Prior to month-long recesses, both the House and Senate approved bills reauthorizing the State Children’s Health Insurance Program (SCHIP) and allowing states to expand eligibility for the program to more children in families above the federal poverty level. Currently, the level is set at $20,650, but several states have recently received waivers allowing them to expand eligibility from 250 to 400 percent above that. Although there are differences between the two versions of the bill that will have to be reconciled in the fall session, both bills support expanding eligibility. Many state governors from both parties also support expanding eligibility and covering more children.
However, on Friday, August 17, 2007, a letter was sent to state health officials from Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, informing them of new administration policies that would severely restrict the ability of states to expand SCHIP coverage. Further, these restrictions would apply to states that had already received waivers and had started covering more children. The restrictions described in the letter include a requirement that states demonstrate that they have already enrolled at least 95% of those children who are eligible under the original requirements, or no more than 200 percent above the poverty level – a standard that advocates and policy experts agree is impossible to meet. Ironically, the Congressional Budget Office reported that President Bush’s budget did not include enough funding for the SCHIP program to cover the children who are enrolled now. Therefore, it will not be able to cover those who are eligible but not yet enrolled, and/or those who might be eligible under an expanded program.
The rationale for the new restrictions is the government’s desire to prevent the SCHIP program from being used as a substitute for private insurance. However, the reason many states want to expand coverage is that numerous lower- and middle-income families do not have private insurance. The data in states where SCHIP has been expanded show that families with private insurance are not abandoning it in favor of the program. The new restrictions will be in force indefinitely, although Congress may attempt to override them in the fall.
The National Hemophilia Foundation (NHF) will continue to monitor this issue, inform the community, and take any appropriate actions to ensure that children and families who rely on this and other programs will be able to maintain access to adequate, reasonable coverage and high-quality care.
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