THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP)

Overview

: Proposed by President Clinton and passed as part of the historic, bipartisan Balanced Budget Act of 1997, the State Children's Health Insurance Program (SCHIP) is the largest single expansion of health insurance coverage for children in more than 30 years. Today, nearly 11 million American children -- one in seven -- are uninsured. This initiative was designed to reach these children, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance. This new initiative set aside $24 billion over five years for states to provide new health coverage for millions of children -- the largest children's health care investment since the creation of Medicaid in 1965. States are able to use part of their federal funds to expand outreach and ensure that all children eligible for Medicaid and the new SCHIP program are enrolled.

The initiative is a partnership between the federal and state governments that will help provide children with the health coverage they need to grow up healthy and strong. At President Clinton's insistence, the SCHIP program requires that states use this new money to cover uninsured children -- and not replace existing health coverage. The program also includes important cost-sharing protections so that families will not be burdened with heavy out-of-pocket expenses.

Funds for the program became available to the states on October 1, 1997. States receive federal matching funds only for actual expenditures to insure children.

HHS has approved SCHIP plans for all 50 states, 5 U.S. territories, and the District of Columbia. Additionally, 37 amendments to SCHIP plans have been approved to enroll even more children. As of September 1999, nearly 2 million children were covered by SCHIP.

The President's FY 2001 budget proposal includes provisions to insure additional children including giving states the option of extending SCHIP to children up to age 20, expanding SCHIP to parents of eligible children, allowing the school lunch program to share information with Medicaid and SCHIP, expanding sites authorized to enroll children in SCHIP and Medicaid, and requiring states to make their Medicaid and SCHIP enrollment equally simple.

EXPANDING CHILDREN'S ACCESS TO HEALTH COVERAGE

The State Children's Health Insurance Program (SCHIP), created under Title XXI of the Social Security Act, expands health coverage to uninsured children whose families earn too much for Medicaid but too little to afford private coverage. It builds on Medicaid, the federal-state health

insurance program that covers approximately 36 million low-income individuals, including 18 million children in 1997. Because Medicaid allows states flexibility in determining eligibility, states currently cover children whose family incomes range generally from below the federal poverty level (FPL) to as high as 300 percent FPL. The majority of states cover children in families between 100 and 150 percent of the FPL. The FPL for a family of four is $17,050 for 2000. In the new SCHIP program, states may either cover children in families whose incomes are above the Medicaid eligibility threshold but less than 200 percent of poverty, or up to 50 percentage points over the state's current Medicaid income limit for children.

Ensuring Meaningful Health Benefits. Under the new program, states have flexibility in targeting eligible uninsured children. States may choose to expand their Medicaid programs, design new child health insurance programs, or create a combination of both. States choosing a new children's health insurance program may offer one of the following benchmark plans: the standard Blue Cross/Blue Shield Preferred Provider Option offered by the Federal Employees Health Benefit Program; a health benefit plan offered by the state to its employees; or the HMO benefit plan with the largest commercial enrollment in the state. A state may also choose to offer the "equivalent" of one of the benchmark plans. If a state chooses this option, its plan's value must be at least equal to the benchmark plan's and it must include inpatient and outpatient hospital services, physicians' surgical and medical services, laboratory and X-ray services, and well baby/child care services including immunizations. In addition, a benchmark-equivalent plan must include benefits similar to the benchmark plan coverage of prescription drugs, mental health services, vision care, and hearing-related care. Under the law, New York, Pennsylvania and Florida can continue to offer the benefit plans under their existing state programs for uninsured children (with some modifications to comply with the law's cost-sharing protections). States choosing the Medicaid option must offer the full Medicaid benefit package.

Limiting Patient Costs. Patient out-of-pocket costs for this program are allowed but limited. If a state expands its Medicaid program, existing Medicaid limits apply to the newly enrolled children. If a new health plan is developed, premiums for families whose income are under 150 percent of the poverty level cannot exceed $19 per family per month and copayments must be nominal. Cost sharing is not permitted for well-baby, well-child or adolescent well visits, and immunizations. For families with incomes above 150 percent of poverty, cost-sharing may be based on an income-related sliding scale with an annual total out of pocket maximum for all children not to exceed five percent of the family's income.

Preventing Cost Shifting. To prevent states from shifting children from the traditional Medicaid program to this new program, states must not tighten the Medicaid eligibility standards for children that were in place on June 1, 1997. In addition, states must screen all applicants, and must enroll in the Medicaid program those who meet the Medicaid eligibility rules, instead of enrolling those children in the SCHIP plan. For states that expand their existing Medicaid programs, children who would have been eligible under Medicaid eligibility rules in effect on March 31, 1997 cannot be counted in the scope of the SCHIP-related expansion. All states must design their programs to address private cost shifting as well. In their child health plans, states will describe methods they will use to prevent "crowd out" or the shifting of children from private insurance to SCHIP.

Ensuring Patient Protections. On November 1, 1999 Secretary Shalala announced a proposed regulation that will extend patient protections to all children enrolled in SCHIP. This proposed regulation is consistent with President Clinton's 1998 Executive Order that all federal health plans - collectively covering over 85 million Americans - should come into compliance with the Patients' Bill of Rights. The protections include access to health care specialists, access to emergency services when and where the need arises, an assurance that doctors and patients can openly discuss treatment options, and access to a fair, unbiased and timely appeals process. This proposed regulation also codifies current SCHIP policies and practices that the federal government developed in partnership with the states. These policies include enrolling all eligible children in the SCHIP program; ensuring that Medicaid eligible children are enrolled when appropriate; ensuring a nominal level of family cost-sharing; and, requiring a meaningful benefits package when a state opts to create a separate SCHIP plan. The proposed regulation had a 60-day comment period. The final regulation will be published after comments have been evaluated.

ACCESSING FEDERAL FUNDING

Under the law, states are eligible to receive an enhanced federal matching rate drawn from an "allotment" for state programs approved by the Secretary of Health and Human Services that expand access to targeted, low-income children under SCHIP. Funds are allotted to each participating state according to their number of uninsured low-income children, accounting for regional cost differences. The reserved state allotments for fiscal year 1998 and fiscal year 1999 were published in the Federal Register on February 8, 1999. Allotments ranged from $118,113 for Northern Mariana Island's relatively small population to a high of $855 million for California.

