August 2007

An Overview of 2007 State Children’s Health Insurance Program (SCHIP) Legislation

• Overview
• Eligibility
• Federal Reauthorization
• Appropriations
• Other Legislation
• Press

Overview

This State Policy Focus is devoted to state legislation regarding the State Children’s Health Insurance Program (SCHIP). States have passed a variety of bills to expand eligibility, appropriate funds, and urge the federal government to reauthorize and expand SCHIP. In addition, a handful of states passed legislation to implement other types of changes to their SCHIP programs, including several proposals aimed at covering the uninsured. According to new data released by the Census Bureau today, the number of uninsured children in the US has increased for the second consecutive year and has reached a new high. Almost nine million children under 18 were uninsured in 2006, making the need for SCHIP’s reauthorization and expansion particularly urgent.

The research team at KSE Focus has analyzed SCHIP legislation enacted in 2007 by 37 states for this report. Nine states - California, Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania and Wisconsin – are still in session and have pending SCHIP legislation. Seventeen states have adjourned but will carry over SCHIP legislation filed in 2007 to their 2008 sessions: Alaska, Delaware, Georgia, Hawaii, Iowa, Kansas, Maine, Minnesota, North Carolina, Nebraska, New Hampshire, Oklahoma, Rhode Island, South Carolina, Tennessee, Vermont and Washington.

Expanding eligibility is a major theme in many of the bills enacted in states in 2007. In Washington state, for example, SB 5093 will expand health care coverage for the state’s low-income children by providing free or state-subsidized coverage to children in families with incomes up to 300 percent of the Federal poverty level (FPL). Currently, federal law requires states’ SCHIP programs to cover infants and children under the age of six in families with incomes up to 133 percent of the FPL and children under the age of 19 in families with incomes up to 100 percent of the FPL. States that wish to cover children in families with incomes greater than 200 percent of the FPL must obtain a waiver from the Centers for Medicare and Medicaid Services (CMS).

While both houses of Congress have passed SCHIP reauthorization bills that would expand eligibility, Bush Administration officials have stated that the President plans to veto the proposed legislation to reauthorize and expand SCHIP over concerns that the program is being used to “expand the nationalization of healthcare.” The President has proposed a $5 billion increase for SCHIP over five years, which would bring the program’s five-year funding level to $30 billion. By comparison, the House’s SCHIP bill would increase funding by $50 billion over five years, and the Senate’s SCHIP bill would increase funding by $35 billion over five years. The Bush Administration has also recently issued a letter to state health officials outlining new enrollment standards for SCHIP that would limit states’ ability to expand eligibility to children in families with income levels above 250 percent of the FPL. To read the letter, issued by CMS on August 17, go to: www.cms.hhs.gov/smdl/downloads/SHO081707.pdf

In a recent article in Health Affairs, Sara Rosenbaum, a health law professor at George Washington University’s School of Public Health and Health Services, calls SCHIP’s reauthorization an opportunity for policymakers to address the high numbers of young adults who are uninsured while also taking into account new developments in Medicaid policy that have changed the interaction between Medicaid and SCHIP. Despite Medicaid’s broad coverage, financing medical assistance for children is so inexpensive - even with comprehensive coverage, children cost Medicaid $719 each, on average, in 2001 - that many states might respond to this opportunity to secure funding for older children, pregnant women and parents, Rosenbaum said. To read the article online, go to: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.5.w608

Outreach and education efforts were also a major part of states’ SCHIP legislation. In New Hampshire, SB 192 requires the state’s Department of Health and Human Services to include a public education and outreach program for SCHIP, with the goal of increasing enrollment by informing new parents about SCHIP and assisting families in the application process. Texas also passed legislation requiring a community outreach and education campaign, including a toll-free number through which families can obtain information about health benefits for their children.

Two recent articles have explored the difficulty states currently face linking children in eligible families to SCHIP. Kevin Sack reported in a New York Times story that nearly 30 percent of children who are eligible for SCHIP have yet to enroll in the program and that some eligible families haven’t even heard of the program. To read the full article, go to: www.nytimes.com/2007/08/22/health/policy/22insure.html?ref=us

According to researchers from the Agency for Healthcare Research and Quality, while SCHIP has made great progress in increasing health coverage for the nation's children, many eligible children remain uninsured. To read their report, published in Health Affairs, go to: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.5.w618

As Congress considers legislation to reauthorize and expand SCHIP, 28 states passed legislation in support of SCHIP. In all 28 states, the legislation urges the federal government to reauthorize SCHIP and provide necessary funding for the program. Most of the legislation also urges the state’s governor to provide the necessary assistance to identify and enroll more eligible children in the program and asks all components of state government to work together to ensure that all available public and private assistance for uninsured children is used to the maximum extent possible.

