Senate SCHIP Letter July 30, 2007

The Honorable Harry Reid
Majority Leader
United States Senate
Washington, D.C. 20515
The Honorable Mitch McConnell
Minority Leader
United States Senate
Washington, DC 20515

Dear Majority Leader Reid and Minority Leader McConnell:

The National Conference of State Legislatures (NCSL) urges you to reauthorize the State Children’s Health Insurance Program (SCHIP) with all deliberate speed. This important program provides resources to states to provide comprehensive health care coverage to low-income children across the country and is widely accepted as a popular, effective complement to the Medicaid program. This program reauthorization must: (1) Provide stable and more predictability; (2) Be equitable across the states, recognizing and addressing the different circumstances among the states and the varying needs of their constituents; and (3) Support a strong role for state legislatures in program oversight, retaining state flexibility with regard to public notice and the solicitation of public input regarding program design and benefits; administration and implementation. Too often legacy states, those states that step out first, are disadvantaged when federal programs mirroring their own are enacted. NCSL supports the continuation of special provisions for the states that significantly expanded coverage to children prior to the enactment of the State Children’s Health Insurance Program.

With respect to the range of issues to be addressed in the upcoming reauthorization process, we offer the following recommendations:

Funding

The SCHIP reauthorization legislation should provide sufficient funding to: (1) cover existing beneficiaries; (2) permit states to cover more children, including those who are currently eligible but not enrolled; (3) recognize and provide for increased health care costs; (4) improve SCHIP coverage for children in the territories; and (5) adequately and effectively administer the program, including expenditures necessary to conduct outreach activities and to implement new accountability programs and requirements. We also strongly urge you to eliminate the provision in current law that returns unexpended SCHIP funds to the federal treasury. Unexpended funds should be retained in SCHIP and should be used to expand or improve health care coverage to children.

State Allocation Formula

NCSL urges you to consider improvements and revisions to the component parts and the data sources for the state allocation formula that would result in state allocations that would more accurately reflect state need and would limit the reliance on the redistribution of funds that exists in current law.

Benefits

It is extremely important that the next generation children’s health insurance program maintains and increases state flexibility in benefit design, including additional flexibility to permit states to leverage public and private dollars through premium assistance and other innovative mechanisms. NCSL opposes new benefit mandates. Finally, we urge you to permit children in state designed programs to participate in the Vaccines for Children program.

Eligibility

We urge you to continue to provide flexibility to states regarding program eligibility and urge consideration of factors other than percentage of the federal poverty level (FPL), such as state median or average income, when setting eligibility parameters. In addition, we urge you to expand eligibility options to include the following eligibility categories that are currently Medicaid options: (1) Pregnant women; (2) Children of state employees; (3) Children ages 1921 years of age; and (4) legal immigrant children. Finally NCSL urges you to allow states some flexibility on the “screen and enroll” requirement. Under current law, states are required to enroll all Medicaid-eligible children in Medicaid, even if they have siblings who are SCHIP, but not Medicaid eligible. NCSL believes that there are circumstances where the “screen and enroll”
requirement makes it more difficult for families to access health care. Families and states should be given more authority to decide what works best.

Quality/Accountability Initiatives

Medicaid and SCHIP should be accessible and provide the highest quality of care to participating children and families. States and the participating providers should be held accountable. Existing programs already underway should be adequate. If new quality/accountability initiatives are enacted, we strongly urge you to build on existing programs and data systems and to provide technical assistance to states. We also strongly support initiatives that would facilitate the sharing of best practices regarding all aspects of SCHIP to help states improve their programs.

Family Coverage

Family coverage through premium assistance has been underutilized in SCHIP. As a result, we have been unable to evaluate the benefits to families or to the program. We urge you to provide more flexibility to states to explore options to expand coverage to families through public/private partnerships that would include, but not be limited to premium assistance programs.

We thank you for this opportunity to share our thoughts with you on this important program. We look forward to working with you and your staff as discussions proceed and hope that you will consider NCSL a resource as you move forward. Please contact Joy Johnson Wilson (202 624-8689 or joy.wilson@ncsl.org) for additional information.

Sincerely,

Senator Leticia Van de Putte, Texas
President, NCSL Senator Gary Dillon, Indiana
Chairman, Committee on Health

cc: Members of the Senate