State Children Health Insurance Programs - Research Paper Example

Children Health Insurance Program Summary Children are the next generation of any country in the world. For this reason, it is important to protect and take care of them. In the recent years, United States children have faced diseases that are fatal hence increase mortality rate, As a result, the government established a balanced budget act in the year 1997 that aimed at expanding the health insurance coverage to the uninsured children and families that otherwise could not afford decent healthcare. The government named the program the State children health insurance program (SCHIP). The program gets its funding from both the federal government and respective states. However, the federal government has laid down guidelines on how to run the program that the states follow. Since the program’s establishment, the federal government had disbursed over 40 billion dollars in support of the program. Additionally, in 2006 approximately 6.6 million children had benefited from the program. Furthermore, 670,000 adults also benefited form the program through exemption of statutory provision. However, the government did not all the program to continue beyond the year 2007 but due to its success, the government opted to reauthorize it. The federal government has give authority to states to customize their eligibility requirement in order to suit the citizens. As a result, states raised their poverty level of eligibility to 200% and the lowest state poverty level eligibility was 140%. Introduction The SCHIP is one of the programs that have greatly succeeded in the United States. Many adults and children who otherwise would have not afforded decent health care can now get it because of the health insurance cover that the states provide. Most of the states compute the eligibility of children by subtracting some amount of the family’s earning and expenses in order to ascertain the family’s net income (Ewing, 2008). However, in some cases there are children that do not qualify for the program or are not eligible. For this reason, the states have devised two main methods of dealing with this issue. The first one is expanding the medical program to incorporate these children. However, in other states they have come up with a separate program under the SCHIP that provides for these children and in some cases the two approaches are used at the simultaneously. For instance, according to statistics, eleven states expanded the program to incorporate children who were not eligible; eighteen states a developed separate program under the SCHIP while twenty-one states combined the two approaches. Overview and development of the SCHIP The requirements for the states that expanded the (SCHIP) in order to cover children that are not eligible need to provide all the benefits that comes with the medical aid program and in addition follow rest of the program requirements. However, the states the provide a separate program under the SCHIP have minimum requirements that they need to fulfill in order to run the program including a benefit package that follows specific benchmarks on insurance planning or the other way is following the equivalent requirements that are approved by the federal government (Patel &Rushefsky, 2006). Every year the federal government allocates resources to support the SCHIP in accordance with the number of children that are in the low-income bracket in each state. Additionally, the federal government takes into account the number of children that are unsecured and the level of wages in the health sector and compares it to the whole country. However, it is a requirement by the federal government to provide matching funds that will meet the expenditure for their allocation. Additionally, they have a timeline of up to three years to spend the allocations. Furthermore, when a state does not use all its allocation within the period of three years then the federal government redistributes the remaining resources to other states that have already finished their allocations. The federal government has developed an incentive that encourages states to participate in the SCHIP by paying shares to any state that actively runs the program than the medical aid program. However, the performing rate varies widely from state to state ranging from sixty-five percent to eighty-five percent. The medical aid program varies fifty to seventy-six percent. However, the federal government releases resources in accordance with the matching expenditure, it is important to note that the Medicaid program varies greatly from the SCHIP in various aspects. The SCHIP is a grant program in which the federal government caps its spending prior to the rolling out of the program while the Medicaid in generally an entitlement program whose sole mandate is to predetermine the overall limit in the spending of federal resources. However, due to the recurring nature of the SCHIP, the federal government lowered its spending on the program initially but as the program continued to gain popularity, it increased its resource allocation towards supporting it. Additionally, some states have managed to spend more that allocated hence forcing them to draw from other reserves to support the program. The spending patterns vary from one state to another, in some year their may be a deficit hence forcing the states to get unused funds from other states while in other years the may be a remaining balance. For this reason, no clear or specified amount that the federal government can put aside for each state due to these variations. Every year each state provides the federal government estimates and projections on how they expect their budget to be like. Additionally, the