For a detailed description of all of the SCHIP-related legislation that has become law in the states, please see below. 

Eligibility

In Montana, new guidelines for SCHIP went into effect on July 1 (SB 22). The 2007 Legislature and Democratic Gov. Brian Schweitzer approved the eligibility increase from 150 percent to 175 percent of the federal poverty guideline. Children from a family of four with an annual income of $36,138 may be eligible for SCHIP. That means a family can earn $5,163 more than the allowable amount under the previous guidelines and still qualify.

“We know the need is there, because many families applied for SCHIP in the past only to find out they’re above the income limit,” said Jackie Forba, SCHIP Bureau Chief.

The Department of Public Health and Human Services (DPHHS) estimates an additional 3,000 children may be eligible for SCHIP under the new guidelines. According to DPHHS, 16 percent, or approximately 37,000 Montana children do not have health insurance. It is estimated about half of those children may be eligible for SCHIP or Medicaid.

HB 198 was signed by the Governor Schweitzer on April 10. This bill expands SCHIP dental care benefits. The bill allows the Department of Public Health and Human Services to adopt rules to allow the department to cover significant dental needs beyond those covered under the basic plan. The department will not be allowed to spend more than $100,000 in state and federal funds for these services. HB 198 became effective on July 1, 2007.

New Hampshire SB 192 was signed by Democratic Gov. John Lynch. This bill will require the Department of Health and Human Services to include a public education and outreach program for the SCHIP. The goal of the program is to increase enrollment by informing new parents of the program’s availability and assisting families in the completion of the application process.

The department will, through the New Hampshire Healthy Kids Corporation, allocate funds for the development of a volunteer program to promote the outreach program to eligible families and to identify those families who may require assistance with the application or redetermination process. The department will also be responsible for the training and supervision of volunteers.

SB 192 will require the department to reimburse designated partner agencies, including health and home visiting providers, which have to provide additional follow-up with applicants. The department may add an enhanced application fee for outreach assistance to individuals requesting assistance in the application or redetermination process. The enhanced fee cannot be more than double the initial application fee.

This bill will take effect on September 14, 2007.

North Dakota HB 1463 was signed by Republican Gov. John Hoeven on April 25. This bill amends SCHIP by increasing the net income eligibility requirement from 140 percent to 150 percent of the federal poverty level.

SB 2069 was signed by Governor Hoeven on March 2. This bill amends the determination of self-employment income for eligibility under SCHIP. The Department of Human Services will need to base the eligibility of a child of a self-employed parent on the lesser of the following:

The previous one year of adjusted gross income or loss from the business, or if the previous year’s federal income tax return has not been filed, from the year prior to that year, less any earned or unearned income on the tax return, plus any current earned or unearned income.

• The average of the previous three years of adjusted gross income or loss from the business, or if the previous year’s federal income tax return has not been filed or the business has been in existence for fewer than three years, from the federal income tax returns from the previous three years that have been filed for the business, less the average of earned or unearned income for each of the previous three years for which federal income tax returns have been filed, plus any current earned or unearned income.

If the most recently available federal income tax return does not accurately predict income because the business has been recently established, terminated, or subjected to a severe change, income statements or any other reliable information may be used to compute self-employment income.

Texas HB 109, a bill that amends or adds sections of the Health and Safety Code relating to the eligibility for and the administration of SCHIP, was signed by Republican Gov. Rick Perry on June 15.

This bill will require the Health and Human Services Commission to conduct a community outreach and education campaign to provide information about the availability of health benefits for children. The commission will be required to conduct the campaign in a manner that promotes enrollment in, and minimizes duplication of effort among all state-administered child health programs. The outreach program will be required to involve school-based health clinics and utilize a toll-free telephone number through which families may obtain information about health benefits coverage for children.