Under current law, the calculation of SCHIP funds for U.S. territories is separate from that used for states, resulting in a lower subsidy than is given to states. In order to provide more equitable funding for children's health care under the Balanced Budget Refinement Act of 1999 (BBRA), U.S. territories, will receive an additional $34.2 million in fiscal year 2000 and in fiscal year 2001. BBRA also gave additional funding to U.S. territories of about $249 million total beginning in fiscal year 2000 through fiscal year 2007.

States and U.S. territories may use up to 10 percent of the SCHIP benefit expenditures for outreach efforts, additional services other than the standard benefit package for low-income children, and administrative costs. To access their fiscal year 1998 allotments totaling $4.3 billion, states and territories had to have their SCHIP plans approved by the Secretary of Health and Human Services by Sept. 30, 1999. The fiscal year 1999 SCHIP allotment is $4.275 billion, which includes $32 million for U.S. territories. Of the $4.275 billion, $60 million will be transferred to special diabetes programs for children and American Indians, which leaves $4.247 billion available to states and territories. States and territories will receive federal matching funds only for actual expenditures used to insure children.

EXPANDING OUTREACH

The Clinton/Gore Administration has made significant efforts to reach out to families whose children qualify for SCHIP. These efforts include:

The Announcement of Public-Private Sector Commitments to Provide Outreach. In February 1999, the President launched the Insure Kids Now outreach campaign.

• A new toll-free number, 1-877-KIDS NOW, that directs families anywhere in the nation to their own State Children's Health Insurance information hotlines. President Clinton announced that the National Governors' Association (NGA), with a grant from Bell Atlantic, established this national toll-free number to help states reach families of uninsured children. The toll-free number, 1-877-KIDS NOW, automatically directs callers to their state's enrollment agency. From February through December 1999, over 224,000 calls were automatically directed to state hotlines.
• Insure Kids Now Web Site. President Clinton also announced the creation of insurekidsnow.gov, a Web site with eligibility and contact information for each state, territory and the District of Columbia. It also contains information about local and national outreach activities, including school-based outreach.
• A national radio advertising campaign to promote the Insure Kids Now Campaign. From February to June 1999, HHS sponsored a national radio advertising campaign to promote the 1-877-KIDS NOW toll-free number and to complement states' outreach efforts. The $1.3 million radio campaign included a four-week paid radio campaign in major markets around the country. In addition, public service announcements in English and Spanish were distributed to an estimated 4,000 radio stations nationwide.
• Supporting the Insure Kids Now Campaign. The Federal Interagency Task Force on Children's Health Insurance Outreach, comprised of over 10 federal agencies, prepared an outreach training kit for use by workers from all federal departments that participate in the Insure Kids Now campaign, in concert with the national toll-free number for children's health insurance outreach. The kit contains a presentation outline, posters, and materials that can be used as handouts. In addition, federal departments have promised to distribute more than 140,000 outreach posters to their grantees, field offices, and human services agencies.
• Promoting the Insure Kids Now Campaign. The President also announced unprecedented new efforts from the private sector specifically television, radio, and print organizations who pledged to promote the Insure Kids Now toll-free number to help ensure that all eligible children receive health insurance.

School-Based Outreach Efforts

• Back-to-School Campaign. HHS, along with the Department of Justice, the Department of Education and 17 national nonprofit organizations including the United Way, coordinated back-to-school enrollment activities in 25 communities nation wide. HHS also sponsored a $1 million paid radio campaign to promote these outreach activities and the Insure Kids Now Toll-free number.
• Presidential Directive to Develop Strategies to Integrate Children's Health Insurance Outreach into Schools. In October 1999, the President signed an executive memorandum instructing the Secretaries of HHS, Education, and Agriculture (with its jurisdiction over the school lunch program, which serves over 25 million children daily) to report to him in six months on steps the federal government can take to institutionalize school-based outreach and enrollment, and to highlight successful ongoing programs. Using schools to target eligible children builds on innovative programs that are already implemented in some states. For example, both Indiana and New Jersey are using their federal authority to conduct on-site enrollment of children in schools.

The Announcement of Historic Public-Private Sector Efforts to Enroll Uninsured Children

• Presidential Directive Launched Government-Wide Efforts. In February 1998, as the first step in his public-private children's health outreach campaign, President Clinton directed executive agencies to commit to enrolling uninsured children in SCHIP and Medicaid. In response, over ten federal agencies developed plans in three areas: how to educate their workforce; how this workforce can help educate families about state health insurance programs; and how to coordinate cross-agency and public-private efforts to identify and enroll children in these programs. In June l998, this Federal Interagency Task Force on Children's Health Insurance Outreach submitted a report to the President, outlining activities that federal agencies would undertake to identify and to help enroll children in Medicaid or other health insurance programs for the upcoming year. The President charged the Secretary of the Department of Health and Human Services with oversight of the implementation of this outreach initiative.
• Since then, each of the departments has actively engaged in outreach activities they identified in this report. For example, the Department of Agriculture widely distributed SCHIP information to WIC programs in states. In Virginia, the WIC Program distributed 100,000 SCHIP brochures and applications to WIC participants during clinic visits. HUD-sponsored Neighborhood Networks centers, which provide computer training at no cost to residents of more than 400 HUD-assisted multi-family housing developments, have started serving as an access point to download federal and state information about Medicaid and SCHIP. In October 1999, the Interagency Task Force submitted a Report to the President outlining their progress and identifying nearly 90 new outreach strategies.
• $45 million in commitments from private foundations across the country. The Robert Wood Johnson Foundation is spending $45 million over three years to fund innovative state-local coalitions to design and conduct outreach initiatives, simplify enrollment processes, and coordinate existing coverage programs. The Kaiser Family Foundation will spend up to $10 million over 5 years on studies to help understand why eligible children do not enroll in existing programs and how best to provide insurance coverage for these children. America's Promise, with support from the Robert Wood Johnson Foundation and in collaboration with the American Academy of Pediatrics, is mobilizing corporations, such as SmithKline Beecham and Schering Plough, and local communities nationwide in children's health outreach efforts.
• New initiatives from corporate and advocacy organizations to reach out to uninsured children. Proctor and Gamble, the manufacturer of Pampers diapers, volunteered to include a letter in its child birth education packages, given to 90 percent of first-time mothers, providing families information about available health insurance options. Grocery stores and chain drug stores across the country committed to providing information about a new toll-free number to their customers. The National Education Association will launch an unprecedented effort to educate teachers on how they can inform children and their families about health insurance, through national newsletters, conferences, and special training sessions. The American Hospital Association's Campaign for Coverage will increase its nationwide initiative to engage hospitals in helping uninsured Americans, including children.