federal government distributes its allocations based on these estimates and projections. In some years, the federal government has to double the allocations to certain states and reduce allocations in others. In the year 2006, the Deficit reduction act that the government enacted in 2005 directed additional funding amounting to 283 million dollars to support SCHIP. The government has a provision in the National Institute of Health Act to reorganize and disburse funds to other states that are in need. The implication of depleted resources varies widely from one state to another. However, other states that provide for Medicaid get direct allocation from the federal government once their resources that support the SCHIP are exhausted. However, the federal government does this at a lower rete than the normal one. However, the states are encouraged by the federal government to cut down their spending as much as possible by employing measures such as capping on in other circumstance increase the premiums. The federal government does not allow the aspect of increasing premiums by states that provide the SCHIP as an expansion of the Medicaid program. However, states that encapsulatea different program under the SCHIP have the authorization of expanding their programs to Medicaid hence this will enable then to access more funds from the federal government. The SCHIP has reduced the number of low-income earning children in different state that are uninsured. According to statistics, the number of children coming from families whose income levels is a hundred percent or two hundred percent when compared with the poverty level. Due to the introduction of the SCHIP by the federal government, the uninsured rate dropped form 22.5 percent in the year 1996 to 16.9 percent after the launch of the SCHIP in the year 2005. Additionally, during this period the rate of middle and higher income level children remained relatively stable Eligibility criteria for low income earning children The federal government developed the SCHIP to help uninsured children under the age of nineteen years. Additionally, the child should be coming from a low income earning families. Furthermore, he or she should be above the threshold of Medicaid. According to the law that governs the program, a child that comes form a family that is below the poverty line as stipulated by the law and above the Medicaid threshold is entitled to the SCHIP. The federal government allows states not to consider some forms of income when checking for eligibility of a child. However, the eligibility is not fixed; it varies form one state to another. Additionally, states that are running a separate program other than the expansion of the Medicaid have more flexibility in enrollment control. For instance, the capping and freezing enrolment is at their discretion. Additionally they have the ability of imposing a waiting period that normally lasts for 3 to 6 months. The children have to finish this duration while uninsured to discourage people from dropping private medical insurance cover. Eligibility criteria for low income earning adults Several states have used the power given by the law regarding SCHIP to provide waivers in order to extend the program to adults. The main rationale for this is that when the parents are covered too it encourages more and more children to enroll for the program (Sultz& Young, 2011). Parents who are already in the program have higher chances of enrolling their children hence enabling the state attain its goal in implementation of the SCHIP. According to the Social Security Act, certain statutory requirements and regulation can be waivered by the Secretary of Health and Human services. As a result, the Secretary has used this provision severally to waiver hence allow more people to access this vital service. However, this is through expansion of the Medicaid program hence allowing pregnant women and adults that have no children to enroll for the program. When the state decides to use the law and apply the waiver it is a requirement by the federal government that the funds set aside for the insured children should not be included in the expansion program. However, the SCHIP provides for funding that will help subsidize private cover for those who opt to take private cover. This is through the premium assistance program. Benefits of the program The program takes two major forms these include expanding the Medicaid or having a separate program under the SCHIP. However, in other cases the state can opt to combine the two. States that opt to provide medical cover by expanding the Medicaid program have to provide all the benefits that come with the Medicaid plan. However, states that opt to have a separate program under the SCHIP must provide benefits in accordance with the provision of an insurance plan or an equivalent of a plan approved by the federal government. However, states have the freedom to develop more innovative way on how best to implement the program as long as they meet the basic requirements of the program (Smith, 2011). As a result, some states have surpassed the federal government expectations hence are covering dental and eyes. The private medical insurance covers do not cover these services. Premiums and the factor of sharing costs States that have opted to use the expansion of Medicaid program option have to implement the cost-sharing factor whereby the state shares the premium with other individual. This case applies when an individual opts to have private medical cover. Original, the federal government exempted children from paying premiums under the cost sharing arrangement. However, currently under the SCHIP the cost sharing aspect is in force under some circumstances. Additionally, for