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SCHIP: What's Happening? What's Next?

Policy & Program Developments


Debbie I. Chang, M.P.H., Co-Chair, Department of Health & Human Services (HHS) Steering Committee on State Children's Health Insurance Programs (SCHIP), Director of Benefits, Coverage, and Payments.

This session served to update workshop participants on the status of the Health Care Financing Administration's (HCFA) proposed regulations governing SCHIP and to explain the latest developments and trends in SCHIP at the State and Federal levels. Ms. Chang began by discussing what issues HCFA was considering for the SCHIP regulations and the process the regulations would need to go though before becoming final. The session ended with question and answers.

SCHIP regulations will be a culmination of the last 18 months of program and policy developments that have transpired between the States and HCFA. Although Ms. Chang was unable to give specifics of what the regulations would contain, she did note that approximately 80 to 90 percent of the document would be derived from the "Dear State" letters, Frequently Asked Questions and Answers and the Title XXI Statute. She did note that while the SCHIP regulations will strive toward giving States flexibility in program design and implementation, they will also focus on making sure that beneficiaries are protected and may also focus on how States can best measure "success" of the program. Once the proposed regulations are released (no definitive time frame), there will be a 60-day public comment period. Once comments are integrated into the regulations, they will be released as final. It is conceivable that the final regulations will not be out until next year, more than 2 years after SCHIP was passed by Congress (August 1997).

HCFA has realized that there are key challenges States and HCFA face with SCHIP:

  • The 10-percent administrative cap.
  • Data, quality and evaluation.
  • Outreach and enrollment
  • Crowd-out.

States are also having difficulty getting time from computer programmers who are too busy with Y2K programming to work on programming for SCHIP. Also, some States' data systems are archaic and need upgrading prior to reprogramming. With many Federal officials wanting more data on SCHIP, States can expect more requests for information, and States are advised to give high priority to their data systems.

Ms. Chang also announced that the public-charge issue of Medicaid and SCHIP participation was resolved at the Federal level. Participation in these public programs will not be counted against anyone when applying for citizenship. This came as a great relief to many States because resident aliens have been hesitant to sign up for SCHIP, fearing it would make them ineligible for citizenship, result in deportation, or force them to reimburse the State for used benefits.

One trend Ms. Chang reported on was that many States that initially expanded Medicaid using SCHIP funds have submitted or plan to submit an amendment to implement a State-designed SCHIP program separate from Medicaid. At the time of the meeting, there were 14 States with State-designed SCHIP programs only and 12 States with a combination of a Medicaid SCHIP expansion and State-designed SCHIP program—many of which will, in the year 2002, only have a State-designed SCHIP program because of the age-in of the "Waxman Kids."

Ms. Chang also made herself available for questions at the end of her presentation, although she was available throughout the 3-day meeting to answer questions or clarify HCFA policy as needed. Some of the questions asked of Ms. Chang (and her responses) are included below. (Questions and answers are paraphrased.)

Question: Can benefit packages for Native American SCHIP enrollees be different from those for other SCHIP enrollees in a State?

Answer: Yes, as long as Title XXI benefit requirements are met. Another question was brought up that indicated that offering a better benefit package to a certain population may be a violation of civil rights. Ms. Chang was going to follow up with her colleagues at HCFA and get back to the person who asked the question.

Question: One State found that 40 percent of those who applied for SCHIP but were Medicaid-eligible declined coverage because they did not want to be enrolled in Medicaid. Will HCFA give some flexibility to allow them to enroll in SCHIP instead?

Answer: The screen and enroll process clearly states in the statute that no Title XXI money can be used to provide coverage for a Medicaid-eligible child. States must have a process in place to screen for children potentially eligible for Medicaid. Those identified in the screening process must go through the Medicaid process for enrollment.

Question: Has there been movement at the Federal level to allow States to cover State employees that are eligible for SCHIP through the non-Medicaid route?

Answer: No.

Question: Can/will Native Americans be waived from SCHIP cost-sharing if a State requires cost-sharing of its general SCHIP population?

Answer: HCFA will give direction on this in the future.

Question: Can non-public employees be allowed to make final eligibility determination for Medicaid?

Answer: No.

The main theme of some of the remaining questions focused on the ability of States to give SCHIP and Medicaid enrollees a choice of being enrolled in Medicaid or SCHIP, to cover children who are underinsured or have costly coverage (more than 5 percent of a family's income), or to allow families to drop coverage without a waiting period to enroll in SCHIP.

This session was recorded in full. Tapes are available. Call the AHRQ Publications Clearinghouse, 1-800-358-9295; or E-mail them at


Chang DI. A preliminary estimate of the Children's Health Insurance Program. Baltimore (MD): Health Care Financing Administration, U.S. Department of Health and Human Services, 1999 Apr.

Health Care Financing Administration, U.S. Department of Health and Human Services. Children's Health Insurance Program. Aggregate enrollment through Dec. 31, 1998. Baltimore (MD): The Administration, 1999 Apr.

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