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The State Children's Health Insurance Program (SCHIP)
New Congress Reauthorizes SCHIP
The 111th Congress moved quickly to reauthorize the State Children's Health Insurance Program. The House passed HR 2, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) on January 14, 2009. The bill reauthorizes SCHIP for four-and-a-half years and increases funding by $35 billion to almost $60 billion. It contains several provisions modifying eligibility and other program requirements:
- increases eligibility levels for children up to 300 percent of the Federal Poverty Level,
- allows states at their discretion to cover children and pregnant women who are legal immigrants,
- prohibits coverage for illegal immigrants,
- phases out coverage for non-pregnant childless adults,
- authorizes a demonstration project for reducing childhood obesity,
- provides for use of eligibility information from other programs, such as Food Stamp or School Lunch programs, in determining eligibility,
- provides performance bonus payments to states that exceed enrollment targets, and
- authorizes states to verify citizenship by submitting names and Social Security numbers to the Social Security Administration.
The Senate passed the bill on January 29, 2009. The Senate bill was amended to require states to review citizenship or legal residency status of applicants whenever eligibility is renewed. The Committee also adopted an amendment that would allow states the option of providing dental benefits to children who have private health insurance but do not have dental coverage. The House approved the Senate changes, and the President signed the legislation on February 4, 2009.
According to the Congressional Research Service, the new law will result in a 187 percent increase in available federal funds for Mississippi in FY 2009, raising the state's allotment from $64.1 million to $183.7 million. The Center for Mississippi Health Policy has prepared an Issue Brief that examines the major provisions of the new law and the potential policy implications for Mississippi.
110th congress passes extension after President Vetoes Two Reauthorization bills
In 2007, Congress passed two bills to reauthorize SCHIP, and both were vetoed by President Bush. After these failures to reauthorize SCHIP, in December 2007 the 110th Congress passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (S 2499). The legislation extended the State Children's Health Insurance Program until March 2009 and included funding to maintain current enrollment levels in all states. The bill was signed by the President on December 29, 2007.
Background
The State Children's Health Insurance Program (SCHIP) was created by Congress in 1998 to provide health coverage to low income children in families not eligible for Medicaid. Congress authorized funding for ten years, establishing a formula to determine the grant amount allotted to each state and providing a mechanism to redistribute funds from states with unspent monies to states that needed additional funds.
SCHIP must be reauthorized by Congress for the Program to continue. The outcome of this process is very important to thousands of Mississippi families. If Congress does not appropriate additional funds and make adjustments to the funding formula, Mississippi will not likely be able to maintain current enrollment levels.
The Center for Mississippi Health Policy prepared an Issue Brief that provides an overview of the reauthorization issues facing the program in Mississippi and a Technical Brief that discusses specific problems with the federal funding formula.
the reauthorization debate
On August 1, 2007, the U. S. House passed HR 3162, the Children's Health and Medicare Protection Act of 2007, and on August 2, the U. S. Senate passed S 1893, the Children's Health Insurance Program Reauthorization Act of 2007. The Senate bill was later folded into HR 976. Both bills reauthorized SCHIP and both measures increased tobacco taxes to fund program expansions.
The House bill expanded SCHIP by $50 billion over the next five years and also included changes to Medicare, most notably reductions in payments to Medicare managed care plans and a reprieve in scheduled cuts to payments to physicians. The Senate bill authorized a $35 billion increase in funding for SCHIP over the next five years.
The legislation passed in both chambers addressed the problems with the funding formula that were detrimental to Mississippi. Both bills based future state allotments on past and projected spending. Growth factors are based on health care costs and child populations. States would have two years in which to spend their allotments, after which the monies could be redistributed to other states.
The Senate bill allowed states to increase eligibility for the program up to 300 percent of the federal poverty level. The current limit is 200 percent of the federal poverty level, with some exceptions. The House bill authorized states the option to extend coverage up to age 24. The age limit is currently 19.
The Senate bill prohibited coverage of childless adults under SCHIP after two years. States could still cover parents, but states would need to meet certain requirements in future years and would receive lower reimbursement levels. Both bills allowed states to cover pregnant women but required states to meet certain conditions before doing so.
The House bill provided states the option of covering legal immigrants under SCHIP and also made optional states' compliance with 2006 proof-of-citizenship requirements for Medicaid and SCHIP. The Senate bill relaxed proof-of-citizenship requirements, allowing 90 days for applicants to prove citizenship after obtaining coverage under SCHIP or Medicaid, and offered states assistance in developing electronic methods for confirming Social Security numbers of applicants with the Social Security Administration.
The Senate bill included a provision for a new grant program to finance outreach and enrollment efforts and a national enrollment campaign. There are seven types of entities that would be eligible to receive an outreach grant, including government agencies and non-profit organizations. Another section of the proposed legislation required states to show efforts to reduce administrative barriers to enrollment, including removing requirements for a face-to-face interview during the application process.
The House bill provided incentive payments to states that adopted five of seven specified enrollment practices, namely twelve-month coverage, administrative verification of assets, presumptive eligibility, elimination of face-to-face interviews, use of a common application form for both Medicaid and SCHIP, automatic renewal, and express lane eligibility.
Negotiations to work out the differences between the two bills were complicated by the inclusion of Medicare provisions in the House bill, which were eventually removed. The compromise bill, HR 976, which more closely resembled the Senate's bill, was passed by the House and the Senate, but vetoed by the President. The House failed to override the veto by 13 votes. The White House had released policy statements on HR 3162, S 1893, and HR 976, threatening to veto each bill.
On October 25, 2007, the House passed HR 3963 to reauthorize the Program. HR 3963 included several changes designed to address the concerns of House Republicans and President Bush:
- Eligibility is capped explicitly at 300 percent of the federal poverty level;
- Applicants will be required to show proof of citizenship if their citizenship status cannot be verified by the Social Security Administration using their Social Security number; and
- Childless adults are transitioned from the program in one year instead of two.
Funding for the program was similar to the provisions included in the vetoed bill. HR 3963 would have increased funding of the program by $35 billion over five years for a total amount of $60 billion, with the additional revenue coming from an increase in tobacco taxes.
The White House issued a policy statement on HR 3963, explaining that the President would veto the bill if significant changes were not made in the legislation, and on December 12, 2007, the President vetoed the bill. SCHIP was continued temporarily through a continuing resolution while a bipartisan group of House and Senate members attempted to negotiate a compromise bill. The group was unsuccessful in reaching an agreement, and Congress passed the longer extension in S 2499.
The Center will continue monitoring the SCHIP reauthorization process and provide updates on the Center's web site.
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