Bush SCHIP limits hurt efforts to expand kids coverage, states say

A new policy would restrict access largely to children from families earning less than 250% of the poverty level.

By Doug Trapp, AMNews staff. Sept. 10, 2007.

Washington -- The Bush administration, unsuccessful in attempts to scale back the scope of State Children's Health Insurance Program legislation, instead is using its administrative powers to rein in the program.

The Centers for Medicare & Medicaid Services released a guidance letter on Aug. 17 severely limiting states' ability to cover families earning more than 250% of the federal poverty level. Before states could make such a move, they would have to prove that they had enrolled 95% of children at or below 200% of poverty. States also would have to show that private health insurance enrollment had not declined more than 2 percentage points among targeted income groups and that new SCHIP enrollees had been uninsured for one year.

The House and Senate have adopted SCHIP reauthorization bills that would allow states to insure children beyond the new Bush administration limit. Lawmakers are expected to work out a joint measure this month.

CMS has given states that already have coverage limits exceeding the 250% level one year to comply with the new rules. Sources estimated that between 16 and 19 states have SCHIP income limits higher than 250% of poverty.

Some states are seeking federal waivers to allow SCHIP eligibility expansions. These efforts face uncertain futures. One example is New York, where state lawmakers earlier this year increased the state's eligibility limit from 250% of poverty to 400%. The Bush administration has not yet signed off on the move. New York is working with other states to get CMS to reverse its new policy, said Paul Larrabee, spokesman for Gov. Elliot Spitzer.