Bipartisan Congressional Health Policy Conference The State Childrens Health Insurance Program: Achievements and Opportunities for Improvement at Renewal January 12-14, 2007 Anne Gauthier Senior Policy Director Commission on a High Performance Health System The Commonwealth Fund THE COMMONWEALTH FUND

THE COMMONWEALTH FUND 2 SCHIP –The Basic Design Adopted as part of the Balanced Budget Act of 1997 (P.L ) to expand health insurance coverage for low-income children States may develop SCHIP programs by expanding Medicaid programs, developing alternative, stand-alone state SCHIP programs, or creating a program that is a combination of Medicaid and SCHIP SCHIP is financed by both the federal and state governments and is administered by the states –Within federal guidelines, each state determines its specific program design, eligibility categories, covered benefits, provider payments, and administrative and operating procedures. –States receive an enhanced federal matching rate that exceeds their federal Medicaid match by about 30 percent, with the federal share capped at 85 percent.

THE COMMONWEALTH FUND 3 U.S. SCHIP Enrollment of Children June of Each Year vs. Number of Uninsured Children, Number of Children (in millions) % Change in SCHIP Enrollment 18.97% 9.6% -1.4% 2.2% Source: Data provided by state officials to Health Management Associates for the Kaiser Commission on Medicaid and the Uninsured; CBO Analysis of Current Population Survery.

THE COMMONWEALTH FUND 4 Separate SCHIP SCHIP/Medicaid Combo No Data Available Source: Kaiser Family Foundation, Statehealthfacts.org. Medicaid Expansion WA OR ID MTND WY NV CA UT AZ NM KS NE MN MO WI TX IA IL IN AR LA AL SC TN NC KY FL VA OH MI WV PA NY AK MD ME VT NH MA RI CT DE DCCO GA MS OK NJ SD Percent of Federal Poverty Level State Variation in Type of SCHIP Program FL

THE COMMONWEALTH FUND 5 Less than 200% More than 220% No Data Available Source: Kaiser Family Foundation, Statehealthfacts.org % WA OR ID MTND WY NV CA UT AZ NM KS NE MN MO WI TX IA IL IN AR LA AL SC TN NC KY FL VA OH MI WV PA NY AK MD ME VT NH MA RI CT DE DCCO GA MS OK NJ SD Percent of Federal Poverty Level Income Eligibility Levels for Children's Separate SCHIP Programs by as a Percent of Federal Poverty Level, 2005

THE COMMONWEALTH FUND 6 SCHIP Reauthorization SCHIPs current period of authorization is scheduled to end after federal fiscal year 2007 SCHIP has strong support from the states and the public. Discussion leading up to reauthorization will include options to: –Provide the SCHIP funding needed to cover more children –Eliminate enrollment barriers that prevent eligible children from receiving coverage –Promote coverage that facilitates the healthy development of children

THE COMMONWEALTH FUND 7 SCHIP Panel Debbie Chang, Senior Vice President and Executive Director, Nemours Health and Prevention Services Gayle Lees Sandlin, Director, Childrens Health Insurance Program. Alabama Department of Public Health Jeanne Lambrew, Associate Professor, George Washington University