A State-by-State Compilation of Key State Childrens Health Insurance Program (SCHIP) Characteristics Page: 2 of 89
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A State-by-State Compilation of Key State Children's
Health Insurance Program (SCHIP) Characteristics
The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33) established the State
Children's Health Insurance Program (SCHIP) under a new Title XXI of the Social
Security Act. In general, SCHIP provides states with federal matching funds to cover
uninsured children in families with income that is above Medicaid eligibility levels.
To date, the upper income eligibility limit under SCHIP has reached 350% of the
federal poverty level or FPL (in one state).
States may choose among three options when designing their SCHIP programs.
They may expand Medicaid, create a new "separate state" insurance program, or use
a combination of both approaches. All 50 states and the District of Columbia have
SCHIP programs in operation. As of June 30, 2003, among these 51 jurisdictions,
15 were Medicaid expansions, 18 were separate state programs, and 18 used a
Medicaid expansion programs must provide all mandatory benefits and covered
optional services offered in the state's Medicaid program. Cost-sharing is prohibited
for children. Separate state programs must follow certain coverage and benefit
options outlined in SCHIP law. While cost-sharing provisions in separate state
programs vary by family income in a number of states, the total annual aggregate
cost-sharing (including premiums, enrollment fees, deductibles, copayments,
coinsurance, and other similar charges) for any family may not exceed 5% of total
income in a year. Preventive services are exempt from cost-sharing.
States must ensure that SCHIP does not substitute for coverage under group
health plans, a phenomenon known as "crowd-out." The primary method for
preventing substitution is requiring a waiting period during which applicants must
be uninsured prior to enrollment in SCHIP.
States that want to make changes to their SCHIP programs that go beyond what
the law allows may do so through what is called a Section 1115 waiver. These
waivers allow states to use SCHIP funds to cover populations not normally covered
under SCHIP, such as pregnant women and parents of SCHIP children, as well as to
modify certain statutory provisions such as cost-sharing limitations and benefit
This report provides an overview of state program characteristics under SCHIP
in each of the areas summarized above (eligibility, benefits packages, cost sharing,
crowd-out prevention, and Section 1115 waivers). Several sources were used to
compile the program data shown in this report. These data represent program status
as of December 31, 2002 through July 31, 2003, depending on the source.
Information is summarized across states, and detailed, state-specific fact sheets are
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A State-by-State Compilation of Key State Childrens Health Insurance Program (SCHIP) Characteristics, report, May 19, 2004; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc805730/m1/2/: accessed April 20, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.