BUILDING ON PREVIOUS CLINTON-GORE ADMINISTRATION ACTIONS

Since 1993, HHS has approved Medicaid waivers for 18 states for comprehensive health care reform projects that allow states to control costs and expand coverage. In addition, the 1996 welfare reform law provides $14 billion over five years in child care funding to help more mothers move into jobs. It also guarantees that individuals who meet pre-welfare reform, welfare-eligibility criteria continue to be eligible to receive Medicaid, and have at least six months of transitional Medicaid when they no longer meet these criteria because they go to work.

President Clinton also signed into law the Health Insurance Portability and Accountability Act of 1996 (HIPAA), creating important new protections for an estimated 25 million Americans, approximately 1 in 10, who move from one job to another, are self-employed, or have pre-existing medical conditions.

SCHIP also builds on the Clinton-Gore administration's long standing commitment to improving health care for children. Last year, the President issued guidelines to eliminate easy access to tobacco products and to prohibit companies from advertising tobacco to children. In addition, President Clinton announced in 1996 that over 90 percent of America's toddlers received the most critical doses of each of the routinely recommended immunizations -- surpassing the administration's goal set in 1993. The FDA also released a rule that requires manufacturers to do studies on pediatric populations for new prescription drugs as well as those currently on the market.

Combined, the Clinton-Gore administration's efforts will help assure that children get the healthy start they need to live long and productive lives.

STATE SCHIP PROGRAMS
Descriptions of approved state SCHIP programs follow:

Alabama

Alabama could receive over $85 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state implemented its SCHIP plan in two phases. Initially, Medicaid eligibility was expanded to uninsured children under 19 years of age whose family incomes do not exceed 100 percent of the federal poverty level (FPL). The ALL Kids program, the second phase, is a separate state children's health insurance program that expands coverage to children up to age 19 whose family income is between 100 and 200 percent of the FPL. ALL KIDS offers coverage comparable to the HMO with the largest insured commercial, non-Medicaid enrollment in the state. Additionally, Alabama provides an enhanced health benefits coverage package for children with special health care needs/conditions who are enrolled in ALL KIDS. In fiscal year 1999, 38,980 children were enrolled, surpassing the state's initial expected enrollment of 36,000 children. Alabama was the first state approved on January 30, 1998, its first amendment was approved August 18, 1998, and its second amendment was approved September 28, 1999.

Alaska

Alaska could receive as much as $6.8 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Alaska is using its SCHIP allotment to expand its Medicaid program, Denali KidCare. Before the expansion, the state covered children to age 1 in families with incomes up to 185 percent of the FPL, children 1-6 in families with incomes up to 133 percent of poverty, and children ages 6-19 in families with incomes up to 100 percent of poverty. The state is using its Title XXI funds to expand Medicaid coverage to children in families with incomes up to 200 percent of the FPL. Eligible children receive the full Medicaid benefit package and there are no cost sharing requirements. The state enrolled 8,033 children in fiscal year 1999, exceeding its initial expectation of 5,000 children. Alaska's plan was approved December 11, 1998.

American Samoa

American Samoa could receive as much as $128,850 in federal funds for fiscal year 1998 and $512,250 in federal funds for fiscal year 1999 for its SCHIP plan. The territory is using its allotment to expand Medicaid to children receiving services through a territory-funded program. The local government is not expanding income limits, but instead expanding the number of children served. Enrollees receive the benefits package provided through the American Samoa Medicaid program and there is no cost-sharing requirement. American Samoa's SCHIP plan was approved April 13, 1999.

Arizona

Arizona could receive as much as $116 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Arizona used its SCHIP allotment to create, KidsCare, a new health insurance program that covers children from birth through age 18. Income eligibility increased over time, beginning at 150 percent of the FPL and rising to 200 percent FPL effective October 1, 1999. Enrollees receive coverage through established Arizona Health Care Cost Containment System plans and state employee health maintenance organizations that elect to participate in the program. American Indians may choose to receive services through the Indian Health Service with no cost-sharing. Non-Indian participants will pay a $5 copayment for non-emergency use of the emergency room. Premiums are imposed on families with income between 150 percent and 200 percent FPL, effective October 1, 1999. To assist with outreach, the state has created an Outreach Coordinator position and has sent applications to organizations that serve low-income children. The state enrolled 26,807 children in fiscal year 1999. Arizona's plan was approved on September 18, 1998; its first amendment was approved on May 21; 1999; its second amendment was approved on August 23, 1999; and its third amendment was approved on December 1, 1999.

Arkansas

Arkansas could receive over $47 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state is using its SCHIP allotment to expand Medicaid coverage to who would otherwise not have health insurance. It will cover children born after September 30, 1982 and prior to October 1, 1983 whose family income is at or below 100 percent of the FPL. Arkansas is currently considering how to structure the second phase of its Title XXI program to cover even more children. The state also has a Medicaid section 1115 waiver, ARKids First, that serves children through age 18 with family incomes up to 200 percent of poverty. The state enrolled 913 children in fiscal year 1999. Arkansas' plan was approved on August 6, 1998.

California

California could receive as much as $854.6 million in federal funds for fiscal year 1998 and $850.6 million for fiscal year 1999 for its SCHIP plan. The state expanded its Medicaid program, known as Medi-Cal, by making children under age 19 eligible if they have family incomes at or below 100 percent of the federal poverty level. The state also expanded its current state program, known as Access for Infants and Mothers (AIM), to cover infants up to age 1 from 200 percent to 250 percent of the federal poverty level. Through SCHIP, California also expanded its Healthy Families program, which will provide coverage for children age 1-19 with family incomes from 100 percent to 200 percent of the federal poverty level. The state enrolled 222,531 children in fiscal year 1999. California's plan was approved on March 24, 1998; its first amendment was approved on June 29, 1998; its second amendment was approved on November 23, 1999; and its third amendment was approved on December 21, 1999.

