SCHIP Reauthorization: Where We Are and Key Issues
Jan 17, 2016
SCHIP Reauthorization: Where We Are and Key Issues
Dawn HornerGeorgetown University Health Policy Institute
Center for Children and [email protected]
ccf.georgetown.edu
National Association of CountiesJuly 14, 2007
SCHIP Reauthorization:Where We Are and Key Issues
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
Voters Strongly Support Investing More Money in SCHIP
4%
14%26%
56%
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
AZAR
MS
LA
WA
MN
ND
WY
ID
UTCO
OR
NV
CA
MT
IA
WIMI
NE
SD
ME
MOKS
OHIN
NY
IL
KY
TNNC
NH
MA
VT
PA
VAWV
CTNJ
DE
MD
RI
HI
DC
AK
SCNM
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
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
Regular Medicaid SCHIP
28 million
6 million
1.7 million are in SCHIP-financed
Medicaid expansions
4.4 million are in separate SCHIP
programs
22.3%21.5%
20.1% 20.0%
18.0%
15.8% 15.9%
14.9%15.2%
1997 1998 1999 2000 2001 2002 2003 2004 2005
Uninsured rate of low-income children under 19
Trends in the Uninsured Rate of Low-Income Children, 1997- 2005
Source: CCF analysis of National Health Interview Survey.
AZAR
MS
LA
WA
MN
ND
WY
ID
UTCO
OR
NV
CA
MT
IA
WIMI
NE
SD
ME
MOKS
OHIN
NY
IL
KY
TNNC
NH
MA
VT
PA
VAWV
CT
NJ
DE
MD
RI
HI
DC
AK
SC
NMOK
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
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
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.
$3.8
$4.3$4.6
$5.1
$6.0$6.2
$4.2 $4.2 $4.2 $4.2
$0.1
$0.9
$2.7
$1.9
$5.0
$5.0$4.1
$3.2$3.2$3.1
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
SCHIP Spending SCHIP Allotment
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.
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
Medicaid & SCHIP are Reaching an
Increasing Share of Eligible Children
73%
48%
82%
68%
0%
20%
40%
60%
80%
100%
Source: 1999 & 2002 National Survey of America’s Families.
SCHIPMedicaid
1999 2002 1999 2002
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
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.
91.3% 8.7%
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
$51,128
$41,732
$29,681
$33,200
$28,552
$10
$15
$20
$25
$30
$35
$40
$45
$50
Durham, NC Omaha, NE Milwaukee, WI Philadelphia,PA
San Jose, CA
Th
ou
san
ds
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
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).
65.40%
58.90%60.80%
55.40%
Children under 18 Working Adults
1999-2000 2004-2005
Timeline for Congressional Action??
July17
Late July
Mid-July
LateJuly
August Sept30
SenateFinance
CommitteeSenateFloor
House Energy
and CommerceCommittee
House Floor Conference
No new funds available
Note: These dates are all tentative
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.
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.
Next Steps/Challenges Ahead
• Facing change in tone in last weeks.
• Bi-partisan agreement important step in process.
• House mark-up offers another opportunity.