National Association Of State Medicaid Directors Says Proposed SCHIP Rules Will Limit Number Of Children With Health Insurance

Main Category: Medicare / Medicaid / SCHIP
Article Date: 07 Sep 2007 - 16:00 PST

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The National Association of State Medicaid Directors and the American Public Human Services Association on Tuesday sent a letter to HHS Secretary Mike Leavitt saying that recent Bush administration guidelines that limit SCHIP enrollment to the lowest-income children will reduce flexibility and make it difficult for states to expand coverage, CQ HealthBeat reports (Wayne, CQ HealthBeat, 9/4).

Under the new standards -- announced on Aug. 17 in a letter from Dennis Smith, director of the Center for Medicaid and State Operations -- states must demonstrate that they have enrolled at least 95% of children in the state below 200% of the federal poverty level who are eligible for Medicaid or SCHIP before expanding eligibility to children in families with incomes greater than 250% of the poverty level. States seeking to expand SCHIP eligibility also must establish a minimum of a one-year period of uninsurance for individuals in families with incomes greater than 250% of the poverty level to prevent them from switching from a private insurance plan to a public program.

In addition, states that insure children in families with annual incomes greater than 250% of the poverty level must prove that the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period. States also will need to adopt policies to prevent employers from changing dependent-coverage policies that would favor a shift to public coverage (Kaiser Daily Health Policy Report, 8/22).

Letter Details
NASMD and the American Public Human Services Association called on the Bush administration to rescind the new rules, but they did not say that they plan to sue the government to block the new standards, according to CQ HealthBeat. According to the NASMD letter, the policy "effectively changes the nature of the SCHIP program by seriously limiting the states' flexibility in designing programs, imposing mandatory cost-sharing requirements, requiring additional reporting mandates and imposing burdensome waiting periods" (CQ HealthBeat, 9/4).

The major concern for the Medicaid directors is the 95% enrollment requirement, which "would be very difficult for most states," NASMD spokesperson Frank Solomon said. According to Solomon, "We think that most states cover between 70% and 80% of the eligible children" (Lopes, Washington Times, 9/5).

Smith in a statement said, "The fact is, we are strongly trying to convey to the states that as more seek to expand SCHIP to children in higher-income families, we need to ensure that states first find their low-income children, the children for whom SCHIP was created, before the program is expanded to higher-income children" (CQ HealthBeat, 9/4).

The letter is available online (.pdf).

Conference Committee
Meanwhile, Senate Republicans on Tuesday blocked a request to appoint conferees to begin negotiations on the House and Senate versions of SCHIP legislation, making it unlikely that a conference committee will convene this week, CongressDaily reports (Johnson, CongressDaily, 9/4).

Senate Minority Leader Mitch McConnell (R-Ky.) objected to a request by Senate Majority Leader Harry Reid (D-Nev.) to appoint conferees to the committee and begin negotiations as soon as the House legislation was received. McConnell said he objected because the House had not formally requested a conference on the bills (CQ HealthBeat, 9/4).

Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said he wants assurances before the conference committee meets on the size and scope of the SCHIP package, according to an aide. An aide for Senate Finance Committee Chair Max Baucus (D-Mont.) said that discussions would begin regardless of whether a formal conference committee convenes (CongressDaily, 9/4).

However, Republicans do not expect that conferees will be able to produce a conference report before the program expires on Sept. 30 because of Senate opposition to Medicare Advantage cuts and other issues present in the House bill (HR 3162), Republican aides said on Tuesday. Without a conference report, lawmakers would need to pass an extension for the program, which likely would maintain current funding levels. It is not clear how long the extension would last, according to CongressDaily (Johnson/Bourge, CongressDaily, 9/5).

Editorials, Opinion Piece

• Baltimore Sun: "Congress should treat" the Bush administration guidelines "as inspiration to quickly come to terms on how the program can be even more effective in making medical services available to this vulnerable group of young people," according to a Sun editorial. It continues, "Ensuring that children get screenings and other preventive care early in their lives is a bargain compared with dealing later with chronic ailments," adding, "Congress should not allow Mr. Bush to sour the deal" (Baltimore Sun, 9/5).
  
  
• Chicago Tribune: "The new rules go too far in straitjacketing some states," and greater "flexibility is necessary because of variations in cost of living and in the price of insurance coverage," a Tribune editorial states. However, the "thrust of the rules is correct: Instead of aggressively expanding benefits further into middle-income families, the better way is to focus on signing up the poorest kids who are already eligible," according to the editorial. The administration "is right to fight what amounts to an ill-considered case of mission creep for this vital program," the Tribune concludes (Chicago Tribune, 9/5).
  
  
• Shikha Dalmia, Detroit News: "By dwelling on" a provision of the House SCHIP bill that would allow states to determine proof-of-citizenship requirements, Republicans "only distract attention from the real problems with what Democrats are doing," Dalmia, a senior analyst at the Reason Foundation, writes in a News opinion piece. Dalmia continues that under an SCHIP expansion, "more kids might well grow up under government coverage than private coverage," which "would be a giant step away from market-based reforms." However, Dalmia writes that "it's far from clear that Americans want a government takeover of health care," and if "that's what Democrats want, Republicans should force them to openly debate their plans," concluding, "That won't happen so long as Republicans keep obsessing about phantom problems like illegal immigration" (Dalmia, Detroit News, 9/5).
  
  
• Evansville Courier & Press: "The financing of the congressional plans" for SCHIP "leaves a lot to be desired" because it "relies on big tax increases on tobacco, a problematic source of revenue, and proposed cuts and savings in Medicare that may not survive," according to a Courier & Press editorial. It concludes, "How Bush and Congress resolve this under the added pressure of the presidential campaigns will do much to determine the direction of federal health care policy in this nation" (Evansville Courier & Press, 9/2).
  
  
• Pittsburgh Post-Gazette: "Congress must stand up against this bullying from the Bush administration" by reauthorizing SCHIP "at meaningful levels so it can continue to grow, and they must do so in sufficient numbers to quiet the threat of a veto," the Post-Gazette writes in an editorial. According to the Post-Gazette, "Legislation also can be crafted to get around the new backdoor rules that take away the flexibility that has enabled states to tailor [S]CHIP to fit their needs." The editorial concludes, "Otherwise, there will be one more black eye on how this nation takes care of its health" (Pittsburgh Post-Gazette, 9/5).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.