children living under the poverty level, it is illegal to pay premiums. However, the federal government allows nominal sharing of certain costs. These costs include prescription drugs and other services for instance nonemergency services that hospitals provide. For families with a poverty level of 150 percent the coinsurance is up to 10 percent and the families do not pay premiums. Additionally, for those children that come from a family of higher income level then payment the law allows for payment of premiums. Furthermore, the copayment is up to twenty percent. The SCHIP allows for cost sharing in some instances. However, the federal government does not allow cost sharing in the Medicaid program in relation to preventive services. In 2005, up to 39 states had embraced the aspect of cost sharing under the SCHIP. However, the states that had expanded the Medicaid program did not use the cost-sharing method. Financing the SCHIP The federal government in conjunction with the states funds the program. Additionally, the state presents its budget estimates and projections in regards to the program for approval by the federal government. The law has a provision for the share of each state in accordance with the need and population. It further discloses the procedures and requirements that entail unused funds. However, unlike the Medicaid program, the SCHIP involves matching the need for funds with respective state requirement. Furthermore, the federal government sets aside 4.2 billion annually to fund the program. However, the main factors that determine the amount of funding that a given state can get are the population and the cost implication of medical services provision. The population for the SCHIP means children under the age of 19 years who come form low-income families. The government gets it s information from the Bureau of Census that shows the number of children who live under the poverty line and is within the age bracket of 19 years. However, the government uses an average figure for budgeting purposes because the figure keeps on fluctuating every year. Another major factor during the allotment of resources is the cost of health care that varies from one state to another. For this reason, the government uses the cost factor in determining the amount to for each state. Sometimes, this cost is termed as the geographical cost Adjustment. The federal government provides each state with a matching rate to cater for the SCHIP. However, the allocation of funds to the Medicaid is generally higher than the allocation for the SCHIP. Nevertheless, both Medicaid and SCHIP require federal funds for administrative purposes and the general running of both programs. Unspent funds redistribution After allocation of funds by the federal government, it gives the states up to three years to spend the money after which any amount that is not spent goes back to the federal government. After the states have returned the unspent amount, the federal government then redistributes this amount to other states that may have had shortages or depleted their resources. The redistribution program is one of the ways that the federal government is using to provide funds for states that has over projected their spending. However, in the recent years the government has amended the rules governing redistribution several timers by the government. For instance,changes in the length or the periods, which a state can retain, unspent amounts before redistribution. However, some states are slower in expenditure than others are hence they can retain the funds for a longer period. In this case, the federal government allows these states to retain some amount before the redistribution. In conclusion, the SCHIP is one of the most successful programs run by both the states and the federal government. It has managed to help children from low-income families to get medical cover who could have otherwise not got the cover. One of the advantages of the SCHIP is that it provides affordable medical cover as an alternative to private medical cover. The effect of this has been reduction of uninsured children under the age of 19 years. Similarly,many people have also benefited from this program because some states provide cover for even adult under the expansion program. Additionally the program has done so well in other states that they even incorporate both dental and vision in the cover something that even the private medical cover companies have not done yet. Furthermore, the extension program has enabled more people to get access to the medical cover at a very affordable rate due to the introduction of cost sharing in premium payment. The program has received a lot of accreditation from many and the implementation process over the years since its inception has been successful. References Andersen, R., Rice, T. H., & Kominski, G. F. (2007). Changing the U.S. health care system: key issues in health services policy and management. San Francisco: Jossey-Bass. Ewing, M. T. (2008). State Childrens Health Insurance Program (SCHIP). New York: Nova Science Publishers. Kovner, A. R., Knickman, J., & Jonas, S. (2011). Jonas & Kovners health care delivery in the United States. New York: Springer Publishers McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2012). An introduction to community health. Sudbury, MA: Jones & Bartlett Learning. Patel, K., & Rushefsky, M. E. (2006). Health care politics and policy in America (3rd ed.). Armonk, NY: M.E. Sharpe. Smith, D. G. (2011). The Childrens Health Insurance Program: past and future. New Brunswick, N.J.: Transaction Publishers. Sultz, H. A., & Young, K. M. (2011). Health care USA: understanding its organization and delivery. Sudbury, MA: Jones and Bartlett. Read More