Colorado

Colorado could receive up to $41 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state expanded children's access to health coverage by building on its own Colorado Child Health Plan. The benefit package includes services such as hospital and emergency room transport, inpatient services, medical office visits, and prescription drugs. Coverage is provided to children from birth through age 18 in families whose income is at or below 185 percent of the federal poverty level. The state enrolled 24,116 children in fiscal year 1999. Colorado's plan was approved on February 18, 1998 and an amendment was approved on September 21, 1999.

Commonwealth of the Northern Mariana Islands

The Commonwealth of the Northern Mariana Islands could receive $118,000 in federal funds for fiscal year 1998 and $470,000 for fiscal year 1999 for its SCHIP plan. The Northern Mariana Islands is using the SCHIP allotment to expand Medicaid for children under age 19 who are currently receiving services through a territory-funded program. The local government is not expanding income limits, but instead expanding the number of children served. Northern Mariana Islands' SCHIP plan was approved on August 26, 1999.

Connecticut

Connecticut could receive approximately $35 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state both expanded its Medicaid population and created a new program based on the state employee's health plan. Under the state's HUSKY program, Medicaid eligibility was expanded to include children ages 14 through 18 with household incomes of up to 185 percent of the federal poverty level. Previously, the Medicaid program only covered children up to age 13 in families with incomes up to 185 percent of the federal poverty level. The new health insurance program, Part B of HUSKY, is targeted toward children up to age 18 in families with incomes up to 235 percent of poverty. The state applies an income disregard - setting aside certain types of income the family may have - effectively bringing coverage to 300 percent of poverty. Before income disregards are applied, HUSKY Part B charges families with incomes above 235 percent of poverty premiums of $30 per child, with an upper limit of $50 per family. Children with special physical and behavioral health care needs receive necessary services under a special third part of the program, HUSKY Plus. The state enrolled 9,912 children in fiscal year 1999. Connecticut's plan was approved on April 27, 1998.

Delaware

Delaware could receive as much as $8 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Delaware created a separate state children's health insurance plan, the Delaware Healthy Children Program, that targets children under age 19 whose family income is less than 200 percent of the FPL. Coverage is provided through the state employee health plan and includes pharmaceutical/prescription drug services, mental health services and substance abuse care. Monthly premiums are charged on a sliding scale based on income. The state enrolled 2,433 children in fiscal year 1999. Delaware's plan was approved on September 1, 1998.

District of Columbia

The District of Columbia could receive as much as $12 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The District expanded its Medicaid program, DC Healthy Families, to children from birth to age 19 whose family income is less than 200 percent of the FPL. Enrollees receive the regular Medicaid benefits package and there is no cost sharing for families. The District has created a single, two-page, mail-in application for both Medicaid and SCHIP. The District enrolled 3,029 children in fiscal year 1999. The District of Columbia's SCHIP plan was approved September 17, 1998.

Florida

Florida could receive as much as $270 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Phase One of Florida's SCHIP plan expanded Medicaid eligibility to children ages 15 through 18 in families earning up to 100 percent of the FPL and expanded Florida's Healthy Kids program, a comprehensive program that was piloted in 20 counties, to additional counties. Phase Two created the Florida KidCare Program which expanded the Healthy Kids program on a state-wide basis, expanded eligibility for the program to children through age 18 in families with incomes up to 200 percent of FPL, created the MediKids program to provide coverage for children up to age 5, and created the Children's Medical Services Network for children up to 18 with special health care needs. The state enrolled 154,594 children in fiscal year 1999. Florida's plan was approved on March 6, 1998; and its amendment was approved on September 8, 1998.

Georgia

Georgia could receive as much as $124 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Georgia created a separate insurance program, called PeachCare for Kids, for children through age 18 whose families have incomes of less than 200 percent of poverty and who are not eligible for Medicaid. Enrollees receive benefits comparable to the current Medicaid package. There is no cost sharing for children under age 6; for children over age 6 there is a monthly premium of $7.50 for one child and $15 for two or more children. The state enrolled 47,581 children in fiscal year 1999. Georgia's plan was approved on September 3, 1998.

Guam

Guam could receive as much as $375,800 in federal funds for fiscal year 1998 and $1.5 million for fiscal year 1999 for its SCHIP plan. Guam opted to use its SCHIP allotment to expand its Medicaid program to children receiving services through a territory-funded program. The availability of SCHIP funds will help the territory serve more children. The local government is not expanding income limits, but instead is expanding the number of children served. The current categorically needy income level in Guam for a family of four is $17,232--slightly higher than the continental United States. The regular Medicaid benefits package is provided and there is no cost for the families participating in the program. Guam's plan was approved on March 29, 1999.

Hawaii

Hawaii could receive as much as $9 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state will expand Medicaid to cover children between ages 1 and 6 with incomes up to 185 percent of the FPL. When implemented, enrollees will receive the state's Medicaid benefit package and there will be no out-of-pocket costs to families participating in the program. Hawaii's SCHIP plan builds on its Medicaid demonstration program -- QUEST -- which is attempting to provide universal coverage for residents who are not covered under the state's mandatory employer-sponsored insurance program. Hawaii plans to launch its SCHIP plan in July 2000 and recently submitted an amendment to expand the program to more children. For outreach activities, the state plans to collaborate with schools to provide Medicaid and SCHIP information. Hawaii will also distribute Medicaid and SCHIP information through health care providers, the unemployment office, the Office of Youth Services, places of worship, and activity-based organizations such as sports, scouts, and schools of Hula. In addition, the state will establish a toll-free information line, a Web site, and a media campaign on the Medicaid/SCHIP program. The state expects to insure an additional estimated 500 children by September 2000. Hawaii's plan was approved January 19, 1999.

Idaho

Idaho could receive as much as $15.8 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Idaho expanded Medicaid eligibility to children up to age 19 in families with incomes up to 150 percent of the federal poverty level. The state has formed a task force to study ways of further expanding Idaho's SCHIP program. Children in the Medicaid expansion receive the state's standard Medicaid benefit package. Outreach activities include mailing postcards to potential enrollees describing Title XXI. The state enrolled 8,482 children in fiscal year 1999, exceeding its initial expected enrollment of nearly 5,600 children. Idaho's plan was approved on June 15, 1998 and its amendment was approved on December 4, 1998.

