1. SCHIP Reauthorization: Where We Are and Key Issues

2. Dawn Horner Georgetown University Health Policy Institute Center for Children and Families dch28@georgetown.edu ccf.georgetown.edu National Association of Counties July 14, 2007 SCHIP Reauthorization: Where We Are and Key Issues

3. A National Priority Strong public and bipartisan support for covering children Great track record Many states poised to move forward Congress should assure funding and policies are in place to keep moving in the right direction

4. Voters Strongly Support Investing More Money in SCHIP Source: Poll conducted by Lake Research Partners for CCF (November 2006). Fund SCHIP at current levels even though some children will lose coverage Increase SCHIP funding so that it can continue to cover the current number of children Increase SCHIP funding so that it can cover even more uninsured children Don’t know/ refuse Which statement best describes your thoughts on what Congress should do about SCHIP? 82% Support investing more money in SCHIP

5. AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA Source: Based on a national survey conducted by the Center on Budget and Policy Priorities for Kaiser Commission of Medicaid and the Uninsured, 2006. TX IL 200% FPL (26 states including DC) FL AL > 200% FPL (15 states) < 200% FPL (10 states) Children’s Eligibility for Medicaid/SCHIP by Income, July 2006

6. Source: Kaiser Commission on Medicaid and the Uninsured analysis of CBO March 2006 baseline and CMS Statistical Enrollment Data System, 2006; and CMS FY 2005 SCHIP Enrollment Report (July 12, 2006). Children’s Enrollment in Medicaid and SCHIP, 2005 28 million 6 million 1.7 million are in SCHIP-financed Medicaid expansions 4.4 million are in separate SCHIP programs

7. Trends in the Uninsured Rate of Low-Income Children, 1997- 2005 Source: CCF analysis of National Health Interview Survey.

8. AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MO KS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA Source: As of June 8, 2007 based on CCF review of state initiatives. TX IL FL AL Implemented or Recently Adopted Legislation to Improve Children’s Coverage (18 states and DC) Considering Significant Proposal to Improve Children’s Coverage (11 states) States are Moving Forward

9. 1.Financing (up to $50 billion in budget resolution) 2.Reaching eligible but uninsured children 3.State flexibility to decide which children and populations to cover SCHIP Reauthorization – Key Issues

10. Financing Stable funding needed to: Assure that no one loses coverage: 40 state facing shortfalls. Support states’ efforts to expand and improve coverage for children. Congressional budget resolution passed earlier this year; up to $50 set aside for SCHIP and Medicaid.

11. SCHIP Needs are Outpacing State Allotments (in billions) Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006). FY2006 and FY2007 spending are projected.

12. 7 out of 10 Uninsured Children are Eligible But Unenrolled 49% are Medicaid Eligible 19% are SCHIP Eligible Source: L.Dubay analysis of March 2005 Current Population Survey using July 2004 state eligibility rules

13. Medicaid & SCHIP are Reaching an Increasing Share of Eligible Children Source: 1999 & 2002 National Survey of America’s Families. SCHIPMedicaid 1999 2002

14. Eligible but Uninsured Assistance to states that are moving forward. –Medicaid “woodwork effect” New tools for identifying and enrolling eligible children. –Express Lane –Citizenship Documentation

15. State Flexibility Original SCHIP law gave state’s flexibility, need to retain and expand. Children: 18 states had income eligibility thresholds above 200% FPL. (May 2007) Parents: 11 states cover parents through waivers. (May 2007) Legal immigrant children.

16. Most Children Covered by SCHIP Have Family Incomes Below 200% FPL At or Below 200% FPL Above 200% FPL Note: The reporting classification of a child with family income above 200% FPL who is determined to be eligible at or below 200% FPL due to deductions or disregards (i.e., a net income test) is up to the discretion of the state and constrained by their reporting systems. Source: C. Peterson & E. Herz, Estimates of SCHIP Child Enrollees Up to 200% of Poverty, Above 200% of Poverty, and of SCHIP Adult Enrollees, Congressional Research Service (March 13, 2007). 6.7 million children enrolled in SCHIP, 2006

17. The Cost of Living Differs Across the Country Note: In 2006, 200% FPL for a family of three was $33,200 annually. Source: CCF analysis using 2006 ACCRA data. The cost of goods and services worth $33,200 in the average city, adjusted for the cost of living. 200% FPL for a family of 3

18. ESI Coverage Rates Have Declined for Children and Adults Source: Percent with employer-sponsored insurance from E. Gould, “Health Insurance Eroding for Working Families,” Economic Policy Institute (September 2006).

19. Timeline for Congressional Action?? July 17 Late July Mid- July Late July AugustSept 30 Senate Finance Committee Senate Floor House Energy and Commerce Committee House Floor Conference No new funds available Note: These dates are all tentative

20. Senate Finance Mark Bi-partisan agreement sets aside $35 billion over 5 years. Financing through 61 cent increase in tobacco tax. New funds used to increase SCHIP allotments and help states that increase enrollment of already-eligible children.

21. Senate Finance Mark: Possible Policies Restrictions to eligibility. Express Lane as demonstration. Parents and adults transitioned off. No state option to cover legal immigrant children. Unclear if will address citizenship doc.

22. Next Steps/ Challenges Ahead Facing change in tone in last weeks. Bi-partisan agreement important step in process. House mark-up offers another opportunity.