HB 109 contains provisions to allow an individual who is determined to be eligible for coverage under the child health plan to remain eligible for those benefits until the end of a specified period, not to exceed 12 months, following the date of the eligibility determination or until the individual’s 19th birthday. The individual must have a net income below 185 percent of the federal poverty level to qualify.

Texas law states that the child health plan must have a waiting period to discourage employers from electing to discontinue coverage for children under employee or other group health benefit plans, and discourage individuals with access to adequate health benefit plan coverage from electing not to obtain or to discontinue coverage for a child. HB 109 will allow the 90-day waiting period to begin the day after a child’s coverage ends.

This bill will become effective on September 1, 2007.

Utah HB 218 was signed by Republican Gov. Jon Huntsman, Jr. on March 7. This bill amends SCHIP by adding that no later than July 1, 2008 the program benefits will be benchmarked to be equivalent to a benefit plan with the largest insured commercial enrollment offered by a health maintenance organization.

Until the benchmark is implemented, SCHIP may, but is not required to, include the following benefits in the program:

• Hospital services.
• Physician services.
• Laboratory services.
• Prescription drugs.
• Mental health services.
• Basic dental services.
• Preventive care, including routine physical examinations, immunizations, basic vision services and basic hearing services.
• Limited home health and durable medical equipment services.
• Hospice care.

The program benefits for enrollees who are at or below 100 percent of the federal poverty level are exempt from the benchmark requirements.

 Legislation for Federal Reauthorization

In over half of the states in the country, legislation was filed to address the federal government’s role in SCHIP. All of the legislation urges the federal government to reauthorize and provide funding for SCHIP. Most of the legislation also asks the state governor to provide the assistance necessary to identify and enroll children who qualify for these programs, and asks all components of state government to work together with educators, health care providers, social workers and parents to ensure that all available public and private assistance for providing health benefits to uninsured children be used to the maximum extent possible.

The following states have enacted legislation regarding the federal reauthorization of SCHIP: Alabama, Alaska, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Iowa, Louisiana, Michigan, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Washington, West Virginia, and Wisconsin.

The following two legislatures have filed SCHIP legislation regarding federal reauthorization and are currently still in session: New Jersey (ACR 249) and Ohio (HCR 12 and SCR 14).

The following states have adjourned, but are carrying over SCHIP legislation related to federal reauthorization to 2008: Kansas (HCR 5011) and Minnesota (HF 634 and SF 462).

The following states introduced SCHIP legislation regarding federal reauthorization, but the legislation died pursuant to the legislature’s adjournment: Indiana, Kentucky, Maryland, Missouri, Texas, Virginia and Wyoming.

Arizona, Connecticut, Hawaii, Idaho, Massachusetts, Maine, North Carolina, New Hampshire, New York, South Dakota and Vermont did not introduce legislation regarding the federal reauthorization of SCHIP.

Appropriations

Alabama HB 208 was signed by Republican Gov. Bob Riley on June 6. This bill appropriates $26.2 million for fiscal year 2007-2008, to the Department of Public Health for the SCHIP program.

Hawaii HB 500 became Act 213 on June 23. This bill appropriates for fiscal years 2007-2008 and 2008-2009 an amount of $24,801,430 from the tobacco settlement and special funds to the Department of Human Services for SCHIP.

Illinois HB 3920 was signed by Democratic Gov. Rod Blagojevich on July 2. This bill will appropriate $7,832,000 from the General Revenue Fund and $2.5 million from the Tobacco Settlement Recovery Fund to the Department of Healthcare and Family Services for operating and administrative costs related to SCHIP. The funds will be distributed during FY 2007-2008, which began July 1, 2007.

Indiana HB 1001 was signed by Republican Gov. Mitch Daniels on May 11. This bill will appropriate from the Tobacco Master Settlement Agreement Fund an amount of $31,363,603 for FY 2007-2008 and $33,863,603 for FY 2008-2009 to the Family and Social Services Administration for SCHIP.

Iowa HF 909 and HSB 301 were signed by Democratic Gov. Chet Culver on May 29.  These bills appropriate the following funds to the Department of Human Services for the fiscal year that began on July 1, 2007:

• $14,871,052 from the General Fund for the maintenance of the healthy and well kids in Iowa (hawk-i) program, Iowa’s SCHIP funded program.
• $8,329,570 from the Health Care Trust Fund to be distributed as follows:
  • $4,697,363 to support current enrollment and natural growth in the program.
  • $135,300 to maintain current outreach efforts.
  • $3,497,907 for increased outreach to and enrollment of eligible children in SCHIP.

