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The State Children's Health Insurance Program: Past, Present, and Future |
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The reauthorization for the State Children's Health Insurance Program (SCHIP) is set to expire at the end of fiscal year (FY) 2007. SCHIP - broadly considered a success - has expanded health insurance for low - income children through federal - state and public - private partnerships. This report reviews the program's history and design, describes its present challenges and successes, assesses issues Congress is likely to consider during reauthorization, and explores future policy options including potential changes in eligibility and financing. For SCHIP, the process will take place at a time when the uninsured rate for children is once again on the rise, budget pressures are leading to constraints on publicly financed coverage, and general concerns about the health system are growing. Past: History and Design of SCHIP SCHIP was created in 1997 to insure children in families with too much income to qualify for Medicaid and too little to afford private insurance. Unlike Medicaid, however, these enhanced federal matching payments are limited by national and state-specific "allotments," or annual limits on federal funding. Enrollment barriers and misunderstandings concerning eligibility are two of the major reasons for their lack of enrollment. But these rules, which include minimums for benefits and the employer contribution, are considered onerous by states; consequently, few states have implemented premium-assistance programs. There are also concerns over substandard benefits in SCHIP and out-of-pocket costs that limit access to care, particularly for special-needs children and other vulnerable populations.
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