Illinois

Illinois could receive over $122 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Illinois expanded Medicaid eligibility for children up to age 19 whose families have incomes at or below 133 percent of the federal poverty level. Prior to the SCHIP expansion, the income level for Medicaid eligibility varied based on the age of the child. Under the new program, KidCare, income thresholds have been equalized. The state enrolled 42,699 children in fiscal year 1999, exceeding their initial expected enrollment of 40,000 children. Illinois' plan was approved on April 1, 1998.

Indiana

Under the SCHIP program, Indiana could receive as much as $70 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Indiana expanded its Medicaid program and created a separate health insurance program called Hoosier Healthwise. Medicaid eligibility was expanded to cover children up to age 19 in families with incomes up to 150 percent of the federal poverty level. The separate program covers children in families with incomes up to 200 percent of the federal poverty level. Children in the Medicaid expansion population receive the state's standard Medicaid benefit package. The benefit package for the separate program is equivalent to the standard Blue Cross/Blue Shield preferred provider option service offered under the Federal Employees Health Benefits Program. The state enrolled 31,246 children in fiscal year 1999. Indiana's SCHIP plan was approved on June 26, 1998 and its amendment was approved on December 22, 1999.

Iowa

Iowa could receive as much as $32 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Initially, Iowa expanded its Medicaid program by raising income eligibility in several different age categories. The Medicaid expansion allows children from age 6 - 18 in families whose incomes are up to 133 percent of the FPL to enroll. Prior to the expansion, the state's Medicaid program covered infants up to one year of age in families with incomes up to 185 percent of FPL and children ages 1 through 5 up to 133 percent of the FPL. Iowa then amended its SCHIP plan to add a non-Medicaid component called HAWK-I. HAWK-I provides health care coverage, via contracts with commercial health plans, to children with family incomes less than 185 percent of FPL, who are not eligible for Medicaid. The benefit package for SCHIP is the same as the Medicaid benefit package. The state enrolled 9,795 children in fiscal year 1999. Iowa's plan was approved September 1, 1998 and its amendment was approved June 16, 1999.

Kansas

Kansas could receive as much as $30 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its SCHIP allotment, Kansas created a separate insurance program called HealthWave for children through age 18 whose families have incomes of less than 200 percent of the FPL. The benefit package for children enrolled in SCHIP is the same as that offered to state employees. Families with incomes above 150 percent of the FPL must pay a monthly premium. Families with income between 151 and 175 percent of poverty pay $10 per month per family, and families between 176 and 200 percent of poverty pay $15 per month per family. The state enrolled 14,443 children in fiscal year 1999. Kansas' plan was approved on September 1, 1998.

Kentucky

Kentucky could receive over $49 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its SCHIP allotment, Kentucky both expanded its Medicaid program and launched a separate insurance program called K-CHIP. The Medicaid expansion covers children through age 18 who are in families with incomes up to 150 percent of the FPL. Children from birth to age 19 in families with incomes up to 200 percent of the FPL, and who are not eligible for Medicaid, are eligible for K-CHIP. The K-CHIP benefit plan is a benchmark equivalent to the Standard High Option HMO plan for state employees. Families with incomes between 150 and 200 percent of the FPL pay a maximum of $120 for a six-month period, and payments can be made monthly ($20) or quarterly ($60). The state enrolled 18,579 children in fiscal year 1999. Kentucky's plan was approved November 25, 1998 and its amendment was approved on September 3, 1999.

Louisiana

Louisiana could receive as much as $101 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state expanded Medicaid to children ages 6 through 18 whose family income is at or below 150 percent of the federal poverty level. The benefit package is the same as the state Medicaid program and there is no cost sharing for families. The state enrolled 21,580 children in fiscal year 1999. Louisiana's plan was approved October 20, 1998 and an amendment was approved August 27, 1999.

Maine

Maine could receive as much as $12 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state both expanded Medicaid and created a statewide children's health insurance program, Cub Care. Through SCHIP, Maine expanded coverage to children through age 18 with family incomes up to 185 percent of the federal poverty level. The Medicaid expansion covers children aged one through 18 in families with incomes up to 150 percent of poverty. The Cub Care program covers children in families with incomes from 151-185 percent of poverty. The state enrolled 13,657 children in fiscal year 1999, exceeding its initial expected enrollment of 10,400 children. Maine's plan was approved on August 7, 1998.

Maryland

Maryland could receive over $61 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Maryland expanded its Medicaid program with its SCHIP allotment. Under the SCHIP plan, children between birth and age 19 whose family incomes are below 200 percent of poverty receive coverage. Children covered by SCHIP receive the Medicaid benefits package. The state enrolled 18,072 children in fiscal year 1999, exceeding its initial expected enrollment of 15,500 children. Maryland's plan was approved July 29, 1998.

Massachusetts

Massachusetts could receive over $42 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state both expanded its Medicaid program and created a separate Family Assistance Plan called MassHealth. Massachusetts provides the state's regular Medicaid benefit package to newly-enrolled children. The eligibility level for Medicaid was increased from the 133 percent of FPL to 150 percent of FPL. The state also created the Family Assistance Plan for children with family incomes between 150 and 200 percent of poverty. Uninsured children with family incomes over 150 percent of poverty are eligible for either a "direct coverage option" or for financial assistance for families to purchase dependent coverage through their employers, the "premium assistance option." The Family Assistance Plan provides coverage equivalent to the insurance plan offered to federal employees in the state. These families pay a monthly premium of $10 per child with a family maximum of $30 per month. The state enrolled 67,852 children in fiscal year 1999, exceeding its initial expected enrollment of 37,000 children. Massachusetts' plan was approved on May 29, 1998.

Michigan

Michigan could receive over $91 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its allotment, the state both expanded Medicaid and created a separate health insurance program. The combined programs, called MIChild, provide comprehensive health care coverage to all children under age 19 whose families have incomes at or below 200 percent of the federal poverty level. Children in families at or below 150 percent of the FPL are enrolled in the Medicaid expansion program. Children whose family incomes exceed 150 percent of the FPL are enrolled in the separate SCHIP program. The benefit package mirrors the state employees' plan and is administered by multiple managed care providers. Some co-payments apply for families between 151-200 percent of poverty. The state enrolled 26,652 children in fiscal year 1999. Michigan's plan was approved on April 7, 1998 and its amendment was approved on June 29, 1998.

