March 22, 2000
The Honorable David M. Walker Dear Mr. Walker: Under the Children’s Health Insurance Program (CHIP), States have a broad set of options and flexibility for expanding coverage to uninsured children. In designing their CHIP programs, more than half of the States chose to use stand-alone or combination approaches. While Medicaid expansions under CHIP essentially use the same enrollment and provider systems as the state’s Medicaid offices, States opting for a stand-alone or combination CHIP approach face more complex coordination issues. For example, title XXI requires that States establishing separate programs screen all applicants for Medicaid eligibility and enroll children in Medicaid if they are eligible. Now that more than two years have passed since CHIP was enacted, I am interested in how comparable CHIP and Medicaid programs are in reaching and enrolling uninsured children. I am also concerned about the mechanisms States use for coordinating the two programs. Accordingly, I would like the General Accounting Office to conduct a review that addresses the following questions: (1) How do CHIP stand-alone or combination programs compare with Medicaid, for example with regard to outreach, application, and eligibility determination processes, including coordination of States’ screening and enrollment procedures for CHIP and Medicaid? (2) To what extent do CHIP and Medicaid programs use the same provider networks and payment rates? (3) What implications (including implications regarding the availability of and access to services and treatments) are suggested by differences in CHIP and Medicaid programs, particularly with regard to application and eligibility determination processes, provider networks, and payment rates? Thank you for your assistance in this matter. If you need additional information about this request, please contact Bridgett Taylor or Amy Droskoski at (202) 226-3400. Sincerely, JOHN D. DINGELL
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