H.R 1535 (Dingell) and S. 895 (Clinton)

Reauthorization of SCHIP and State Allotments
Reauthorizes SCHIP permanently. In 2008 and every second year, state allotments will be equal to the previous year's federal payments indexed by growth in the state's population of children and the increase in per capita national health expenditures. Allotments for intervening years equal previous year's allotment indexed to population and expenditures growth. Additional funds provided if state enrollment in previous year exceeded target based on child population growth. Funds are available to states for two years. The bill would change how unused allotments are distributed to states with funding shortfalls. Costs of Medicaid presumptive eligibility for children would not longer count against SCHIP allotments.

States that elect option to expand coverage to 400% of FPL (see "Coverage Expansions" below) automatically receive additional funds necessary to meet program expenditures as long as the state imposes no limits on enrollment.

Coverage Expansions
Provides for new state option to cover children under SCHIP up to 400% of FPL. (Current eligibility is generally limited to 200% of FPL but is higher in some states.) Higher matching rate available to states electing this option if other requirements are met (see "Outreach and Enrollment"). States electing this option to a level between 200% and 400% of FPL may allow families or employers to buy into SCHIP coverage for higher income children, with a community rated premium required and higher cost sharing permitted. States electing the option at 400% of FPL are required to offer buy-in to additional children. States choosing this option at 400% may use SCHIP funds to purchase employer coverage if the plan meets SCHIP benchmark, premiums of the plan do not vary by health status, and the state provides wraparound benefits up to the SCHIP level. Federal match for subsidy up to 50% of SCHIP cost.

Provides for new state coverage options: coverage of pregnant women meeting SCHIP income eligibility requirements with automatic enrollment of newborns, coverage of legal immigrant pregnant women and children under Medicaid and SCHIP, and coverage of older children up to age 25.

Other changes to SCHIP or Medicaid coverage for children
Makes changes to SCHIP benchmark plans. Prescription drugs and certain other benefits (mental health, vision, hearing) must be provided at 100% of their actuarial value in benchmark plan (75% under current law). Eliminates option for Secretary-approved plans (except where already in effect). Most popular plan for dependent coverage becomes state employee plan benchmark. Requires coverage of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit including dental, and of federally qualified and rural health centers.

Directs the Secretary to consult with state Medicaid and SCHIP directors and develop a model process for coordination of enrollment and coverage across states for children who are outside their state of residency because they are migrant families, experience emergency evacuation, for educational needs, or for other reasons.

Outreach and enrollment
States choosing coverage expansion up to 400% of FPL (see "Coverage Expansions" above) receive additional federal matching rate of up to 15% if they implement 12 months continuous eligibility and at least 3 of the following: 1) application outreach, 2) one step application process, 3) simplified income verification, 4) simplified application form and process, 5) use of administrative renewal, and 6) presumptive eligibility.

Provides 90% federal match for school-based outreach and enrollment and 75% federal match for information technology expenditures aimed at outreach and enrollment improvements and for translation and interpretation to aid enrollment.

Provides states the option of using an "express lane" process for determining a child's eligibility under Medicaid or SCHIP. Under this process, income determinations made through application federal programs including temporary assistance to needy families (TANF), Food Stamps, child nutrition and school lunch programs can be used to determine eligibility for Medicaid or SCHIP. A child found to be ineligible using the "express lane" process may still apply for these programs directly.

State option to modify documentary evidence requirements for proof of citizenship.

Extends existing requirements for Medicaid outreach to all pregnant women and children.

Other provisions
Creates "Medicaid-SCHIP Payment Advisory Commission" to review payment policies and report annually.

Financing
No provision.

Effective Date
Generally 10/1/2007.