Minnesota

Minnesota has been among the most progressive states in the nation in providing health insurance coverage for children and families. The approval of Minnesota's plan enabled the state to lay the groundwork for its SCHIP program and secure its SCHIP allotment, which could be as much as $28 million in federal funds for both fiscal year 1998 and fiscal year 1999. Minnesota currently covers approximately 50,000 children who would otherwise be uninsured through a Section 1115 Medicaid waiver amendment, granted in 1995. The MinnesotaCare program provides health coverage to pregnant women and children with family incomes up to 280 percent of the federal poverty level. The state enrolled 21 children in fiscal year 1999. Minnesota's plan was approved July 17, 1998.

Mississippi

Mississippi could receive as much as $56 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Mississippi expanded Medicaid and created a separate program. The Medicaid expansion covers children ages 15 through 18 in families with incomes up to 100 percent of the federal poverty level. Recipients receive the regular Medicaid benefit package and there are no cost sharing requirements. The separate program covers children up to age 19 in families with incomes between 100 and 200 percent of the federal poverty level. The benefit package for the new separate program is equivalent to that offered to state employees, with the addition of vision, hearing and dental services. There is no family cost-sharing requirement. Eligible children and families have access to employer-sponsored health insurance where the plan pays the insurance premium for coverage under the employer's plan if it meets certain criteria. The state enrolled 13,218 children in fiscal year 1999. Mississippi's plan was approved October 26, 1998; its first amendment was approved February 10, 1999; and its second amendment was approved on December 17, 1999.

Missouri

Missouri could receive more than $51 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Missouri expanded insurance coverage to children within the state's existing Medicaid managed care program, known as MC+. This program expanded eligibility to children in families with incomes up to 300 percent of the federal poverty level. Missouri's statewide health care reform demonstration plan was approved through a Section 1115 Medicaid waiver. It allows the state to slightly alter the Medicaid benefit package and also enroll the SCHIP children in Medicaid after the state's SCHIP funds are exhausted. This Medicaid waiver also provides coverage for certain adults, including working parents leaving welfare and mothers who otherwise would have lost their Medicaid following childbirth. The state enrolled 49,529 children in fiscal year 1999. Missouri's plan was approved on April 28, 1998 and its amendment was approved on September 11, 1998.

Montana

Montana could receive over $11 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. Montana created a separate statewide children's health insurance program. Children under age 19 whose families have incomes of less than 150 percent of the FPL qualify for the Montana SCHIP plan. The benefits package mirrors the state employee health plan, including prescription drugs, emergency room services, and mental health and substance abuse treatment services. For families with incomes at or above 100 percent of the FPL, the state charges an annual enrollment fee of $12 for one child and $15 for families with two or more children enrolled. Copayments for some services are charged for families whose income is above 100 percent of FPL. Copayments are capped at $200 per family per year. The state enrolled 1,019 children in fiscal year 1999. Montana's plan was approved September 11, 1998.

Nebraska

Nebraska could receive as much as $14.8 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The first phase, Kids Connection Phase I, expanded Medicaid coverage to children age 15 through 18 whose family income is at or below 100 percent of the federal poverty level. Enrollees in Phase I receive the state's regular Medicaid benefit package. The amendment, Kids Connection Phase II, expanded Medicaid eligibility to children under age 19 whose family incomes are up to 185 percent of the federal poverty level. Neither phase includes cost-sharing for enrollees. The state enrolled 9,713 children in fiscal year 1999. The state's original plan was approved August 7, 1998 and its amendment was approved October 13, 1998.

Nevada

Nevada could receive over $30 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its SCHIP allotment, the state created Nevada Check Up, a statewide health insurance program which provides coverage to children up to age 18 in families with incomes at or below 200 percent of poverty. To encourage enrollment, the state has simplified the SCHIP eligibility application, which will be available statewide through schools, child care facilities, family resource centers, social service agencies, and other locations where eligible children and/or their parents frequent. The state has also established a toll-free information number, which is listed on posters, marketing brochures, and the application form. The state enrolled 7,802 children in fiscal year 1999. Nevada's plan was approved on August 13, 1998.

New Hampshire

New Hampshire could receive as much as $11.4 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its allotment, the state expanded its Medicaid program and created a separate statewide children's health insurance program. Healthy Kids-Gold, or Phase I, expanded Medicaid eligibility for newborns and infants up to age one in families with incomes up to 300 percent of the FPL. Healthy Kids-Silver, or Phase II, is a separate statewide health insurance plan that mirrors the benefit package offered to federal employees in the state. Healthy Kids-Silver is aimed at children ages 1 to 19 in families with incomes up to 300 percent of poverty. In order to expand its coverage to this level of family income, the state applies an income disregard-setting aside certain types of income the family may have. The state enrolled 4,554 children in fiscal year 1999, exceeding its initial expected enrollment of 4,000 children. New Hampshire's plan was approved September 15, 1998 and an amendment was approved on March 25, 1999.

New Jersey

New Jersey could receive as much as $88 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state created NJ KidCare, which includes a Medicaid expansion and a new state SCHIP plan. The Medicaid expansion provides comprehensive health care coverage to all children under age 19 whose families have incomes at or below 133 percent of the federal poverty level. The new SCHIP insurance program is targeted at children in families with incomes between 133 percent and 350 percent of poverty. The new program charges families a $15 per month premium. The state enrolled 75,652 children in fiscal year 1999. New Jersey's plan was approved on April 27, 1998; its first amendment was approved on May 7, 1999; and its second amendment was approved on August 3, 1999.

New Mexico

New Mexico could receive approximately $63 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its allotment, the state expanded its Medicaid program for children from birth to age 18 in families with incomes up to 235 percent of the FPL. Enrollees receive the state's Medicaid benefit package. Families with incomes between 186 and 235 percent of the FPL are subject to copayments of $5 for most services as long as cost sharing does not exceed five percent of a family's income. In accordance with the SCHIP law, preventive services and prenatal care are exempt from cost sharing. The state enrolled 4,500 children in fiscal year 1999. New Mexico's SCHIP plan was approved January 11, 1999.

