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Coordinating Publicly Funded Healthcare Coverage for Children

References

DeParle B., Fox C. Administrator, Health Care Financing Administration, and Acting Administrator, Health Resources and Services Administration. Letter to: State health officials. 1998 Jan 23.

Florida Healthy Kids Corporation. Healthy Kids 1999 Annual Report. Tallahassee, FL.

Fox H, Graham R, McManus M, et al. An analysis of States' CHIP policies with special health care needs. Washington, DC: Maternal and Child Health Policy Research Center; 1999 Apr.

Fox H, McManus M, Graham R, et al. Plan and benefit options under the State Children's Health Insurance Program. Washington, DC: Maternal and Child Health Policy Research Center; 1998 Jan.

Perry M, Stark E, Valdez R. Barriers to Medi-Cal enrollment and ideas for improving enrollment: findings from eight focus groups in California with parents of potentially eligible children. Menlo Park, CA: Kaiser Family Foundation; 1998.

Richardson S. Director, Center for Medicaid and State Operations, Health Care Financing Administration. Letter to: State health officials. 1998a Nov 23.

Richardson S. Director, Center for Medicaid and State Operations, Health Care Financing Administration. Letter to: State health officials. 1998b Sep 10.

Selden T, Banthin J, Cohen J. Medicaid's problem children: eligible but not enrolled. Health Affairs 1998 May/June; 17(3): 193-208.

Shuptrine S, Grant V, McKenzie G. Improving access to Medicaid for pregnant women and children in Georgia. Columbia, SC: Sarah Shuptrine and Associates; 1993.

Shuptrine S, Grant V, McKenzie G. Addressing the need for outreach to pregnant women and children. Columbia, SC: Sarah Shuptrine and Associates; 1994.

Shuptrine S, Grant V, McKenzie G. Southern regional initiative to improve access to benefits for low income families and children. Columbia, SC: Southern Institute on Children and Families; 1998.

Shuptrine S, McKenzie G. Information outreach to reduce welfare dependency: a Georgia welfare reform initiative. Columbia, SC: Southern Institute on Children and Families; 1996.

Thorpe K, Florence C. Covering uninsured children and their parents: estimated costs and number of newly insured. New York, NY: The Commonwealth Fund; 1998.

Ullman F, Bruen B, Holahan J. The State Children's Health Insurance Program: a look at the numbers. Washington, DC: Urban Institute; 1998.

Notes

1. This report focuses on issues relating to coordinating separate State Children's Health Insurance Program (SCHIP)-funded programs with Medicaid. But other important coordination issues arise in the context of SCHIP. The SCHIP law requires States to coordinate SCHIP coverage with other public and private sources of health coverage for children and to ensure that SCHIP-funded coverage does not substitute for coverage under group health plans. It also requires States to include in the State evaluations, which must be submitted to the Secretary by March 31, 2000, a review and assessment of State activities to coordinate SCHIP with other public and private programs, including Medicaid and maternal and child health services.

2. According to the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research), which analyzed 1996 Medical Expenditure Panel Survey data, as many as 4.7 million out of 11.3 million uninsured children were eligible for Medicaid but not enrolled (Selden, Banthin, and Cohen, 1998). Using data from the 1997 Current Population Survey (CPS) (Thorpe and Florence, 1998) estimated that out of a total of 11.3 million uninsured children, 5.1 million were eligible for Medicaid but not enrolled. The Urban Institute makes adjustments to the CPS data and has lower estimates of the number of uninsured children and of the number of uninsured children who are eligible for Medicaid and for SCHIP-funded expansions (Ullman, Bruen, and Holahan, 1998).

3. SCHIP funds have been allocated for 10 years. However, under the 1997 law, the total funds available to States dips in the year 2002 by almost 26 percent. In any given State, this drop in overall SCHIP funds may be offset in part or in full by unused SCHIP funds carried over by that State and by unused SCHIP funds that have been reallocated from other States. States have 3 years to use their SCHIP allotments. Unused funds will be reallocated to States beginning in Federal fiscal year 2001.

