Federal Link: www.cms.gov/schip/
What is it: The State Children’s Health Insurance Program (SCHIP) is a program created in 1997 to provide health insurance coverage to children (ages 0-18 in most states) in families that earn too much to be eligible for traditional Medicaid but not enough to afford private health insurance. It is jointly administered and financed by states and the federal government. States have broad flexibility under Title XXI of the Social Security Act, which authorizes the SCHIP program, to expand coverage to uninsured children either through Medicaid, a separate health insurance program, or a combination of both.
Who qualifies: Youth that do not currently have health insurance are likely to be eligible, even if working. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger, whose families earn up to $34,100 a year (for a family of four in 2003) are eligible.
What it covers: States create their own benefit packages.
www.cms.gov/schip /chpa-map.asp OR www.insu rekidsnow.gov/about.htm
What it costs : States are allowed to impose premiums, deductibles, or fees for some services and for some groups.
- Cost sharing for all children may not exceed 5% of the family's income.
- States may not require cost sharing for mandatory populations of children and pregnant women.
- No co-payments are allowed for pediatric preventive care, including immunizations, at any income level.
Impact for YOUTH: Provides health care coverage for youth not eligible for Medicaid. Youth cannot be turned down due to pre-existing conditions. May provide coverage for youth who lose Medicaid coverage at age 18 from age 18 to age 19.
EXPANDED SCHIP – Maine has begun an innovative program MaineCare for Childless Adults
- Youth need to meet low income eligibility
- Plan pays insurance premiums for those who meet certain criteria
- Plan uses employer-sponsored insurance for the expansion
How to Apply: Varies from state to state.
Contact State Medicaid Office. www.cms.hhs.gov/medicaid/consumer.asp
Resources:
Insure Kids Now
www.insurekidsnow.gov/about.htm
Insure Kids Now! Is a national campaign to link the nation’s 10 million uninsured children—from birth to age 18—to free and low-cost health insurance. Many families simply don’t know their children are eligible. Site links to state SCHIP web sites and application forms.
AMERICAN ACADEMY OF PEDIATRICS
SCHIP
www.aap.org/advocacy/schip sum.htm
Summary of provisions of SCHIP.
FAMILY VOICES
SCHIP Implementation Project
www.familyvoices.org/SCHIP/home.htm
This project is focused on facilitating and promoting family leadership involvement at the state agency level where policy decisions are being made about SCHIP coverage. The project collects information about what is working, what needs improvement and how together we can assess what is happening in your state. With tightening state and federal budgets, health insurance programs for children are threatened and through waivers states can change their SCHIP and Medicaid programs through the Health Insurance Flexibility and Accountability Act (HIFA).
Centers for Medicare & Medicaid Services - State Children’s Health Insurance Program
State-by-State SCHIP Approved Plan Files
www.cms.gov/schip/chpa-map.asp
Site includes state-by-state links containing: State Plans, Approval Letters, Fact Sheets, Press Releases, Official Correspondence, Annual Reports and State Evaluations.
KAISER FAMILY FOUNDATION
State Health Facts Online
www.statehea lthfacts.kff.org/
(click on Medicaid and SCHIP). If the person’s income is below the threshold listed, the person is probably eligible for Medicaid and/or SCHIP. Even some people whose incomes are above the thresholds will be eligible because federal rules require states to disregard certain types of income.
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