured children continues to rise, particularly among families that cannot qualify for SCHIP. An October 2007 study by the Vimo Research Group found that 68.7 percent of newly uninsured children were from families 200 percent above the federal poverty level.

Federal dollars with state administration
Like Medicaid, SCHIP is a partnership between federal and state governments. The programs are run by the individual states according to requirements set by the federal Centers for Medicare and Medicaid Services. States may design their SCHIP programs as an independent program separate from Medicaid (separate child health programs), use SCHIP funds to expand their Medicaid program (SCHIP Medicaid expansion programs), or combine these approaches (SCHIP combination programs). States receive enhanced federal funds for their SCHIP programs at a rate above the regular Medicaid match.

States with separate child health programs follow the regulations described in Section 42 of the Code of Federal Regulations, Section 457. Separate child health programs have much more flexibility than Medicaid programs. Separate programs can impose cost sharing, tailor their benefit packages, and have a great deal of flexibility in eligibility and enrollment matters. The limits to this flexibility are described in the regulations, and states must describe their program characteristics in their SCHIP state plans. Out of 50 state governors, 43 support SCHIP renewal.

In Ohio, SCHIP funds are used to expand eligibility for the state's Medicaid program. As a SCHIP Medicaid expansion program, all Medicaid rules and regulations (including cost sharing and benefits) apply. Children from birth through age 18 who live in families with incomes above the Medicaid thresholds in 1996 and up to 200% of the federal poverty level are eligible for the SCHIP Medicaid expansion program. In 2004, the maximum annual income needed for a family of four to fall within 100% of the federal poverty guidelines was $18,850, while 200% of the poverty guidelines was $37,700.

Other states have similar SCHIP guidelines with some states being more generous or restrictive in the number of children they allow into the program. SCHIP Medicaid expansion programs typically use the same names for the expansion and Medicaid programs, and separate child health programs typically have different names for their programs. A few states also call the SCHIP program by the term "Children's Health Insurance Program" (CHIP).

Debate over impacts
SCHIP has cost the federal government $40 billion over its first 10 years, and the debate over its fiscal impacts reflects the larger debate in the U.S. over the government's role in health care. In 2007, researchers from Brigham Young University and Arizona State found that children who drop out of SCHIP cost states more money because they shift away from routine care to more frequent emergency care situations. The conclusion of the study is that an attempt to cut the costs of a state program could create a false savings because other government organizations pick up the tab for the children who leave SCHIP and later need care. In a 2007 analysis by the Congressional Budget Office, researchers determined that "for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children." The CBO speculates this is because the state programs offer better benefits at lower cost to enrollees than the private alternatives. A Cato Institute briefing paper estimated the "crowding out" of private insurers by the public program could be as much as 60%.

HR 976
In 2007, both houses of Congress passed a bipartisan measure to expand the SCHIP program,. The measure would have expanded coverage to over 4 million more participants by 2012, while phasing out most state expansions in the program that include any adults other than pregnant women. The bill called for a budget increase for five years totaling $35 billion, increasing total SCHIP spending to $60 billion for the five-year period. Despite claims that it also would have increased the eligibility from couples earning up to 200% of the federal poverty level to couples earning 300% of the federal poverty level,, FactCheck.org has noted that this eligibility was already possible under the old program and was not required by the new bill. The expansion of the SCHIP program was to have been funded by increasing the federal excise tax from 39¢ to $1.00 per pack of cigarettes nationwide.

On October 3, 2007, President Bush vetoed the bill, stating that he believed it would "federalize health care", expanding the scope of SCHIP much farther than its original intent. The veto was the fourth of his administration. After his veto, Bush said he was open to a compromise that would entail more than the $5 billion originally budgeted, but would not agree to any proposal drastically expanding the number of children eligible for coverage.

On October 18, 2007, the House of Representatives fell 13 votes short (273-156) of the two-thirds majority required to override the president's veto, although 44 Republicans joined 229 Democrats in supporting the measure.