Weems: SCHIP coverage stable

A senior Bush administration health official on Wednesday rejected Democratic assertions that some children currently covered by a government health program will be kicked off the rolls next year.

Acting Centers for Medicare and Medicaid Services (CMS) Administrator Kerry Weems told reporters that the administration has no intention of requiring states to disenroll children from the State Children’s Health Insurance Program (SCHIP) despite a recently adopted policy restricting states from signing up kids from higher-income families.

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“It’s explicitly not my understanding of how that would work,” Weems said. “We certainly don’t see states kicking kids off the rolls.” The administration’s aim, as articulated in the past by President Bush, is to focus SCHIP resources on the poorest children, Weems said.

In the administration’s August announcement of the SCHIP policy, however, that agency warns that states will be subject to “corrective action” if they do not comply by next August.

Some congressional Democrats are declaring that the administration’s policy would inevitably lead to children being removed from SCHIP coverage next year.

According to an analysis by the Georgetown University Health Policy Institute’s Center for Children and Families, 14 states that provide SCHIP coverage to children in families with incomes above 250 percent of the federal poverty level (FPL), $42,925 a year for a family of three, “will likely be forced to roll back their eligibility levels at some point before August 2008, or assume new coverage costs with state funds.”

On the House floor Wednesday, Democratic Caucus Chairman Rahm Emanuel (Ill.) asserted that kids in those 14 states would lose their benefits next summer. “Because of the president’s executive order [sic], kids in those states will actually come off the rolls in August,” Emanuel said, adding that governors would have to begin developing plans to notify those children and their families.

House Energy and Commerce Committee Chairman John Dingell (D-Mich.) said that Weems’s comments were at odds with CMS’s stated policy. “Perhaps CMS officials are reading their directive differently than the rest of us,” Dingell said in a written statement.

Dingell also focused on the effect the policy has had on states that were considering expanding their SCHIP programs. “We know of states that have intended to move forward to reach more uninsured children but have been stopped by [the Department of Health and Human Services] on the basis of CMS’s August directive. What’s clear is that this administration has made it increasingly difficult for states to help protect the health of our nation’s neediest and most vulnerable kids,” he said.

The nation’s governors also have qualms about the SCHIP directive. In a letter sent to Congress by the National Governors Association Monday, the governors asked Congress to “address the issues raised in the … guidance issued by CMS.” The SCHIP bill headed to President Bush does not include provisions on the directive.

These cautions come as the House was expected to follow the Senate’s lead and pass an extension of SCHIP through March 2009. The approval comes after Democrats failed to overcome Republican objections and two presidential vetoes of a bill that would have added $35 billion to the program over five years.

CMS laid out the disputed policy in a directive sent to the states in August, shortly before Weems assumed the helm at the agency. The directive says that all states seeking to cover children from households with incomes above 250 percent of the federal poverty level must provide CMS with “Assurance that the state has enrolled at least 95 percent of the children in the state below 200 percent of the FPL who are eligibl­­e for either SCHIP or Medicaid” in order to obtain federal approval for their expansions.

CMS rejected New York’s application to expand eligibility to 400 percent of the poverty level. Other states, such as Indiana and Oklahoma, scaled down their expansion plans in response to the directive.

The policy, however, also would apply to states that already implemented eligibility expansions approved by CMS. The directive says those states also must comply with the 95 percent threshold.

Nevertheless, Weems predicted that SCHIP enrollment would actually increase because of the CMS policy. “It’s our goal that, in fact, what we’ll see are states reaching to the poorest of children and bringing them onto rolls. That was the purpose of the directive,” he said.

Rather than enforce the directive by requiring state to reduce enrollment, CMS will work with those states not meeting the 95 percent requirement to develop plans to sign up the lowest-income children, Weems said.

“States can meet that 95 percent standard in a number of ways, and we actually expect several states to meet that standard in the coming year,” he said. The adoption of universal or near-universal health insurance laws at the state level, such as the program in Massachusetts, will accelerate this process, he added. Weems acknowledged that states are already in the process of moving adults from SCHIP to Medicaid.

“We’re going to look at the individual circumstances in states and, you know, work with them to make sure that people remain covered but also that they’re complying with our directive,” he said.

Not all of CMS’s Democratic overseers are concerned that the agency will remove children from the SCHIP rolls. A spokeswoman for the Senate Finance Committee indicated that the directive is more applicable to states seeking expansions. “The concern is not so much about children getting ‘dumped off,’ but about states not being able to implement new plans that would cover additional children who need [S]CHIP,” she wrote in an e-mail.