SCHIP Reauthorization.

• Position: STATESTATS - State Children's Health Insurance Program

Twenty-two states and the District of Columbia plan to or do cover uninsured children in families with income above 250 percent of the federal poverty line (FPL) through the State Children's Health Insurance Program (SCHIP). This has been restricted, however, because of:

* The failure of Congress and the Bush administration to agree on the reauthorization of SCHIP last year. The program is operating under a continuing resolution until March 31, 2009, with no new funds for expansions.

* A directive issued by the Centers for Medicare and Medicaid Services (CMS) on Aug. 17, 2007, that provides specific criteria states must meet by August 2008 before they may cover children in families with income above 250 percent of the FPL. The criteria are intended to prevent "crowd-out" (the substitution of public for private coverage). The directive requires states to have at least 95 percent of children with family income under 200 percent of the FPL enrolled in Medicaid or SCHIP; to establish cost-sharing provisions comparable to private plans; and to require that children who were previously covered under private insurance be uninsured for at least one year before being enrolled in SCHIP.

The Congressional Research Service and the Government Accountability Office have issued opinions that the directive must be submitted to Congress and the comptroller general for review before it can take effect. The CMS responded that it does not intend to change the requirements. On May 7, CMS sent a second letter to state health officials clarifying the provisions in the directive and re-affirming the...