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Thursday, August 23rd 2007

CHIP Is For Who?

I’ve talked before about where the line should be drawn concerning CHIP qualification. The government providing for children, whose parents can’t provide, is something else than the dream of ‘universal coverage’. There’s some reason to it, even from the libertarian end I’m occupying.

The question is which families should qualify for assistance in providing for their children’s health? Apparently, with the SCHIP renewal, Congress drew the line too low…

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess. In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

Noble goals, but I think trying to determine what ‘low income’ is when it comes to being able to afford health insurance for your children is a difficult deal.

The poverty level for a family of four is $20,650 in annual income. New York now covers children in families with income up to 250 percent of the poverty level. The State Legislature has passed a bill that would raise the limit to 400 percent of the poverty level — $82,600 for a family of four — but the change is subject to federal approval.

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.

More than $82,000 for a family of four? Even in NY; are you kidding me?

In the letter sent to state health officials about 7:30 p.m. on Friday, Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.

Before making such a change, Mr. Smith said, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.

Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”

That seems like a perfectly reasonable goal to put on the states. Plenty of the enrollment problems, at least down here in Texas (one of the worst states for enrollment), can be put on the state itself. The people who do qualify are in no position, in terms of their literacy of public assistance options, to find and apply for CHIP coverage without assistance. Assistance I imagine most states fail at.

The enrollment numbers are not pretty.

Despite a decade of marketing efforts by governments and private foundations, nearly 30 percent of children who are eligible for the health insurance program and are not covered by private plans have yet to enroll, according to a new government study.

Late last week, the Bush administration published new standards aimed at preventing states from expanding eligibility for the program to cover children from middle-class families. But a more fundamental debate over the program has been raging in Washington for months: how to find and enroll the 1.7 million low-income children who are already eligible but have not signed up.

The challenge of enrolling those who are already eligible demonstrates how difficult it will be for states to meet the federal standards. The new policy says that states can only expand eligibility for their programs — by raising income limits above certain levels — if they have first enrolled 95 percent of those who now qualify. Few states have come close to doing that; the national enrollment rate in 2004-2005 was 72 percent, according to the study.

Debate over the best way to find those eligible who aren’t enrolled? 95% may be too ridiculous a figure, but down here in south Texas around actual patients I’ve got to say it isn’t a matter of finding the best effort to enroll these eligible kids…it’s a matter of putting forth a legitimate effort at all.

If states are falling short of the new guidelines for eligible enrollment plenty of that goes on them themselves.