One year after the federal Balanced Budget Act of 1997 earmarked $24 billion for children's healthcare, some states are still a long way from perfecting their plans for expanding coverage to millions of low-income uninsured children.
As states submit their plans for expanding child health insurance coverage, many have proposed simple Medicaid expansions with the hope of later giving HCFA a more comprehensive plan.
States submitting such "place-holder" proposals want their share of the federal government's multibillion-dollar commitment to expand children's health insurance coverage between now and 2002 while states fine-tune their programs. The balanced-budget law gave states broad authority to determine how they will cover poor, uninsured children, whether through Medicaid, new state-run health-insurance programs or a combination of the two.
Of 49 plans submitted so far, 27 have been simple Medicaid expansions, 14 have been state-specific programs and eight have been hybrids. The Virgin Islands has submitted a Medicaid expansion plan, and Puerto Rico has received approval for a Medicaid expansion.
HCFA has approved Medicaid expansions in 16 states, nine of which have indicated that their plan is the first part of a two-stage proposal.
Experts cited tight deadlines as a major reason some states creating their own health insurance apparatus made only incremental Medicaid expansions.
The enactment of the balanced-budget law last year came after most state legislatures adjourned for the year. The original Sept. 30 deadline for submitting plans gave legislatures only a single session to complete work on a children's insurance plan.
Federal appropriations legislation enacted earlier this year, however, extended the deadline to Sept. 30, 1999. That extension gave states like Texas, which didn't have a legislative session this year, a chance to deliberate further.
It also gave states like Arkansas-which is still negotiating with HCFA over how to fold its existing Medicaid expansion into the wider programs authorized under the Balanced Budget Act-a chance to access the federal health insurance money.
"Those states that were choosing separate state programs needed a little more time," said Victoria Pulos, associate health policy director for Families USA, a healthcare consumer group.
White House healthcare adviser Chris Jennings said the states have been proposing "a very healthy mix" of Medicaid expansions and state-specific programs.
"I think the congressional intent, and also our desire, was not to preconceive or preordain" any specific children's healthcare structure, Jennings said.
Last week, HCFA approved health insurance expansion plans in Delaware, Iowa and Kansas. Combined, the three states estimate they will cover more than 50,000 children under the programs HCFA has thus far approved.