Journal of Health and Biomedical Law
State Health Reform; Medicaid & SCHIP
In 2005 Medicaid will turn 40, a momentous event in the life of the largest and most complex of all means-tested public entitlement programs. Since 1997, Medicaid has co-existed with the State Children’s Health Insurance Program (SCHIP), a small program which covers a fraction of the number of Medicaid enrolled children but whose legislative structure looms large against its much beleaguered companion. To the unpracticed eye, SCHIP and Medicaid appear to be quite similar in design; in reality however, their differences could not be more profound, and it is in these differences that clear directions for Medicaid’s possible future become visible. It is these differences and their meaning for U.S. child health policy which are the subject of this article.
The majority of States that have implemented SCHIP as a separately-administered program have opted for benefit and coverage design in the case of early childhood preventive and developmental services that are considerably less comprehensive than the standard of coverage furnished to infants and young children under Medicaid. Researchers found that all States with separate SCHIP programs cover basic well-baby and well-child care in their service agreements; however, wide variation was found among the study States in their use of coverage standards that explicitly require participating health plans to cover child development services required under Medicaid, such as anticipatory guidance (18%), lead screening (43%), and comprehensive developmental assessments (68%). In addition, only half of the study States require participating health plans to use a medical necessity standard comparable to the Medicaid standard. The authors conclude that when States are given the flexibility to do so, they tend to reduce the level of coverage to that found in standard health insurance products, rather than the level of coverage in the Medicaid Early and Periodic Screening Diagnosis and Treatment program.
Rosenbaum, J.D., Markus, A., Sonosky, C. (2004). Public health insurance design for children: The evolution from Medicaid to SCHIP. Journal of Health and Biomedical Law, 1, 1-47.