On Friday, September 21st, the House and Senate reached agreement on a bill to extend the State Children’s Health Insurance Program (SCHIP) for five years, although the president threatens a veto. SCHIP is due to expire September 30 unless new legislation is passed. The program provides health insurance for children with family incomes a bit higher than the Medicaid limits but without access to insurance.
The agreement calls for $35 billion in new funding for SCHIP over the five-year period. The bill ensures that the 6.6 million children who currently participate in SCHIP continue to receive health coverage and expands the program to cover up to four million more uninsured children. Coverage of dental and mental health services will be expanded, and early and periodic screening, diagnosis and treatment (EPSDT) services will be protected.
Concessions to administration concerns
The White House has proposed $5 billion for SCHIP over the five-year period, contending that the states have abused the program by covering parents and childless adults and by efforts to cover children at up to 400 percent of the federal poverty level (FPL). The agreement retains the ban on CMS' grants of waivers to allow states to cover childless adults or parents. States would have the option to cover pregnant women. Currently covered childless adults will transition off SCHIP. For states with existing waivers, the agreement terminates those waivers after a one-year period, provides temporary Medicaid funding for already-enrolled adults, and allows states to apply for a Medicaid waiver for coverage.
Congress also addressed the administration's concerns about "crowd-out," or the use of SCHIP funds to cover children with higher incomes while leaving poorer children without coverage. In response to a CMS letter of August 17, 2007, the agreement gives states time and assistance in developing and implementing best practices to address crowd out. The agreement also puts the lowest income children first in line by phasing in a new requirement for coverage of low-income children as a condition of receiving SCHIP funding for coverage of children above 300 percent of the poverty level.
White House reaction
The White House maintains that the bipartisan congressional compromise extends the scope of coverage far beyond its original intent to cover children whose families cannot afford private health insurance but do not qualify for Medicaid. "Our goal should be to move children who have no health insurance to private coverage -- not to move children who already have private health insurance to government coverage," Bush said. He insists that Congress must pass a "clean, temporary extension" that he can sign before September 30th.
Other responses to the agreement
Legislators in both houses and on both sides of the aisle praised the "bicameral, bipartisan" agreement. "This legislation will get the Children’s Health Insurance Program back on track and reclaim precious resources for low-income kids. It breaks the legislative impasse and should have strong support from both Democrats and Republicans," said Sen. Charles Grassley (R-Iowa), ranking member of the Senate Finance Committee.
Sen. Orrin Hatch (R-Utah) said, "I have been fighting for legislation that will not only continue the SCHIP program, but also cover more low-income kids who are eligible for SCHIP. Today, we are unveiling our bipartisan compromise that accomplishes those two very important goals." "I am hoping that he will work with us on this program because this is a true compromise within the Senate between Democrats and Republicans, and between the House and the Senate," he added.
Source: CCH Washington Bureau, Sept. 21, 2007.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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