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THE STATE OF AMERICA'S CHILDREN YEARBOOK 1998 Box 2.1 A State Advocate's Cllecldlst for l_pl...nII.. CHIP (continued) tI' tI' children's needs; don't limit benefits to those offered by commercial insurance, which was developed for working adults. Such insurance often denies the speech and physical therapy that developmentally delayed children need to speak and walk, the eyeglasses and hearing aids that schoolchildren need to see the blackboard and hear their teachers, the ongoing mental health care needed by survivors of violence or child abuse, and treatment ofdental problems. Simplify Medicaid eligibility. Under current Medicaid rules, many families will have their youngest children in Medicaid and their older children in a separate state program. To reach the commonsense goal of letting parents enroll their children in a single health plan and program, Medicaid eligibility must be simplified so that a child's age is not a factor. A family with a 4-year-old and a 14-year-old should not have to cope with multiple programs with different rules and procedures. Use a single outreach and application process for both Medicaid and the separate state program. Use the same organizations to educate the public about both programs. Have a single, common application form-don't ask families to fill out two different forms for two programs. And let families apply for both programs at the same places (including by mail). In short, make the system simple and seamless for families. Key features. Key features of the State Children's Health Insurance Program include: • A focus on uninsured children. The core of the program is coverage for uninsured children. Ninety percent ofa state's CHIP funds must be spent on health insurance for children; no more than 10 percent can be used for administrative costs, outreach, direct health services for children, or other purposes. • State flexibility. Each state can choose whether to participate in the new grant program and how to design its program. Participating states may use CHIP money to extend Medicaid benefits to more children, to create (or expand) a separate state program for children's health insurance, or to cover some uninsured children through Medicaid and others through a separate program. States may spend each year's funding allotment that same year or in the two following years. However, to receive frrst-year funding, a state must have its plan approved by the U.S. Department of Health and Human Services (HHS) before October I, 1998. HHS has advised states that they should submit their plans no later than July 1 to receive timely consideration. • Costs to the states. To receive federal funds, a state must put up a matching amount. The state's contribution is relatively modest: 70 percent of its matching rate under Medicaid. Thus a state that pays 50 percent of general Medicaid costs would pay only 35 percent of the costs for newly insured children, whether they are covered through Medicaid expansion or a separate state program. • A focus on low-wage, working families. Generally, CHIP funds can be used to provide health coverage only to children with family income above the Medicaid ceiling but still too low to afford private family coverage-up to 200 percent of the federal poverty level ($26,660 a year for a family of three in 1997). However, there is an exception for states that, before the enactment ofCHIP, provided Medicaid to children with family income above 150 percent of poverty ($19,995 for a family ofthree). In such states, new CHIP funds can cover children up 28 CHI L D R E 'S D E FEN S E FUN D
CHILD HEALTH to 50 percentage points above the old state eligibility level. Also, because states have leeway to defme what is counted as income to determine eligibility, they may be able to design programs to cover even more uninsured children. • A guarantee of certain benefits. If a state decides simply to expand Medicaid to include more children, Medicaid's EPSDT program covers all medically necessary care. States that instead decide to create a separate state program must provide benefits at least equivalent to those in specified commercial insurance plans. The state may choose a different combination of services so long as the total value of all services is the same as or better than under one ofthese benchmark commercial plans. Advocates must work to ensure that the benefits included in separate state programs take into account the special health needs of children and are not simply modeled on commercial plans designed to meet the needs of workingage adults. (See figure 2.3 illustrating differences in the health problems of children and adults.) • Limits on costs for families. As a general rule, Medicaid bars states from imposing costsharing on low-income parents through copayments, premiums, or other fees for children's coverage and care. However, CffiP makes limited cost-sharing permissible in separate state programs. In such programs, families with income at or below 150 percent of the poverty level can be charged no more than the same small amounts for premiums, deductibles, copayments, and coinsurance that are permitted for adults under Medicaid. Families with income over 150 percent of poverty can be charged more, but total payments may not exceed 5 percent offamily income. Regardless of the family's income level, well-baby care, wellchild care, and immunizations are exempt from fees. • Preservation of Medicaid coverage. To receive grants under the new program, a state must maintain the Medicaid eligibility standards in effect for children in June 1997. A state that creates a new child health program must screen applicants for possible Medicaid coverage and enroll all eligible children in Medicaid. Figure 2.3 Common Health Problems of Children and Working-Age Adults Children and workingage adults have very different health care needs. Children are 300 "a. o 8- 200 Shorl·term medical problems • Children (under age 18) • Adults (ages 18-64) Chronic medical problems 120 .--------------, • Children (under age 18) • Adults " (age. 18-64) a. o 8- 107.8 more susceptible to ° o °o o. respiratory and ear infections, for example, but less prone to certain chronic conditions, such ~ " a. '" r:: .,g '0 100 - r:: o U ~ " a. '" r:: o ;-g 40- r:: o U as arthritis and high blood pressure, that may require costly care. All acute conditions Respiratory (onditions Acute ear infertions Asthma a. So few cases are reported among children that the estimated rotes for children are not reliable. Source: U.S. Deportment of Health and Human Services, National Center for Health Statistics, 1995 National Health Interview Survey. Calculations by Children's Defense Fund. CHI L D R EN'S D E FEN S E FUN D 29
Page 2 and 3: About CDF he Children's Defense Fun
Page 4 and 5: Copyright © 1998 by Children's Def
Page 6 and 7: Acknowledgments Susanne Martinez, d
Page 8 and 9: THE STATE OF AMERICA'S CHILDREN YEA
Page 20 and 21: _____T...:H_._E... S T ATE 0 F AM E
Page 22 and 23: .... T...-HE STATE OF AMERICA'S CHI
Page 36 and 37: ....._--"T..;H;;..;;;.E STATE OF AM
Page 46 and 47: ......._---'T;..;;.;;H....;;E STATE
Page 48 and 49: '--__...;T;...;;;H...;E;;....S T AT
Page 72 and 73: L-__T.HE STATE OF AMERICA'S CHILDRE
Page 77 and 78: CHAPTER CHILD NUTRITION any America
Page 79 and 80: CHILD NUTRITION gram requirements,
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Page 83 and 84: CHILD NUTRITION ;;0".;'-'- .... pro
Page 85 and 86: .... ....;;.c H I L D N U TR IT I O
Page 87 and 88: CHAPTER CHILDREN AND FAMILIES IN CR
Page 89 and 90: CHILDREN AND FAMILIES IN CRISIS pas
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Page 93 and 94: CHILDREN A D FAMILIES IN CRISIS kin
Page 95 and 96: CHILDREN AND FAMILIES IN CRISIS Box
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THE STATE OF AMERICA'S CHILDREN YEA
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CHAPTER ADOLESCENT PREGNANCY fter r
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ADOLESCENT PREGNANCY 512,115 babies
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ADOLESCENT PREGNANCY sexual activit
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ADOLESCENT PREGNANCY ings. However,
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ADO L ESC EN T PRE G NAN C Y .... h
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106 CHI L D R EN' S D E FEN S E FUN
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THE STATE OF AMERICA'S CHILDRE YEAR
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THE STATE OF AMERICA'S HILDREN YEAR
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Selected Web Sites Listed below are
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