California, New York Mull Response to New Kids’ Insurance Rules
New guidelines released last week by the Bush administration to limit eligibility for the State Children's Health Insurance Program would strain efforts in California to expand the program, according to health care advocates, the Ventura County Star reports.
Healthy Families, California's version of SCHIP, provides health care services to children in families with an income that does not exceed 250% of the federal poverty level.
Gov. Arnold Schwarzenegger (R) seeks to expand eligibility to 300% of the poverty level as part of his proposal to overhaul California's health care system (Collins, Ventura County Star, 8/22).
Under the new federal guidelines, however, states seeking to expand SCHIP eligibility also "must establish a minimum of a one-year period of uninsurance for individuals" in families with incomes greater than 250% of the poverty level to prevent them from switching from a private insurance plan to a public program.
The new guidelines state that before expanding SCHIP eligibility to children in families with incomes greater than 250% of the poverty level, states must demonstrate that they have "enrolled at least 95% of children in the state below 200% of the poverty level" who are eligible for Medicaid or SCHIP (California Healthline, 8/21).
Children in California currently are eligible for the program if they have been uninsured for three months.
Jean Ross, executive director of the California Budget Project, said, "What the governor wants to do and what the Democratic (legislative leaders) want to do isn't an allowable use of federal funds" under the new guidelines.
Anthony Wright, executive director of Health Access, said the guidelines are "a direct attack on attempts for health care reform in California."
Ronald Spingarn -- deputy director of legislation and external affairs for the California Managed Risk Medical Insurance Board, which operates Healthy Families -- said, "It would likely be impossible for California or any state to meet" the new requirement that 95% of eligible children already be enrolled in SCHIP before an expansion can occur.
Spingarn said more clarification from the federal government is needed before California officials can assess the impact of the new guidelines (Ventura County Star, 8/22).
New York Gov. Eliot Spitzer (D) said he will lobby against the new rules, which endanger his plans to expand eligibility in the state to children in families with annual incomes less than 400% of the poverty level, the New York Times reports.
Expanding eligibility to that level would effectively cover all children in the state and would give New York the highest SCHIP income ceiling in the nation.
State health officials -- including Deborah Bachrach, state deputy commissioner of the Office of Health Insurance Programs -- are preparing a written response to federal officials that will argue for changes to the guidelines. If the response is not effective, the Spitzer administration will work with national lawmakers from New York and other states to pass a law altering the guidelines.
If Spitzer moves forward with the SCHIP expansion without federal approval, the state will have to contribute an additional $41 million in lost federal funding. The state enrolls about 88% of children eligible in families with annual incomes less than 200% of the poverty level, falling short of the new guidelines, and leaving about 60,000 children ineligible for SCHIP under the new rules (Confessore, New York Times, 8/22).
Three broadcast programs reported on reactions to the Bush administration's new guidelines for SCHIP enrollment. Summaries appear below.
- American Public Media's "Marketplace": The segment includes a discussion with "Marketplace" Washington, D.C., bureau chief John Dimsdale (Ryssdal, "Marketplace," American Public Media, 8/21). A transcript and audio of the segment are available online.
- KPBS' "KPBS News": The segment includes comments from Spingarn (Goldberg, "KPBS News," KPBS, 8/21). A transcript and audio of the segment are available online.
- NPR's "Morning Edition": The segment includes comments from Ann Kohler, New Jersey deputy commissioner of human services; Dennis Smith, director of the Center for Medicaid and State Operations; and Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities (Rovner, "Morning Edition," NPR, 8/22). Full audio and a partial transcript of the segment are available online.