Medicaid directors object to SCHIP rules

State Medicaid directors plan to join a growing chorus of opponents to a plan by the Bush administration to force states to sign up more poor children for taxpayer-funded health insurance before coverage can be offered to better-off families.

 

Martha Roherty, executive director of the National Association of State Medicaid Directors, said the group would ask the administration to back off its proposal, which was announced late Friday (Aug. 17).

 

If the administration refuses, she said, Medicaid directors will lobby Congress to override the rules as it tries to pass a major piece of legislation on children’s health insurance by Sept. 30.

 

As many as 18 states could lose federal funding for the State Children’s Health Insurance Program (SCHIP) by next year if the administration’s plan remains in effect, Roherty told reporters Wednesday (Aug. 22). States share SCHIP costs with the federal government.

 

The states affected by the new rules have been among the most aggressive in trying to provide health insurance for kids under SCHIP, which already covers 6.1 million Americans, mostly children.

 

As states have expanded the numbers of low-income people eligible for the coverage, the Bush administration increasingly has tried to rein in the program and make sure federal money is focused on covering poor children before it reaches out to middle-class families.

 

The 18 states offer SCHIP coverage to kids in families making more than 250 percent of the federal poverty level, or $51,625 for a family of four.

 

New York Gov. Eliot Spitzer (D) championed a measure this spring to extend his state’s coverage to families making up to four times the poverty level, the highest threshold in the country. And California Gov. Arnold Schwarzenegger (R) wants to boost the eligibility level for kids in the Golden State as part of his universal health care proposal.

 

Roherty said the most successful states typically cover 70 percent to 80 percent of their eligible populations, making the 95 percent level dictated by the new federal rules unachievable. Just determining a state's rate of coverage can be a difficult and contentious process, she said.

 

Dennis Smith, the director of the federal Center for Medicaid and State Operations, told state officials in a letter that the changes should ensure public money is spent on people who currently don't have insurance instead of on those who already have private coverage.

 

Smith also said the administration would require other changes. States only would be able to sign up enrollees who have gone without insurance for a year or more, and the public plans would have to have co-payments and premiums similar to private coverage.

 

The letter, sent while Congress is in recess, is the latest salvo in an escalating conflict between the Bush administration and Congress over how large the SCHIP program should be.

 

Before Congress split for its summer break, both the House and Senate signed off on plans for massive expansions of the program.

 

The House voted to add $50 billion more over five years, while the Senate approved $35 billion in additional funds over five years. President Bush, who panned the plans as “Congress’ attempt to federalize medicine,” is holding out for an increase of only $5 billion.

 

In order to continue the decade-old program, Congress must act by Sept. 30. SCHIP enjoys support from both parties, but renewal efforts have touched off fierce fighting over how large to make the program and how to pay for its expansion.

The states that are likely to be affected by the change, according to the Medicaid directors, are California, Connecticut, Hawaii, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Rhodes Island, Vermont and Washington.