After years of congressional wrangling, short-term fixes and presidential vetoes, the State Children’s Health Insurance Program has received the long-awaited boost health advocates have been hoping for.
In early February, in one of his first legislative acts as president, Barack Obama signed the Children’s Health Insurance Program Reauthorization Act of 2009, officially extending the successful program through 2013 and providing an additional $32.8 billion in funds financed primarily by a 62-cent increase in the federal cigarette tax. Created in 1997, SCHIP currently provides health care coverage to more than 7 million U.S. children and with the recent reauthorization, the program is expected to expand to an additional 4 million children who would otherwise go uninsured. Congressional policy-makers had been working to renew SCHIP since its authorization expired in 2007, twice passing legislation that would have extended the program through 2012. Unfortunately, then-President George Bush vetoed both bills, forcing SCHIP to operate under a temporary extension that expired last month. Now, with new funding, new mandates as well as a slew of positive rule changes, SCHIP is poised to continue its critical role in improving children’s health.
Members of Congress applaud as President Barack Obama signs the SCHIP reauthorization bill in February.
Photo by Win McNamee, courtesy Getty Images
“Covering our children by expanding SCHIP is a down payment toward ensuring quality, affordable access to health care for all and is a key milestone on the road to health reform,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E), who attended the White House bill signing.
SCHIP’s reauthorization comes at a time when demands on health-related safety net programs are expected to increase as more families face job loss, and often with it, the loss of health insurance coverage. In 2008, according to the U.S. Department of Health and Human Services, SCHIP enrollment increased 4 percent over 2007 numbers, and Acting HHS Secretary Charles Johnson in January said the agency predicts such enrollment trends will continue throughout 2009. Targeting uninsured children living in families with incomes at about 200 percent of the federal poverty level, which was about $42,000 for a family of four in 2008, SCHIP fills a critical gap for families who make too much to qualify for Medicaid but too little to afford private coverage. To better reach such families and children in need, the new SCHIP law provides new funding to support outreach activities as well as new tools to better streamline the enrollment process.
“While more children are relying on the program, we know millions more children need health care coverage,” Johnson said. “President Obama believes that healthy children are the key to a healthy economy and a healthy future for our country. We look forward to…working with the states to do everything we can to enroll every eligible child in the program.”
Among the law’s new enrollment efforts are $100 million to support national, state and local Medicaid and SCHIP outreach activities, and a new performance bonus system that encourages states to enroll more of the uninsured children already eligible for Medicaid coverage. However, to qualify for the bonuses, states must have also adopted a handful of measures aimed at easing the enrollment process, such as doing away with in-person interviews during initial enrollment and renewal, or adopting the new “Express Lane” option. The Express Lane lets states use relevant data from other public programs, such as food stamps, when determining a child’s eligibility for SCHIP coverage.
Ideally, the option could significantly cut down so-called bureaucratic “red tape” by allowing states to automatically — with family consent — enroll an eligible child in SCHIP or Medicaid based on data from other assistance programs and without requiring the family to go through another application process. To support the Express Lane option, the SCHIP law makes it easier for states to access and share databases from other public programs. With such data stored in different formats and locations, sharing it will probably be harder than it sounds, but the notion of “opening up opportunities” and making enrollment less of a burden on families is a change in the right direction, said Alan Weil, JD, MPP, executive director of the National Academy of State Health Policy.
“Once you’ve made the commitment that this is a program that people need, the next step is finding ways to get people in the door,” Weil told The Nation’s Health.
To help in that process, the academy, with funding from the Robert Wood Johnson Foundation, is heading up the new Maximizing Enrollment for Kids program, a four-year initiative that will assist eight states in strengthening their Medicaid and SCHIP enrollment and outreach. Among the initiative’s many goals, Weil said, is the creation of a self-assessment tool that eventually every state could use in improving its enrollment processes. Even though a majority of uninsured children are eligible for public health care programs, factors such as parental awareness and language barriers can create enrollment obstacles, Weil noted.
“The best way to enroll people is to find them and sit down with them in a place that’s comfortable to them — whether that be a library, a school, a community center — and help them through the process,” Weil said. “Putting an ad on the side of a bus is important, but it doesn’t help people through the process.”
In addition to new enrollment support, the SCHIP reauthorization addresses coverage for low-income pregnant women and legally residing immigrants as well as the quality of health services offered. Thanks to the new law, states will no longer have to apply for a federal waiver to extend SCHIP coverage to eligible pregnant women and will have the option to eliminate the five-year waiting period previously imposed on legal U.S. immigrants. Though states had been prohibited from providing federally funded SCHIP or Medicaid coverage to legal immigrants in their first five years of U.S. residence, almost 20 states did so anyway using state funds, according to Georgetown University’s Center for Children and Families. The rule change “sends an important message to immigrant populations that we care about them, that we’re going to help provide care for them,” said Lee Partridge, health policy advisor at the National Partnership for Women and Families. Partridge also touted the law’s new commitment to measuring and reporting on the quality of care kids receive.
The reauthorized SCHIP law is expected to bring health insurance to 4 million additional children who lack coverage.
Photo by Pathathai Chungyam, courtesy iStockphoto
“I can’t think of anything more important to a family facing job losses or cutbacks than protecting the health of their children,” Partridge told The Nation’s Health. “It was absolutely essential that (reauthorization) was among the first decisions made by the new Congress and president.”
Shortly after signing the SCHIP bill, Obama also directed the Centers for Medicare and Medicaid Services to immediately withdraw a 2007 Bush administration directive, often referred to as the “Aug. 17” directive, that severely restricted states’ ability to expand SCHIP eligibility and coverage.
For more information about SCHIP, visit www.cms.hhs.gov/home/schip.asp or www.nashp.org.
- Copyright The Nation’s Health, American Public Health Association
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