HF 909 also adds that if state funding is available and if the federal reauthorization of SCHIP provides a sufficient federal allocation, the department can expand coverage as follows:

• Eliminate the exclusion of state employees from receiving SCHIP benefits.
• Provide coverage for legal immigrant children and pregnant women not eligible under current federal guidelines.
• Cover children up to age 21, or up to age 23 if the child is attending school.

The bill also states that if the United States Congress does not authorize additional federal funds necessary to address the shortfall for SCHIP for the federal fiscal year beginning October 1, 2006, and ending September 30, 2007, the department may use 100 percent state funds from the appropriation made in this section for the period beginning July 1, 2007, and ending September 30, 2007, and may, after consultation with the governor and the general assembly, utilize funding from the appropriations made in this Act for medical assistance to maintain the program. 

Maryland HB 50 became Chapter 487 on May 8. This bill appropriates $190,217,320 to the Department of Health and Mental Hygiene - Medical Care Programs Administration for SCHIP for the fiscal year that began on July 1, 2007, and will end on June 30, 2008.

North Carolina HB 1473 was signed by Democratic Gov. Mike Easley on July 31. This bill appropriates $368,000 for FY 2007-2008 to the Department of Health and Human Services, Division of Medical Assistance for the production of a report that identifies the most cost-efficient and cost-effective method for developing and implementing a program of comprehensive health care benefits for children from birth to age 18 in families with annual incomes between 200 percent and 300 percent of the federal poverty level.

The report must address the following:

• The U.S. Congress’ reauthorization of SCHIP with respect to:
  • The amount of federal funds authorized for each of the fiscal years covered in the reauthorization.

• The number of fiscal years that federal funding awarded to the states remains available to each state.

  • The adequacy of the formula by which federal funds are distributed to the states.
  • The ability of states to expand SCHIP coverage to children whose family incomes exceed 200 percent of the federal poverty level.
• The fact that eligibility and benefits are not an entitlement, are for legal residents of North Carolina, and are subject to availability of state and federal funds and requirements.
• The most cost-effective use of limited state funds to offer health care services to children in families between 200 percent and 300 percent of the federal poverty level.
• Children enrolled in the program must be ineligible for Medicaid, Medicare, or other government-sponsored health insurance. The department must examine whether children must also be without private health insurance for a specified amount of time, e.g. six months.
• The health care benefits covered in the proposed expansion program will not exceed the benefits currently covered by NC Health Choice.
• The establishment of cost-sharing measures for the families of children with an income above 200 percent of the federal poverty level, including:
  • A monthly premium per child that is at an optimal level that simultaneously is affordable, encourages participation by families, controls costs, and provides revenue to reduce the cost of the program to the state. The amount of the premium may increase as income increases above 200 percent of the federal poverty level.
  • Increased co-payments and cost-sharing that are affordable and sufficient to control costs, while not discouraging families from seeking and continuing prescribed treatment for children.
  • A deductible that is to be applied to certain health care benefits.
  • A limit on out-of-pocket expenses that is no more than five percent of family income.
• The establishment of a comprehensive annual benefit limit per child that is no more than the current annual benefit limit under NC Health Choice.
• The most cost-effective and efficient way of administering and managing enrollment in the program and the collection of premiums. This may include having the current administrator of NC Health Choice be the entity to collect premiums, or designating some other benefit management or administrative entity to do so, including the department.

The department is required to submit an interim report of its findings and recommendations no later than January 1, 2008. The report will need to be submitted to the Senate Appropriations Committee on Health and Human Services, the House Appropriations Subcommittee on Health and Human Services, the Joint Legislative Commission on Governmental Operations, and the Fiscal Research Division.

The department must submit its final report no later than February 1, 2008. The General Assembly will review the department’s recommendations before the implementation of the program to expand access to health insurance to children above 200 percent of the federal poverty level. The program will become effective July 1, 2008, or upon approval of all required federal waivers, whichever occurs later.

HB 1473 also appropriates $7 million to the department for FY 2008-2009 to be used to implement this newly developed program.

New Jersey SB 3000 was signed by Democratic Gov. John Corzine on June 28. This bill appropriates $276,928,000 to the Department of Human Services for SCHIP for FY 2007-2008.

