Academic journal article Journal of School Health

The Impact of School Enrollment-Based Health Insurance on the State Children's Health Insurance Program (SCHIP)

Academic journal article Journal of School Health

The Impact of School Enrollment-Based Health Insurance on the State Children's Health Insurance Program (SCHIP)

Article excerpt

Success of the US school enrollment-based health insurance (SEBHI) movement coincided with earlier child health insurance initiatives nationwide to influence approval of the State Children's Health Insurance Program (SCHIP). In addition to other initiatives that predated SCHIP, SEBHI programs provided affordable health insurance to Medicaid-ineligible, school-aged children from families lacking health insurance. Initially, some SEBHI programs offered limited coverage such as primary health screenings to participants' preschool siblings and working parents, who could neither afford private health insurance nor qualify the family for Medicaid.[1] The SEBHI and similar programs helped designers of SCHIP focus attention on this segment of the US population.

Interest in child health insurance initiatives increased as the Clinton administration, states, and other fiscal entities evaluated their progress, and watched their positive impact on previously uninsured children and families. SEBHI efforts such as Florida's Healthy Kids Program, Arkansas' Delta Health Insurance Initiative, New Hampshire Healthy Kids, and Texas Healthy Kids provided solid models that influenced the design of SCHIP as part of President Clinton's KiddieCare proposal to Congress.[2] This paper describes the current status of the SCHIP program nationwide, describes roles that SEBHI programs play in Florida, New Hampshire, and Texas, and summarizes lessons SEBHI programs can offer SCHIP as states work toward full implementation.


To provide health insurance coverage for an estimated 10.7 million uninsured US children and adolescents, the SCHIP received Title XXI funding estimated at some $40 billion over 10 years through fiscal year 2007.[3] Progress was slow initially due to traditionally unsynchronized federal and state legislative calendars. Passed by the US Congress in August 1997 as part of the Balanced Budget Act, states had little time to develop plans for SCHIP funds allocation before the 1998 fiscal year.[4]

The SCHIP was designed as a state-federal matching program offering higher federal matching payments than available under Medicaid. SCHIP funding helps raise the Federal Poverty Level (FPL) income ceiling, used by public health insurance to determine eligibility, to enable coverage of more uninsured children of low-income parents. The new SCHIP code allowed states to use new SCHIP funds in Medicaid expansions (ie, expanding Medicaid benefits and/or raising FPL ranges); in new state-designed programs distinct from Medicaid that would expand benefits and/or FPL ranges above Medicaid's upper FPL limits; or in combining these two approaches. All approaches aimed at recruiting more minor dependents of low-wage earning families into SCHIP-funded health insurance programs.[5]

In August 1999, President Clinton admonished conferees at the annual meeting of the National Governor's Association for not being aggressive enough in implementing SCHIP. In the two years since the SCHIP debut, states collectively enrolled some 1.3 million SCHIP-eligible children,[6] or 42% of the estimated national total eligible for the program,[3,7] yet some states with disproportionately high uninsured child populations continue to lag behind. Texas did not begin a SCHIP program until May 2000, and Texas children lacking health insurance may comprise as much as one-tenth of the total number of uninsured children nationwide. In New York, which began using SCHIP funds in April 1998 to augment the existing NY Child Health Plus Program, more than 770,000 resident children remain without health insurance statewide. Nearly three-quarters of uninsured children in New York City are currently eligible for, but not enrolled in, either Medicaid or Child Health Plus. Of this uninsured New York state population, 37% are estimated to be Medicaid-eligible and 27% eligible for Child Health Plus in 1999.[8]

President Clinton expressed concern because states face significant challenges before, during, and after SCHIP implementation. …

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