State Children's Health Insurance Program (SCHIP) (U.S.)

Background on SCHIP program
The State Children's Health Insurance Program (SCHIP) was created in 1997 to provide matching funding to states to provide health care coverage to children - aged 18 and under - of families whose income was too high to qualify for Medicaid but too little to afford health insurance, a level pegged by the original legislation at twice the federal poverty level, or about $41,000 in 2007. States are given the option of providing health care coverage by expanding their Medicare programs, funding private insurance programs, creating new state health care programs or some combination of the three. States could also apply for a waiver from the federal government to cover people other than children aged 18 and younger and families who exceeded the income limit.

Income levels for eligibility and coverage
States have different levels of income for eligibility because they administer the programs themselves and are allowed to apply to the federal government for waivers for incomes in excess of 200 percent of the federal poverty level. As of February 2007, 25 states and the District of Columbia have income limits at 200% of the federal poverty line, 13 states exceed that, and 12 states have maximum income levels below 200%. The highest is New Jersey, with an eligibility level of 350%, the only state to exceed 300%. According to the Congressional Research Service, 92 percent of those covered are below the 200% level (83% children and 9% adults) and 8 percent were from families with incomes higher than 200%.

Eligibility and coverage of non-children
Some states cover people other than children aged 18 and under and are able to do so by applying for a waiver from the federal government. As of March 2006, 15 states had obtained waivers under the SCHIP program (for either partial or regular federal financing) to cover others: 12 states covered adults with children, typically parents of children enrolled in Medicaid or SCHIP; four states covered some childless adults; and nine states cover pregnant women whose children would be eligible for SCHIP when they are born and includes prenatal and childbirth services. According to the Congressional Budget Office, 6.6 million children and 670,000 adults received coverage at some point in 2006.

Children in 2006 who were eligible but not enrolled
In 2006, 5.4 million children eligible for SCHIP or Medicaid were uninsured (because states use a mixture of the programs in different ways, a total figure gives the most accurate picture). Of those, 1.7 million children were eligible for SCHIP under the current state eligibility levels and another 3.7 were eligible but not enrolled in Medicaid. 90% of the eligible but uninsured children were from families with incomes below double the poverty level (something addressed by some of the 2007 bills by increasing outreach programs). There are a total of 9.4 million uninsured children aged 18 and under in the U.S.

Increase in funding required in 2007 to maintain current levels of enrollment
When the program was first created, it allocated roughly $20 billion over five years ($4 billion a year). By 2007, the program cost $5 billion per year. In order to cover the same number of people, the Congressional Budget Office estimated that the program would need an additional $13.4 billion over the next five years (2008 - 2012), for a total of $38.4 billion.

President Bush's position on renewal
President Bush proposed a $5 billion increase in SCHIP over five years, for a total of $30 billion. That level of funding would require cuts in the number of people covered, though Bush had said he might be willing to go higher.

Secretary of Health and Human Services Mike Leavitt said on September 20, 2007 that "We desire to see SCHIP continue to cover those children who are under 200 percent of the poverty line... We believe that the $5 billion is adequate to do that."

Related SourceWatch articles

 * health care
 * insurance industry