Pennsylvania HB 1286 was approved by Democratic Gov. Edward Rendell on July 17. This bill appropriates $199,113,000 in federal funds to the Department of Insurance for FY 2007-2008 for SCHIP. The bill appropriates $6,272,000 in state funds for an enhanced SCHIP.

HB 1286 also appropriates additional funds for bills incurred and remaining unpaid expenses for FY 2006-2007. This portion of the bill appropriates $172,487,000 in federal funds to the department for SCHIP.

Texas HB 1 was signed by Republican Gov. Rick Perry on June 15. This bill appropriates $2.1 billion for CHIP for the 2008-2009 biennium. Of this funding, $637.8 million will come from the General Revenue Fund and be used for the following:

•  To provide two full years of perinatal (pre- and post-natal) services.
• Dental premiums.
• To address caseload increases.
• Fund cost growth.
• Fund rate restoration and increases.
• Change certain eligibility standards (see HB 109 mentioned earlier in this report).

Utah SB 1 was signed by Republican Gov. Jon Huntsman, Jr. on March 20. This bill reduced appropriations previously provided to the Department of Health for SCHIP for FY 2006-2007. The department lost only $900 in federal funds and $100 in general funds from the Tobacco Settlement Account. The bill took effect immediately.

HB 1 was signed by Governor Huntsman on February 2. This bill appropriates $52,443,700 to the Department of Health for SCHIP for the fiscal year that began on July 1, 2007. The monies will be distributed from the following funds:

•  $40,245,700 from federal funds.
• $790,100 from dedicated credits revenue.
• $10,321,500 from the Tobacco Settlement Account.
• $61,700 from revenue transfers from other agencies.
• $24,700 from revenue transfers within the agency.

HB 150 and SB 228 were signed by the governor on March 20. HB 150 appropriates an additional $19,882,800 to the Department of Health for SCHIP for the fiscal year that began on July 1, 2007. The funds are a one-time appropriation to be used to expand program enrollment. The monies will be distributed from the following funds:

•  $2 million from the General Fund.
• $15,882,300 from federal funds.
• $2,000,500 from the Tobacco Settlement Account.

SB 228 appropriates $56,000 to the department for the fiscal year that began on July 1, 2007, for personnel and contract-related expenses for SCHIP.

Other SCHIP/Uninsured Legislation

 Colorado SB 211 was signed by Democratic Gov. Bill Ritter. This bill creates a 15-member advisory committee to develop and oversee the implementation of a plan to provide health coverage for all low-income children by the end of 2010. The committee will:

•  Make recommendations for changes in legislation and rules to increase enrollment of children in Medicaid and SCHIP.
• Analyze enrollment and reenrollment barriers to Medicaid and SCHIP, and methods to overcome the barriers.
• Investigate the feasibility of expanding the sites with direct access to the state system for enrollment in Medicaid and SCHIP.
• Investigate the feasibility of centralizing enrollment in Medicaid and SCHIP.
• Analyze methods to improve communication among the State Department, the Department of Human Services and county departments of social services.
• Investigate the feasibility of sharing income eligibility information and verification with other benefit programs.
• Review quarterly enrollment data for Medicaid and SCHIP by county or geographic region.

The committee must submit reports and recommendations no later than November 1, 2007, and on or before November 1 each year thereafter. The committee is scheduled to terminate on July 1, 2012.

SB 211 also requires the State Department, no later than January 1, 2008 (and by January 1 each year thereafter), to submit a report to the Health and Human Services committees of the Senate and House on measures of access to and quality of health care for children eligible for programs developed by this bill. The report must contain data that provides an answer to the following questions:

Are providers for children participating in the programs and accepting eligible children as patients on a regular basis?

• Are eligible children enrolling in programs under this title and remaining enrolled in order to receive continuity of care?
• Are eligible children receiving early and periodic screening, diagnosis and treatment (EPSDT) services required by federal law, including regular preventive care and timely specialty care?
• Are providers accurately reporting data from these visits and using other appropriate measures of access and quality to improve health outcomes and maximize health care resources?