New York

New York was one of three states for which existing children's health coverage benefit packages were "grandfathered" into the SCHIP legislation. The state could receive as much as $256 million in federal funds for fiscal year 1998 and $254 million in fiscal year 1999 for its SCHIP plan. New York expanded its existing CHPlus program to children up to age 19 whose families have net incomes at or below 192 percent of the federal poverty level. CHPlus is a partnership between the state and private insurers with the state subsidizing private coverage for enrollees. The benefit package includes a full range of inpatient and outpatient services. The state enrolled 521,301 children in fiscal year 1999, exceeding its initial expected enrollment of 343,000 children. New York's plan was approved on April 1, 1998 and an amendment was approved on September 24, 1999.

North Carolina

North Carolina could receive over $79 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. North Carolina created a separate state health insurance program, called NC Health Choice for Children, to provide coverage to uninsured children whose family income does not exceed 200 percent of the federal poverty level. Families whose incomes rise above 200 percent of poverty up to a maximum of 225 percent may buy into the program for one year. The benefit package is equivalent to that offered to state employees, plus Medicaid-equivalent benefits for children with special health care needs and dental benefits for all children. The state enrolled 57,300 children in fiscal year 1999, exceeding initial expected enrollment of 35,000 children. North Carolina's plan was approved on July 14, 1998; its first amendment was approved on January 15, 1999; its second amendment was approved on June 23, 1999; and its third amendment was approved on September 30, 1999.

North Dakota

North Dakota could receive as much as $5 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state initially expanded its Medicaid program to include 18-year-old children whose family income is at or below 100 percent of the federal poverty level. Prior to this expansion, North Dakota's Medicaid program covered children age seven through 17 whose families have incomes of 100 percent of poverty or less and children up to age 6 are eligible if their families have incomes at or below 133 percent of poverty. The state then created a separate program, called Healthy Steps, that covers children in families with incomes up to 140 percent of the federal poverty level. The benefit package is the same as the Medicaid program in the state. The state enrolled 266 children in fiscal year 1999. North Dakota's plan was approved October 9, 1998 and an amendment was approved on November 11, 1999.

Ohio

Ohio could receive over $115 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. With its SCHIP allotment, Ohio expanded eligibility within its existing Medicaid program. The Medicaid expansion, called Healthy Start, covers children up to age 19 whose families have incomes at or below 150 percent of the FPL. The state enrolled 83,688 children in fiscal year 1999. Ohio's plan received approval on March 23, 1998.

Oklahoma

Oklahoma could receive over $85 million in federal funds for both fiscal year 1998 and fiscal year 1999. With its allotment, the state expanded its Medicaid program, SoonerCare, to children born on or after October 1, 1983, with family incomes up to 185 percent of the federal poverty level. Oklahoma provides the state's regular Medicaid benefit package to enrolled children. The state enrolled 40,196 children in fiscal year 1999. Oklahoma's plan was approved on May 27, 1998 and its amendment was approved on March 25, 1999.

Oregon

Oregon could receive as much as $39 million in federal funds for both fiscal year 1998 and fiscal year 1999. With its allotment, the state created a separate health insurance program that covers children from birth to age 6 with incomes between 133 percent and 170 percent of the federal poverty level. Coverage was also extended to children from age 6 to age 19 with family incomes between 100-170 percent of poverty. Children in the new SCHIP program receive the same benefit package as children currently enrolled in the state's Medicaid section 1115 waiver demonstration. The benefit package includes inpatient and outpatient hospital services, inpatient psychiatric services, physician services, dental services, home health services, lab services, prescription drugs and other medically necessary services. The state enrolled 27,285 children in fiscal year 1999, exceeding its initial enrollment expectation of 17,000 children. Oregon's plan was approved on June 12, 1998.

Pennsylvania

Pennsylvania could receive approximately $117 million in federal funds for both fiscal year 1998 and fiscal year 1999, which state officials will use to fund its existing Pennsylvania SCHIP program. Pennsylvania is one of three states that had the benefit package of their existing state children's health program grand-fathered under SCHIP. Initially, coverage was provided to children age one through 16 with family incomes at or below 185 percent of poverty. Eligibility was then expanded to include children from birth to age 18 in families with incomes up to 200 percent of the federal poverty level. Outreach activities in the state include canvassing local businesses, day care centers, school districts, hospitals, religious organizations, social service agencies and civic groups. The state enrolled 81,758 children in fiscal year 1999. Pennsylvania's plan was approved on May 28, 1998 and an amendment was approved on October 29, 1998.

Puerto Rico

Puerto Rico could receive as much as $9.8 million in federal funds for fiscal year 1998 and $39 million for fiscal year 1999 under the SCHIP program. Puerto Rico expanded Medicaid eligibility to cover children through age 18 in families with incomes below 200 percent of the commonwealth poverty level ($8,220 for a family of four). Puerto Rico's program also includes children currently under its public health system, which receives no federal funding. Puerto Rico enrolled 20,000 children in fiscal year 1999. Puerto Rico's plan was approved June 26, 1998.

Rhode Island

Rhode Island could receive as much as $10.6 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state expanded its Medicaid program, Rite Care, to provide comprehensive health care coverage to children whose family income is below 300 percent of the federal poverty level. Beginning at 185 percent of the federal poverty level, families will begin paying modest premiums or co-payments. The state enrolled 7,288 children in fiscal year 1999, exceeding the initial expectation of 4,000 children. Rhode Island's plan was approved on May 8, 1998 and an amendment was approved February 5, 1999.

South Carolina

South Carolina had already begun to expand its Medicaid program, Partners for Healthy Children, when the SCHIP law was enacted, and could receive over $63 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state expanded Medicaid eligibility to children under age 19 whose family incomes are at or below 150 percent of the federal poverty level. There is no cost-sharing. The state has placed eligibility workers in public schools, hospitals, clinics, pharmacies and other places frequented by families with potentially eligible children. The state enrolled 45,737 children in fiscal year 1999. South Carolina's plan was approved on February 18, 1998.

