In what seems to be a softening of its previous stance, the Bush administration in its just-released budget proposal last week offered to funnel more money into the State Childrens Health Insurance Program.
Yet, there seems to be few strings attached on SCHIP-eligibility requirements.
The Bush administration in its fiscal 2009 budget proposal last week offered up a legislative proposal to reauthorize SCHIP that would increase state allotments by $2 billion in fiscal 2009 and by more than $19 billion through fiscal 2013. Originally, the administration pushed for just a $5 billion increase to the program over five years.
Based on what HHS officials are saying, it appears that the legislative proposal would set even more stringent eligibility requirements than a controversial directive issued in August 2007 (Jan. 14, p. 12). States were informed last year they could no longer expand their coverage to children from families with incomes above 250% of the federal poverty level ($53,000 for a family of four based on 2008 guidelines) unless they successfully enrolled 95% of the eligible children from families below 200% of the poverty level in either SCHIP or Medicaid. Children above 250% also cant get coverage if states have experienced a decline in employer-sponsored insurance coverage of more than 2% among those families over the past five years.
In a meeting with reporters last week, Kerry Weems, CMS acting administrator, made it clear that states would never be allowed to cover children above 250% of the federal poverty level under this proposal, although children in families with higher income levels already covered under SCHIP would be grandfathered in. The 250% threshold would be a hard cap on eligibility, Weems said.
Ron Pollack, executive director of the not-for-profit Families USA, said its unclear whether the Bush administrations $19 billion increase to SCHIP would result in more children getting coverage, as it doesnt necessarily take into account the increased cost of healthcare in the current program, or the money needed to cover state funding shortfalls on SCHIP.
The HHS budget request states that 5.6 million children would be enrolled in SCHIP on average or nearly 9 million would be enrolled at some time during the year by 2013, if the reauthorization proposal was approved by Congress. Various proposals on Capitol Hill have sought to cover 10 million children under SCHIP with an increase of
$35 billion over the programs baseline of $25 billion over five years.
Members of the Senate Finance Committee seemed surprised by the administrations willingness to invest more money in SCHIP, although they nevertheless criticized the $19 billion increase, claiming it still wasnt adequate. Sen. Chuck Grassley (R-Iowa), the panels ranking member, acknowledged it was an improvement over the administrations previous proposals to fund SCHIP.