SCHIP

*headdesk*

Tommy Thompson, 2001:

So, working with the President, we've developed a new program that will provide better health care for the millions of Americans who lack medical insurance or access to affordable care. The President announced the program a short time ago on his weekly nationwide radio address, and I'm here today to outline to you how it will work.

It's called the Health Insurance Flexibility and Accountability Initiative. This new model waiver program makes it faster, easier, and simpler for states to expand access to health insurance to low-income citizens through Medicaid and through SCHIP demonstrations.

The program is budget neutral, and it's a partnership between Washington and the states. It's not top- down. We want to work with you, in partnership, to expand health insurance to the most vulnerable and needy members of our society, most especially, to those whose incomes are under 200 percent of the poverty level.

You know what works best in your home states. You know the specific needs of your people. We've designed the model waiver program to give you the tools and the flexibility you need to advance benefits and quality care to those back home who need it the most.

Mark McClellan, 2006:

To provide States with the ability to structure their SCHIP plans to improve coverage and the quality of services available to beneficiaries, the Secretary has the authority to waive aspects of the Federal statute and regulations governing SCHIP. This allows States to amend their programs to increase health insurance coverage and encourage innovation. Using section 1115 of the Social Security Act, States can more effectively tailor their programs to meet local needs and can experiment with new approaches to providing health care services. These demonstrations have been used to provide health insurance to uninsured children, parents, caretaker guardians, and pregnant women. For example, CMS recently extended a demonstration in Minnesota that allows the State to use SCHIP funds to provide coverage to those with incomes from 100 to 200 percent of FPL who are parents and relative caretakers of Medicaid- and SCHIP-eligible children. Extending coverage to parents and caretaker relatives not only serves to cover additional uninsured individuals, but it may also increase the likelihood that they will take the steps necessary to enroll their children. Extending coverage to parents and caretakers may also increase the likelihood that their children remain enrolled in SCHIP. For example, in New Jersey, which covers parents through a section 1115 demonstration, the State found that having one parent enrolled increased the likelihood that a child remains enrolled.

Dennis Smith, 2007:

In addition, to ensure that expansion to higher income populations does not interfere with the effective and efficient provision of child health assistance coordinated with other sources of health benefits coverage, and to prevent substitution of SCHIP coverage for coverage under group health plans, we will ask for such a State to make the following assurances:

• Assurance that the State has enrolled at least 95 percent of the children in the State below 200 percent of the FPL who are eligible for either SCHIP or Medicaid (including a description of the steps the State takes to enroll these eligible children);
  
• Assurance that the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five year period; and
  
• Assurance that the State is current with all reporting requirements in SCHIP and Medicaid and reports on a monthly basis data relating to the crowd-out requirements.

We will continue to review all State monitoring plans, including those States whose upper eligibility levels are below an effective level of 250 percent of the FPL, to determine whether the monitoring plans are being followed and whether the crowd-out procedures specified in the SCHIP state plans are reasonable and effective in preventing crowd-out.