State Children’s Health Insurance Program

Congress created the State Children’s Health Insurance Program in 1997 as Title XXI of the Social Security Act.19 The objective was to increase health insurance coverage for lower-income children through Medicaid expansions or creation of separate state programs or both. (If a child is legally eligible under a state’s Medicaid program requirements, he or she is supposed to be enrolled in Medicaid as such.)

With federal matching funds, states can extend coverage to children in families with incomes that are 200 percent of the federal poverty level. For states that had already expanded Medicaid eligibility to optional groups, the law raised the income threshold to 50 percent above the state’s existing limit. Certain technical actions (i.e., use of “income disregards” allowed for in Medicaid under Section 1931 of Title XIX) can allow other states to exceed the 200 percent figures (AHSRHP, 2001). State SCHIP programs are, like state Medicaid programs, highly variable.

Separate SCHIP programs may or may not provide the same covered benefits as the state Medicaid program and may or may not use state-approved Medicaid managed care plans to provide services. A recent analysis indicated that “among the 34 states with separately administered SCHIP programs in effect in 2000, 32 states use coverage exclusions that would not be permissible in Medicaid” (Rosenbaum et al., 2001, p. 2). Services that tended to be excluded from separate SCHIP programs were hospice, case management services, and home and community-based services. Depending on the availability of other support, the result could be inadequate palliative and end-of-life care for children and their families. Also, if the state creates a separate SCHIP program, it is not precluded—as it would be for its Medicaid program—from requiring copayments.

For states with separate SCHIP programs, coverage may be part of the basic program or part of a program designed specifically for children with special needs. Some state programs, for example, Wisconsin’s BadgerCare program, also offer coverage to low-income uninsured parents who have a child under age 19 living with them (see http://www.dhfs.state.wi.us/badgercare).

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For general information about SCHIP, several Web sites provide useful descriptions or analyses including CMS/HCFA (http://www.hcfa.gov/init/children.htm); George Washington University’s Center for Health Services Research and Policy (http://gwhealthpolicy.org); American Academy of Pediatrics (http://www.aap.org/advocacy/schip.htm); and American Public Health Association (http://www.apha.org/ppp/schip/); and Health Services Research (http://www.hsrnet.com/pubs/pub04.htm).



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