Cindy Mann

1
Immigrants and Child Health Policy The
Implications for SCHIP Reauthorization
Cindy Mann Georgetown University Health Policy
Institute Center for Children and
Families crm32_at_georgetown.edu ccf.georgetown.edu
Population Resource Center Friday, April 20,
2007
2
Medicaid and SCHIP Some Basics
3
State Medicaid/SCHIP Income Eligibility Levels,
July 2006
NH
VT
ME
WA
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
OH
NE
IN
NV
DE
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
gt 200 FPL (15 states)
lt 200 FPL (10 states)
200 FPL (26 states including DC)
Note The Federal Poverty Line (FPL) for a family
of three in 2006 is 16,600. Source Based on a
national survey conducted by the Center on Budget
and Policy Priorities for Kaiser Commission of
Medicaid and the Uninsured, 2006.
4
Participation Among Eligible Children Has
Increased in Medicaid SCHIP
Note These participation rates consider children
who are eligible based on income and assets, but
does not consider non-financial eligibility
criteria such as immigration status. Source L.
Dubay analysis of National Survey of Americas
Families.
5
New Entries in Santa Clara County, 2001-2002
Note Differences are statistically significant
at p lt .01. Source C. Trenholm. Expanding
Coverage for Children The Santa Clara County
Childrens Health Initiative. Mathematica Policy
Research, Inc., April 2005.
6
Trends in the Uninsured Rate of Low-Income
Children, 1997 - 2005
Source Georgetown CCF analysis based on data
from the National Health Interview Survey,
November 2006. Beginning in 2004, the NHIS
changed its methodology for counting the
uninsured. This results in the data for 2004 and
later years not being directly comparable to the
data for 1997 2003.
7
Coverage Disparities Continue but Narrow

• (C)ontinued growth in public coverage has been a
  major factor in improving rates of health
  coverage for children. These changes have been
  particularly dramatic for minority children.
• AHRQ, (September 2006)

8
What Are the Key Issues in SCHIP Reauthorization?
9
Childrens Health Care Coverage, 2005

• 88 have at least one employed parent.
• Uninsured children are disproportionately in the
  South (43) and West (29).
• A disproportionate share (38) of uninsured
  children are Hispanic.
• 35 of uninsured children live in families with
  incomes below 100 FPL.

77.9 million children under 19
Source CCF analysis of CPS 2006 March
Supplement and Campaign for Childrens Health
Care, No Shelter from the Storm Americas
Uninsured Children (September 2006).
10
Most Uninsured Children Are Eligible for Public
Coverage (2004)
SCHIP Eligible
Medicaid Eligible
Medicaid Eligible
SCHIP Eligible
Not Eligible
Not Eligible
9.0 Million Uninsured Children
6.5 Million Low-income Uninsured Children
Source L. Dubay analysis of March 2005 Current
Population Survey using July 2004 eligibility
rules.
11
Key Issues in SCHIP Reauthorization Financing

• How much SCHIP funding will be available?
• Level of funding
• Distribution of funds
• Source of any new funds

SCHIP Spending is Outpacing New Funds Being Made
Available
12
Key Issues in Reauthorization (continued)

• Who can be covered?
• Income range of children
• Treatment of adults, including pregnant women
• Ending the exclusion for legally present
  immigrant children and pregnant women
• What kind of coverage will be provided?
• Benefit standards
• Quality measures
• How do we reach eligible, but uninsured children?
• Procedural barriers/citizenship documentation
• Express Lane eligibility
• Outreach funding
• Funding to improve language access
• Performance-based financial support for
  increasing enrollment/maintaining high
  participation rates

13
Conclusion

• SCHIP, along with its larger companion program,
  Medicaid, has a strong track record covering
  children.
• Yet, 9 million children remain uninsured and a
  disproportionate share are immigrants or from
  immigrant families.
• SCHIP reauthorization presents a unique
  opportunity to move childrens coverage
• forward.