Child Health Coverage Faces New Limits

White House Issues New Guidelines To Limit Eligibility Of Kids Above Poverty Level In SCHIP Program

(CBS/AP)  Many children who attempt to enroll in a popular children's health insurance program will have to be uninsured for at least a year before they'll be allowed to participate, the Bush administration has informed state health officials.

The administration has repeatedly voiced concerns that some states were expanding their Children's Health Insurance Programs to the point that families were dropping private coverage for public coverage. Its latest directive is designed to prevent what it calls "crowd out" from occurring.

In a letter to state health officials, Dennis Smith, the administration's point man for the SCHIP program, laid out certain criteria that states must meet before they expand insurance coverage to those families above 250 percent of the poverty level — or $42,900 for a family of three.

For example, states must establish that a child has been without insurance for a minimum of one year before the child can get coverage through SCHIP. States will also have to assure the federal government that at least 95 percent of the children eligible for the program or for Medicaid are enrolled in either of those two programs.

But, currently, no state can make such an assurance for their participation rates. The best that any state is doing is Vermont, with about 92 percent participation. So, essentially, eligibility for states' SCHIP programs would be capped at 250 percent of poverty, said health officials who examined the administration's new policy. The policy went out in the form of a letter to state health officials late Friday.

Since many families above that threshold still can't afford private insurance, "the effect of this policy is to have more uninsured kids," said Rachel Klein, deputy director of health policy for Families USA, an advocacy group.

Some 19 states, including the District of Columbia, provide health insurance coverage to children in families with incomes above 250 percent of the poverty level, or are in the process of doing so.

Some states seeking to expand coverage have raised the income limits of families eligible for SCHIP, and consequently have placed certain systems in place (such as databases to ensure applicants were not covered under private plans), but the letter from the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services, would make mandatory certain provisions, for example:

• Waiting Periods: A minimum one-year period of "uninsurance" for individuals prior to receiving SCHIP coverage;
  
• Verification: States must monitor health insurance status at time of application, and must include information regarding coverage eligibility through a non-custodial parent;
  
• Cost Sharing: Imposing cost sharing in approximation to the cost of private coverage;
  
• Dependency Policies: States must prevent employers from changing dependent coverage policies that would favor a shift to public coverage;
  
• Reporting: States must report on a monthly basis data relating to the crowd-out requirements.

One of the stated aims of the new requirements is to prevent "higher income populations" from replacing their private health insurance (such as group health plans) with SCHIP coverage. "We expect affected States to amend their SCHIP state plan" within 12 months, the letter states, "or CMS may pursue corrective action."

The new guidelines could have a dramatic impact on those states as well as any other that wanted to follow in their steps, said Cindy Mann, executive director of the Georgetown University Center for Children and Families.

"It's a pretty radical departure in policy that has been in existence for 10 years," Mann said. "It attempts to stop in their tracks those states that have already or want to expand coverage."

Both chambers of Congress recently passed bills that would dramatically increase funding for SCHIP. The Bush administration opposes both measures, claiming that the increased funding sought by the two chambers is unwarranted and would result in less private coverage and more public coverage for children.

The letter from Smith said the new guidelines would not affect current enrollees.

"We appreciate your efforts and share your goal of providing health care to low-income, uninsured children," Smith told state officials.

About 6.6 million people participate in SCHIP. The program subsidizes insurance for those families with incomes too high to participate in Medicaid but not enough to afford private insurance.

The administration wants to spend about $30 billion on the program over the next five years. The Senate has called for spending about $60 billion. The House called for spending of about $75 billion. Negotiators have yet been appointed to work out the differences in the two bills.

[seh0041]

i don''''t have 45 children. i have two. their father''''s death was neither their fault nor mine. the loss of my job, also not their fault or mine. it''''s a little bit too late to, shall we say, put them back. now that i can''''t afford to insure all three of us (what percentage of your post-tax income is $8000?), what would you suggest i do?

like so many people, you seem to go to the most extreme hypothetical situations, present them as the norm, and then get on your soapbox to rail against social programs. there are positives and negatives in any scenario, but i''''d like to think that as a nation we would like to err on the side of compassion and decency, not fear and profitability.
Posted by justsane at 01:45 PM : Aug 21, 2007

Hmmm, so has anyone answered justane''s question? What does a person do in these kinds of situations? As someone in the business of assisting families with these exact problems, I''m curious to get the answer too.
CHIP is generally a good place to start...

[rudy654-2009]

So why don''''t the people who hate it so much leave and make room for the ones who are killing themselves to get in?
Posted by katg21 at 08:04 AM : Aug 22, 2007

Why don''t you? At least they''re willing to work and not sit home all day ranting about others having access to health care. As for those killing themselves to come here, I don''t think Third World illegals count as everybody. You certainly don''t see "everybody" from Western Europe killing themselves to get over here. Big difference.

[rudy654-2009]

How can a nation with so many people claiming to be christian, and so many of them being against providing health care for kids (and everybody else), while all the other advanced countries provide it?Posted by actornaught at 03:50 PM : Aug 22, 2007

Religion is just a patch they wear. Nothing to be taken seriously, just a tool to beat others over the head with when they want to feel a little "moral" superiority. This is shown in their opposition to abortion, which is countered by their could-care-less attitude after the child is born.

[actornaught]

How can a nation with so many people claiming to be christian, and so many of them being against providing health care for kids (and everybody else), while all the other advanced countries provide it?

This issue shows the neocon true colors:

Religion without morality is pure evil.

[katg21]

That''''s always been the way, let in illegal immigrants who tend to vote republican(Russian jews, Cubans, Irish,eastern europeans,Koreans,etc.) but kick out those who tend to vote democratic(hispanics,haitians,african refugees).
Posted by realpatriot1 at 08:33 AM : Aug 22, 2007

Now that''s funny and sooooo wrong!!! Are you advocating illegals voting? Please. Illegal is illegal, none should be voting and all should go home.

[realpatriot1]

I don''t see anyone saying that we have the worst of everything, people are simply advocating making what we have better. That''s why people want to come here, because we are dynamic and forward thinking and always have been.

I find it amusing that the same people screaming to keep those coming in out now want to talk about letting them in to replace those who disagree with them.

That''s always been the way, let in illegal immigrants who tend to vote republican(Russian jews, Cubans, Irish,eastern europeans,Koreans,etc.) but kick out those who tend to vote democratic(hispanics,haitians,african refugees).

[katg21]

then why is everybody killing themselves trying to get in?
Posted by gunnerv1 at 07:50 AM : Aug 22, 2007

Exactly! So why don''t the people who hate it so much leave and make room for the ones who are killing themselves to get in?

[gunnerv1]

If we have the worst of everything here in the United States, worst Gov''t leaders, job market, healtcare, security, taxes, retirement, transportation, entertainment (except for Jerry Lewis (Comic Genius)), then why is everybody killing themselves trying to get in?

[katg21]

Oh will you people learn German correctly if you must quote it??? Ach du lieber Himmel!!
Posted by rudy654 at 07:26 PM : Aug 21, 2007

Tell that to McVet. I don''t give a *** if it was correct, stick it.

[rudy654-2009]

Seig Heil Posted by katg21 at 07:15 PM : Aug 21, 2007

Oh will you people learn German correctly if you must quote it??? Ach du lieber Himmel!!