child care - Digital Library Collections

THE STATE OF AMERICA'S CHILDREN YEARBOOK 1998
For example, under Connecticut's recently enacted
statute, children with family income up
to 185 percent of the federal poverty line
($24,661 for a family of three in 1997) qualify
for Medicaid, and those with income between
185 and 300 percent of poverty ($39,990 for a
family of three in 1997) qualify for a separate
program. If a child with family income at 175
percent of poverty applies for the separate program,
the child must be enrolled in Medicaid.
Because the full range of Medicaid benefits is
guaranteed, children are generally better protected
by Medicaid.
Implementation of CHIP and related research.
A number ofstates were quick to develop plans for
implementing the State Children's Health Insurance
Program. Indeed, even before its enactment,
Arkansas, Indiana, Oklahoma, Rhode Island,
South Carolina, Tennessee, and Virginia had all
expanded Medicaid eligibility for children.
Advocates working with state officials to design
state programs have worked through many
different issues, ranging from funding the state
match to basic program design. COP's Web site
(http://www.childrensdefense.org) provides an upto-date
report on the status ofstate plans and information
on key implementation issues.
Several newly released studies address the
charge that expansion of public health insurance
programs "crowds out" other insurers from the
market and leads to losses ofemployer-based coverage.
For example, a 1997 Urban Institute study
suggests that 40 percent of near-poor pregnant
women reached by recent Medicaid expansions
may otherwise have received employer coverage.
That study, however, candidly admits that the cited
declines in work-based coverage could be unrelated
to Medicaid growth.
Indeed, other research published in 1997 refutes
the notion of a cause-and-effect relationship
between expanded public health insurance and reduced
employer coverage. Two studies examined
public health insurance programs for low-income
children in Florida and Minnesota and found that
only a tiny fraction (2 and 3 percent, respectively)
of new enrollees were previously covered through
an employer. The Robert Wood Johnson Foundation's
Alpha Center surveyed states that expanded
children's health coverage and reported that state
officials did not find significant "crowd-out."
New Federal Developments in
Medicaid Coverage
The Balanced Budget Act of 1997 included
other important Medicaid changes. The legislation
gives state Medicaid programs the option
of covering children for 12 consecutive
months even iffarnily income rises or children lose
eligibility for other reasons. This allows states to
promote continuity of care and meet children's
health needs despite changes in family circumstances.
States also received the option to give children
"presumptive eligibility," granting interim coverage
before final eligibility has been determined, which
can take months. Ifa preliminary investigation suggests
that a child's family income is low enough to
qualify for Medicaid, the child can be enrolled and
begin receiving care immediately. By the end ofthe
month after presumptive eligibility is granted, the
family must apply for the child's ongoing Medicaid
coverage. Whether or not the child is ultimately
found eligible, the state reimburses providers for
services furnished during the presumptive eligibility
period, and the federal government matches
state spending. Some of the costs are subtracted
from a state's CHIP allocation, sometimes using
the enhanced federal matching rate under CHIP.
Another important development in 1997 concerned
the EPSOT Medicaid benefits package for
children. In this case, the news is what did not
happen. Advocates feared that Congress would
resume the assault on EPSOT's guarantee of medically
necessary treatment-an assault that began
with the broader, unsuccessful push for Medicaid
block grants in 1995 and 1996. Indeed, an early
draft proposal from the Senate Finance Committee
would have repealed this guarantee. Thanks to a
prompt and vigorous response by a broad range of
groups-including children's advocates, disability
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