The State Department will also develop standards and methods for collecting, analyzing and disclosing information regarding clinical performance, including immunization rates, medical home standards, clinical care guidelines, care coordination, case management, disease management and coordination and integration of mental health services. The department will review the data collected, assess the health outcomes for programs administered by the department, and report to the Senate and House Health and Human Services committees on or before July 1, 2008.

Hawaii HB 1008, a bill creating temporary three-year pilot programs for infants and children, was signed by Republican Gov. Linda Lingle on June 30.

HB 1008 will create the Hawaii infant health care program. This program will provide continuous, quality health care services to uninsured newborn children between one day and 30 days of age. The program will provide up to $10,000 of health care assistance per eligible infant.

The Department of Human Services (DHS) must report to the legislature no later than 20 days prior to the convening of the 2008-2009 regular session, and annually thereafter, on the number of children who were provided services through the Hawaii infant health care program and the annual cost of the program. The report must provide a list of health care providers and manage care plans participating in the program and any proposed legislation to improve the program.

The bill will also establish a pilot program, entitled the Hawaii Children’s Health Care Program, to provide health care coverage to uninsured children. The coverage will be provided through a public-private partnership between DHS and one or more managed care plan that offers accident and health or sickness insurance plans.

To qualify for this pilot program, a child must be between 31 days old and 19 years old, and have been uninsured continually for at least six months. Infants between 31 days and six months old must be uninsured continually since birth to qualify. The child must also be ineligible for any other state or federal health care coverage.

DHS and the managed care plan will share equally the cost of the premium for each child enrolled in the pilot program and will pay the state’s share of the premiums under the pilot program on a quarterly basis.

The managed care plan will be responsible for determining the eligibility of Hawaii Children’s Health Care Program applicants and enrolling applicants in the pilot program. The managed care plan must provide a quarterly report to DHS and the legislature on the number of children enrolled in the program.

Other private organizations will be allowed to partner with the state to offer coverage to uninsured children under the pilot program, provided that the plan benefits will be equal to or better than those offered through the pilot program established by the state and managed care plan.

DHS and any participating managed care plan must report to the legislature no later than 20 days prior to the start of the 2008-2009 regular session, and annually thereafter, on any problems experienced with the program involving crowding out eligible participants, instances of people dropping their previous coverage to receive free coverage, the amount of funding used and for what purposes, any other problems encountered in the administration of the program, and any proposed legislation necessary to better administer the program.

HB 1008 also requires DHS to provide state-funded medical assistance free-of-charge to persons younger than age 19 whose family income is at or below 300 percent of the federal poverty level. The person must be a legal permanent resident and/or non-immigrant from the Trust Territories of the Pacific Islands, who are otherwise eligible for benefits under the state’s Medicaid programs, including QUEST and SCHIP, but are ineligible due to restricted eligibility rules.

The department must provide medical assistance under QUEST-Net at no charge to children ages 19 or younger whose family income is at or above 250 percent, but does not exceed 300 percent, of the federal poverty level and who are otherwise eligible for QUEST-Net benefits.

The bill appropriates the following amounts from general revenue:

• $150,000 for FY 2007-2008 and $250,000 for FY 2008-2009 for the Hawaii infant health care program.
• $700,000 for FY 2007-2008 and $900,000 for FY 2008-2009 for the Hawaii Children’s Health Care Program.
• $109,000 for fiscal year 2007-2008 and $218,000 for fiscal year 2008-2009 for state-funded medical assistance.
• $350,000 for FY 2007-2008 and $700,000 for FY 2008-2009 to provide medical assistance under QUEST-Net.

This bill became effective on July 1, 2007. The pilot programs are scheduled to terminate on June 30, 2010.

Louisiana HB 542, a bill to create the Louisiana Children and Youth Health Insurance Program within the Department of Health and Hospitals, was signed by Democratic Gov. Kathleen Blanco on July 10 and became effective immediately. The department will have the same powers and authority to administer the program as provided to it for administration of the Medicaid program and LaCHIP, and will coordinate the program with the existing children’s health programs it operates.

To be eligible for the program, HB 542 requires a child to be ineligible for medical assistance under the Medicaid program or benefits under LaCHIP with family income between 200 percent and 300 percent of the federal poverty level.

The child must also meet at least one of the following requirements:

• Be without health insurance for a period of time set forth in rules promulgated by the department.
• Have a parent who has lost employment and health insurance, which leaves the child without coverage as a dependent, until such time as affordable employer-sponsored health insurance coverage is again available for the child.
• Be a newborn whose responsible party does not have available, affordable private or employer-sponsored health insurance.
• Lost medical benefits under the Medicaid program or LaCHIP within one year of applying for coverage under this program.

