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Systems of Accountability: Implementing Children's Health Insurance Programs
for information and communication based on experiences with other national and state programs, especially those that involve low-income working families.
ACCOUNTABILITY FOR SCHIP
Having enacted SCHIP and appropriated $24 billion over 5 years, Congress will oversee DHHS's administration of the program. The legislation requires states to submit written plans to DHHS describing their programs as well as their strategic objectives, performance goals, and performance measures. With these legislative requirements, Congress established a basic template for SCHIP accountability.
DHHS has created an interdepartmental steering committee to implement SCHIP. State plans are being submitted to the Health Care Financing Administration (HCFA) and are being reviewed by HCFA's national and regional offices in collaboration with the Health Resources and Services Administration, the Agency for Health Care Policy and Research, the Office of the Assistant Secretary for Planning and Evaluation, and other participants on the steering committee. To qualify for their first-year SCHIP allotments, states must have federal approval for their plans by September 30, 1999.
For several months, DHHS has been actively providing information and technical assistance to states as they develop and implement their SCHIP plans. With only half of the state plans submitted as of the beginning of April 1998, it is too early to tell how DHHS will handle the variety of performance measures proposed by the states or whether any uniform performance measures will be recommended or required.
The recommendations in this report are based on an extensive review of evidence on the relationship between insurance coverage and access to care, as presented in the committee's companion report, America's Children: Health Insurance and Access to Care (IOM, 1998). The recommendations are also based on the following assumptions:
New Opportunities. SCHIP offers new opportunities for innovation and flexibility in insurance expansion, for improving existing programs, for increasing children's access to health care, and for developing child-specific performance measures.
Accountability for Public Funding. The $24 billion in federal funds allocated for SCHIP and Medicaid improvements represents a significant national commitment to insurance expansion for children. This commitment should be monitored to ensure that the legislation's goals are fulfilled.
Need for Sustained Efforts. Although SCHIP will help to reduce the number of uninsured children, millions of children will remain uninsured or underinsured even assuming its full implementation. To guide future insurance expansions, careful evaluation of the multitude of state approaches used under SCHIP will be essential.