1. SCHIP Reauthorization: What’s at Stake for Michigan Liz Arjun State Health Policy Analyst Georgetown University Health Policy Institute Center for Children and Families Michigan’s Promise & Voices for Michigan’s Children Training July 12, 2007

2. Key Policy Ingredients of Original SCHIP Legislation Block grant / No entitlement to coverage No mandates / State option with “enhanced matching funds” Funds dedicated to NEW coverage Medicaid treated as the base off of which states would build State flexibility to use Medicaid and/or a separate state program with fewer federal standards

3. SCHIP Enrollment, 1997-2004 (in millions) SCHIP adopted (August 1997) 51 st state implements SCHIP; enrollment efforts are strong; states pursue family coverage waivers (2000) State fiscal crisis and extensive SCHIP cutbacks (2002 – 2004) $1.3 billion in unspent SCHIP funds lost (2004) HIFA initiative allows SCHIP funds to be used for coverage of childless adults (2001) Source: CCF; and enrollment data from Kaiser Commission on Medicaid and the Uninsured.

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

5. 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).

6. Coverage Gains Over the Past Decade Have Come Equally from Medicaid & SCHIP Enrollment of Children in Public Coverage (Millions) Source: CCF analysis based on CMS enrollment data for children ever-enrolled over the course of a year. 21.0 23.5 22.3 25.2 27.2 32.3 30.8 34.0

7. Coverage Gains Have Come Equally from Medicaid & SCHIP Enrollment of Children in Public Coverage Source: Michigan enrollment data from the Michigan Department of Community Health, Michigan Critical Health Indicators: 2007 (April 2007); U.S. enrollment data from CCF analysis of CMS data based on children ever-enrolled over the course of a year. 164 465 21.0 34.0 MichiganU.S. (Thousands)(Millions)

8. Michigan has been Successful in Its Effort to Cover Children Uninsured Rate of All Children Uninsured Rate of Low- Income Children Participation in Medicaid/SCHIP Among Low- Income Children U.S. average 11.0%17.9%74.2% Michigan5.8%9.5%85.2% Source: CCF analysis of CPS 2005 and 2006 March Supplement (i.e., data from 04-05).

9. Michigan Has Been Successful and Innovative with its SCHIP Dollars One of the lowest rates of uninsured children in the country Significant growth in Medicaid + Unspent SCHIP Dollars = Michigan looking for ways to use its dollars Bush Administration encouraged states to use these resources to address issues of uninsured in states Obtained a waiver in 2004 to cover 65,000 childless adults with incomes less than 35% FPL

10. National Picture Today Most Uninsured Children are Eligible Recent Surge of Activity at the State-Level Indicates States are Ready to Move Forward Voters Strongly Support Efforts to Get Children Covered SCHIP Must be Reauthorized by September 30, 2007

11. 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

12. 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 July 9, 2007 based on CCF review of state initiatives. TX IL FL AL Implemented or Recently Adopted Legislation to Improve Children’s Coverage (23 states and DC) Considering Significant Proposal to Improve Children’s Coverage (5 states) States are Moving Forward

13. Strategies Improving participation rates among currently eligible children Reaching more children by expanding income eligibility Eliminating/limiting restrictions based on immigration status Integrating public and private coverage/funding

14. Americans Strongly Support Covering Children 84% New York Times, March 2, 2007

15. (in billions) Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006); 2007-2012 spending data from CBO March 2007 SCHIP baseline (February 2007) includes outlays plus additional SCHP spending required to maintain current programs. SCHIP Spending is Rapidly Outpacing New Funds Being Made Available

16. SCHIP Reauthorization: Key Issues for Michigan Level of funding (up to $50 billion in promised in budget resolution) Stable and predictable flow of funding New options/financial supports to support and improve coverage/participation Will the state be prevented from using unspent dollars for childless adults? Benefits and quality

17. Timeline for Congressional Action?? July AugustSept 30 Senate Finance Committee Senate Floor House Energy and Commerce Committee House Floor Conference No new funds available

18. Getting to the Finish Line Building on the success of the past decade, a diverse array of states are moving forward Different strategies, different circumstances, but children are consistently a centerpiece

19. Questions? Liz Arjun Phone: (202) 784-4576 Email: eaa37@georgetown.edueaa37@georgetown.edu www.ccfgeorgetown.org