An eligible child will remain eligible for the program for 12 months, but will lose eligibility if the required premiums are not paid in a timely manner, or if the child is in the custody of a juvenile or adult detention facility.

HB 542 requires the department to promulgate rules regarding hardship provisions, annual renewals of eligibility for the program, reenrollment, grace period, notice requirements and hearing procedures. The department must also determine the availability and affordability of private or employer sponsored health insurance, with consideration of such factors as the percentage of income needed to purchase individual or family health insurance, the availability of employer subsidies, and other relevant factors.

The department will be required to use the same simplified enrollment processes and application form that are used for the Medicaid program and LaCHIP. In addition, the department must provide a secure application for submission by electronic transmission via the Internet, make presumptive eligibility determinations for children as provided by federal guidelines, and contract with local entities throughout the state to assist with outreach and enrollment activities.

The department will be required to establish requirements concerning monthly premiums, co-payments, and coinsurance for health care services. This cost-sharing must be on a sliding scale based on family income up to 300 percent of the federal poverty level. The department will work in conjunction with the Children’s Defense Fund of Louisiana,  Agenda for Children, Louisiana Maternal and Child Health Coalition, Covering Kids and Families, Louisiana Partnership for Children and Families, Families Helping Families of Louisiana, Louisiana Chapter of the National Association of Social Workers, Louisiana Chapter of the American Academy of Pediatrics, Louisiana Chapter of the March of Dimes, and the Louisiana Primary Care Association in the rulemaking process regarding the sliding scale based on family income.

There will be no co-payment required for well-baby or well-child health care, including but not limited to age-appropriate immunizations, as required under state and federal law.

The department will have the authority to:

• Collect required premiums from the family or responsible party for a child receiving benefits.
• Notify the family or responsible party of a child who is paying a premium of any changes in such premium or co-payment requirements.
• Refuse payment of services for nonpayment of premium.
• Monitor the availability and retention of employer-sponsored dependent health insurance coverage to promote retention of such insurance and timely access to health care services.

Montana HJ 48 was finalized when it was filed with the Secretary of State on May 4. This joint resolution requires the Legislative Council to designate an appropriate interim committee to study and make recommendations on reforms of the Montana health insurance and health care systems, including publicly funded health care programs. The study must address the creation of a system of universal, portable, affordable health insurance coverage for all Montanans that involves private health insurance issuers, and incorporates existing public programs and ways to improve the quality, affordability and delivery of health care.

The committee must examine the concept of a health insurance exchange and how such a concept could be implemented in Montana. The committee must also consider the following:

• Similar reforms enacted in other states, including the cost of the reforms to the state and to consumers, the extent to which the reforms have improved the availability and affordability of health insurance coverage, and barriers that states may have encountered and overcome to improve newly enacted health insurance coverage systems.
• The advantage and disadvantage of mandating private universal coverage.
• The ways in which existing state-supported private insurance programs, including the Insure Montana program and the Montana Comprehensive Health Association plan, may be incorporated into any reforms.
• Whether public employee health benefit programs should be included in a reformed system.
• Potential changes to publicly funded health care programs, including the Medicaid program and SCHIP, to maximize the use of federal funds and ensure broader coverage of those in need of assistance.
• The ways in which health care providers handle uncompensated care, including whether those costs are shifted to other entities or individuals, and an estimate of total uncompensated costs.
• The ways in which the state could work with the federal government on integrating aspects of health care services and programs operated by the federal government, including the Indian Health Service, into the state’s health care system.
• Other issues related to access to health care, including access in rural areas.
• The potential for coordinating state health care workforce planning with federal, state and private funding for medical education.

The study, including presentation and review requirements, must be concluded no later than September 15, 2008.

Oregon SB 3 was signed by Democratic Gov. Ted Kulongoski. This bill will create the Oregon Healthy Kids Program, which will provide affordable, accessible health care for Oregon’s children. The program will be comprised of:

• Medical assistance administered by the Department of Human Services provided to children under the state programs funded by Medicaid, Medicare and SCHIP.
• A private health option administered by the Office of Private Health Partnerships.
• A statewide Healthy Kids Advice Line.
• A statewide Healthy Kids Healthcare Access Line.

