State Children's Health Insurance Program (SCHIP): An Overview

Wednesday, October 17, 2007; 7:46 PM

Frequently Asked Questions about the State Children's Health Insurance Program (SCHIP)

Q: How does the program work and who does it cover now?

A: The $5 billion-a-year program was created 10 years ago with the goal of covering children from families with annual incomes at or below about twice the poverty level, or $41,300 for a family of four. The target population is children whose parents earn too much to qualify for Medicaid but not enough to afford private insurance on their own.

Currently, 18 states and the District of Columbia have eligibility levels above 200 percent of the poverty level. New Jersey is the highest at 350 percent. No other state is above 300 percent.

About 6.6 million children and 671,000 adults received health coverage through SCHIP in 2006, according to the Congressional Budget Office (CBO).

About 83 percent of those enrolled were children at or below 200 percent of the poverty level, and another 9 percent were low income adults, according to the Congressional Research Service (CRS). The remaining 8 percent were children from families with incomes above twice the poverty level.

Q: How many children are eligible, but not enrolled?

A: About 5.4 million uninsured children are eligible for coverage under SCHIP or Medicaid, the federal health insurance program for the poor, according to an analysis of Census data by the Urban Institute. Of those, 1.7 million are eligible for SCHIP and 3.7 million for Medicaid.

About 90 percent of children who are eligible but still uninsured are from families with incomes below twice the poverty level. Some eligible families have incomes above twice the poverty level because some state SCHIP programs have income limits above 200 percent.

Q: Who would be covered under the bill approved by Congress and vetoed by President Bush?

A: Under the bill, states could receive the full federal matching rate to cover children from families earning as much as three times the poverty level, or $61,950 for a family of four. States seeking to cover families with higher incomes would receive a less favorable federal matching rate. In either case, states would have to receive approval from the Bush administration to raise their eligibility levels that high.

About 70 percent of those who gain or retain coverage under the bill would be from families earning less than 200 percent of the poverty level, according to an analysis by the Urban Institute. The analysis includes an assumption that some states would raise eligibility levels.

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