4. The Health Care Financing Administration (HCFA) has provided some guidance to States on the coordination requirement as it relates to enrollment (DeParle and Fox, 1998; Richardson, 1998a). It has not released guidance on procedures that need to be in place to assure that children whose circumstances change can transition from one program to another without a gap in coverage.

5. The coverage provided to SCHIP-covered children is subject to the Federal SCHIP rules, not the Federal Medicaid rules. This means, for example, that SCHIP rules relating to cost-sharing, benefits, and entitlement apply to the SCHIP-funded children.

6. Medicaid rules do not prevent private entities from doing initial processing of Medicaid eligibility (for example, at out-stationed application sites) or to screen applications for Medicaid eligibility as long as the final Medicaid eligibility determination is made by State agency personnel.

7. According to the Center on Budget and Policy Priorities' survey of States, as of July 1, 1999, Nevada is the only State with a separate SCHIP-funded program that does not use a joint application and does not currently have plans for developing one. New York is piloting a joint application, Pennsylvania is close to completing development of a joint application, and Montana plans to adopt one by January 2000. Utah has a separate application for its SCHIP-funded program as well as a joint SCHIP/Medicaid application.

8. HCFA's model joint SCHIP/Medicaid application is attached to guidance issued on September 10, 1998. One disadvantage of short SCHIP/Medicaid applications is that they may not allow for consideration of eligibility for other family members. Some States, however, have adopted simplified applications that cover parents as well as children. Rhode Island and the District of Columbia use a simple two-page application to enroll children, pregnant women, and parents.

9. Comparisons among States based on application length are not always informative. Some States use supplemental forms, while others integrate all questions on their basic form. Some States include detailed instructions on their forms, while others rely on brochures or other documents to convey similar information. Moreover, some States have squeezed so many questions into a few pages that the application may not be as easy to complete as one that is the same number of pages but has fewer questions or one that is longer but has more blank space or larger print. Most State child health applications are now posted on the Center on Budget and Policy Priorities Web site, http://www.cbpp.org/shsh/.

10. The HCFA guidance encourages States to inform families about Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits, the prohibition against cost-sharing for children in Medicaid, and other differences between Medicaid and the State's separate SCHIP program. The guidance further advises that families "should be informed that they do not have the choice of program; they may not be enrolled in SCHIP when determined to be Medicaid eligible." (Richardson, 1998a).

11. Under Federal Medicaid rules, the income of all legally responsible relatives living with the child is counted. Income from individuals who are not legally responsible (for example, an aunt or grandmother) is not counted unless that person is actually contributing to the child's support. In addition, States are required to disregard certain sources of income and to apply certain deductions when eligibility is determined. The main deductions are for work-related expenses, including child care.

12. Income from certain benefit programs cannot be counted as income in SCHIP programs pursuant to the laws that authorize those benefits.

13. Massachusetts and Oregon base their eligibility determinations for the SCHIP and Medicaid components of their program on gross income; no deductions are allowed for Medicaid-eligible children pursuant to section 1115 waivers. It is possible to use a gross income standard in Medicaid without a waiver if the standard is high enough to assure that all children who would have been eligible for Medicaid if deductions were applied still qualify for coverage.

14. Eight States that have expanded coverage exclusively through Medicaid and do not have a separate SCHIP-funded program have adopted continuous eligibility in Medicaid.

Prepared for the User Liaison Program (ULP), Agency for Healthcare Research and Quality (AHRQ), Contract Number 290-98-0009

Prepared by the Center on Budget and Policy Priorities
(Cindy Mann, Laura Cox, and Donna Cohen Ross)
(Edited by Sandra K. Isaacson and Maggie Rutherford, AHRQ)

AHRQ Publication No. 00-0014
Current as of February 2000


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Internet Citation

Coordinating Publicly Funded Healthcare Coverage for Children. Research Report. AHRQ Publication No. 00-0014, February 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/making/ulplink.htm


 

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