With the enactment of this bill, a child is eligible for enrollment in SCHIP if the household income of the child’s family is no more than 200 percent of the federal poverty guidelines, and the child has been uninsured for a minimum of 60 consecutive days immediately preceding enrollment.

The Office of Private Health Partnerships will be created to administer a private health option to expand private health care coverage for Oregon’s children. The office will contract with carriers to provide health benefit plans that must offer benefit packages comparable to those provided by medical assistance programs and must cover mental health, vision and dental services. The plans cannot exclude coverage of pre-existing conditions. The plans may also impose co-payments or co-insurance amounts that are based upon criteria adopted by the office.

The office must provide a subsidy for a health benefit plan for a child whose family’s household income is more than 200 percent but no more than 300 percent of the federal poverty guidelines. The amount of the subsidy will be based on household income, family size and other factors established by the office. The office will adopt rules that allow families with household incomes that are more than 300 percent of the federal poverty guidelines to purchase health benefit plans offered through the private health option.

SB 3 imposes a tax increase on all tobacco products in order to fund the Oregon Healthy Kids Program. In order for this program/bill to become effective, the voters of the state must approve a constitutional amendment (SJR 4) to “okay” the 84.5 cent per pack tax increase. The question will be put to voters on the November 6, 2007 ballot as Measure 50.

Rhode Island HB 6560 became effective without Republican Gov. Don Carcieri’s signature on July 7. This joint resolution requests that the Department of Human Services enroll children, parents and pregnant woman, who are eligible for medical assistance or SCHIP, to be enrolled into the RIte Care or RIte Share program without undue delay. The resolution requests that the department act in the best interest of persons in need of health insurance by requesting only the eligibility and enrollment documentation that is required by federal law and regulations, and nothing more stringent.

Vermont HB 526 was signed by Republican Gov. Jim Douglas on June 11. This bill requires the Joint Fiscal Office, in consultation with the Office of Vermont Health Access; the Department of Banking, Insurance, Securities, and Health Care Administration; and the Department of Education to study how to maximize federal Medicaid funds by ensuring that all students eligible for Medicaid or Dr. Dynasaur are enrolled and stay enrolled in the programs. 

The study must include estimates of:

• The number of children with individualized education plans who lose health care coverage through Dr. Dynasaur because of nonpayment of a premium.
• The number of children who are uninsured and eligible for Medicaid or Dr. Dynasaur.
• The number of children who are privately insured and eligible for Medicaid or Dr. Dynasaur.
• The financial impact on schools due to the lack of enrollment or disenrollment in the program.
• The potential cost-savings to Medicaid of targeting enrollment of children eligible for SCHIP‑funded Dr. Dynasaur services.

The Joint Fiscal Office is required to report results of the study to the House Education and Human Services committees and to the Senate Education and Health and Welfare committees by December 1, 2007.

Washington Gov. Christine Gregoire signed SB 5093, a bill that will expand health care coverage for Washington children. The bill, sponsored by Sen. Chris Marr, D-Spokane, will expand access to state health care for low-income children by providing free or state subsidized coverage to any family with income up to 300 percent of the federal poverty level. Currently, in order to qualify for state health care benefits, children must live in families whose annual income is 250 percent of the poverty level. Proponents believe that this new measure will provide coverage for an additional 38,000 children over the next two years.

Press

On August 8, President Bush reinstated his intention to veto legislation that would reauthorize and expand SCHIP. Senate legislation (S. 1893), which was approved by a 68-31 vote on August 2, would reauthorize SCHIP and increase the federal cigarette tax by 61 cents per pack to boost funding for the program by $35 billion over five years.  House legislation (H.R. 3162), which was passed by a 225-204 vote on August 1, would reduce payments to Medicare Advantage plans and increase the federal cigarette tax by 45 cents per pack to increase funding for SCHIP by $50 billion over the next five years. The House bill would also make a number of revisions to Medicare.

When SCHIP was created in 1997, the program focused on families with incomes less than twice the poverty level, but many states have obtained federal waivers to cover children with somewhat higher family incomes because those families cannot afford private insurance. President Bush has proposed a $5 billion increase over five years for SCHIP, which would raise the program’s total five-year funding to $30 billion.