South Dakota

South Dakota could receive as much as $8.5 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state expanded Medicaid eligibility limits for children through age 6 from 133 percent of FPL to 140 percent of FPL and for children ages 6 to 18 from 100 percent of FPL to 140 percent of FPL. The benefit package for children enrolled in SCHIP is the same as that offered to other children in the state's Medicaid program. Families are not charged for medical care under this SCHIP program. The state enrolled 3,191 children in fiscal year 1999. South Dakota's plan was approved on August 25, 1998 and an amendment was approved on October 29, 1999.

Tennessee

Tennessee could receive as much as $66 million in federal funds for both fiscal year 1998 and fiscal year 1999. Tennessee opted to use its SCHIP allotment to expand its Medicaid program, TennCare, to children born before October 1, 1983 who are under age 19 in families with incomes at or below 100 percent of the federal poverty level and who could not have been enrolled under the operating rules for the state's Medicaid demonstration program before April 1, 1997. The full Medicaid package of benefits is offered and there is no family cost-sharing. The state enrolled 9,732 children in fiscal year 1999. Tennessee's SCHIP plan was approved on September 3, 1999.

Texas

Texas could receive as much as $561 million in federal funds for fiscal year 1998 and $558 million for fiscal year 1999. Texas expanded Medicaid eligibility to children up to age 19 in families with incomes below 100 percent of the federal poverty level. The state will also create a separate health insurance program, anticipated to begin in May 2000, to cover children in families with incomes below 200 percent of the federal poverty level. The state enrolled 50,878 children in fiscal year 1999. Texas' plan was approved on June 15, 1998 and an amendment was approved on November 5, 1999.

Utah

Utah could receive as much as $24 million in federal funds for both fiscal year 1998 and fiscal year 1999. With its allotment, the state created a separate state health insurance program to provide coverage to uninsured children up to age 19 whose family incomes do not exceed 200 percent of the federal poverty level. The plan does have some cost sharing for services, but no premiums or enrollment fees are charged. Copayments and out-of-pocket maximums are determined by income level. The state enrolled 13,040 children in fiscal year 1999. Utah's plan was approved July 10, 1998.

Vermont

Vermont could receive as much as $3.5 million in federal funds for both fiscal year 1998 and fiscal year 1999 for its SCHIP plan. The state created a separate health insurance program to cover children up to age 18 in families with incomes between 225 and 300 percent of the FPL. The state also has a Medicaid waiver that was amended to allow the state to expand coverage to underinsured children up to 300 percent of the FPL. The benefits package for the Vermont SCHIP program is the same as provided through the state's Medicaid program. The state enrolled 2,055 children in fiscal year 1999, exceeding their initial expectation of 1,000 children. Vermont's SCHIP plan was approved December 15, 1998 and its amendment was approved on August 11, 1999.

Virginia

Virginia could receive as much as $68 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state created a separate children's health insurance plan, the Virginia Children's Medical Security Insurance Plan, which provides coverage for children under age 19 in families with incomes up to 185 percent of the FPL. The benefit package is comprehensive and includes inpatient and outpatient care, laboratory services, and substance abuse treatment. The state enrolled 16,895 children in fiscal year 1999. Virginia's plan was approved October 22, 1998.

Virgin Islands

The Virgin Islands could receive $279,000 in federal funds for fiscal year 1998 and about $1.1 million in fiscal year 1999. The territory expanded its Medicaid program to children receiving services through a territory-funded program. SCHIP funds help strengthen federal support for children's health in the Virgin Islands. The local government did not expand eligibility, but the current income level for a family of four is $8,500 - or about half the level of states. The Virgin Islands enrolled 120 children in fiscal year 1999. The Virgin Islands' plan was approved September 17, 1998 and an amendment was approved on February 4, 2000.

Washington

Washington could receive over $46 million in federal funds for fiscal year 1998 and fiscal year 1999. Washington created a separate state SCHIP program to cover uninsured children under age 19 in families with incomes between 200 and 250 percent of the federal poverty level. The full Medicaid package of benefits is offered. Washington charges $10 per month per child enrolled in SCHIP, with a family maximum of $30 per month. Cost sharing includes $5 copayments for physician services and prescription drugs. An emergency room copayment of $25 is required for each visit that does not result in an inpatient admission. The state imposes a cap on family spending of $300 per child per year or a $900 family maximum cap. Washington's SCHIP plan was approved on September 8, 1999.

West Virginia

West Virginia could receive over $23 million in federal funds for both fiscal year 1998 and fiscal year 1999. The state expanded Medicaid eligibility to children between the ages of 1-5 in families with incomes up to 150 percent of FPL. The state previously had an income cutoff for that group of 133 percent of FPL. These children receive the regular Medicaid benefit package at no cost to their families. The state also created a separate program that covers children between the ages of 6 and 18 whose family incomes do not exceed 150 percent FPL. The state enrolled 7,957 children in fiscal year 1999. West Virginia's plan was approved on September 15, 1998 and an amendment was approved on March 19, 1999.

Wisconsin

Wisconsin could receive over $40 million in federal funds for both fiscal year 1998 and fiscal year 1999, to expand its Medicaid program. Phase One of the state's BadgerCare plan expanded Medicaid eligibility to children ages 15-18 in families with incomes below 100 percent of the federal poverty level. Wisconsin also had a SCHIP amendment and a Medicaid waiver approved. While the SCHIP expansion provides health coverage to children through age 18 with family incomes up to 185 percent FPL, the waiver for the state's Medicaid program allows Wisconsin to enroll the parents of SCHIP-eligible children in that program. All eligible children receive the full Medicaid benefit package with no out-of-pocket costs for families. The state enrolled 12,949 children in fiscal year 1999. Wisconsin's plan was approved May 29, 1998 and its amendment was approved January 22, 1999.

Wyoming

Wyoming could receive over $7 million in federal funds for both fiscal year 1998 and fiscal year 1999. Wyoming created a separate state SCHIP program to cover children age 6-19 in families with incomes at or below 133 percent of the federal poverty level. Prior to the new program, Wyoming's Medicaid program only covered children under age 6 in families with incomes up to 133 percent of poverty. The full Medicaid package of benefits is offered and there is no family cost-sharing, Wyoming's SCHIP plan was approved on September 8, 1999.