S. 1224 (Rockefeller)

Reauthorization of SCHIP and State Allotments
Reauthorizes SCHIP permanently and appropriates $8.525 billion in funds for FY08, and increasing annual amounts are specified up to $15.4 billion in FY 2012. Amounts for subsequent years to be increased by national growth in per capita health expenses and child population.

Changes formula for state allotments in 2008 to be the sum of an amount based on prior SCHIP spending and an amount based on the number of uninsured low-income children in the state.

Allotment for 2009 equal to 2008 allotment updated by national growth in per capita health expenses and child population.

In 2010 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. Funds are available to states for two years. The bill would change how unused allotments are distributed to states with funding shortfalls, and would in addition make up to 5 percent of the total allotment for each year available for redistribution to shortfall states. Costs of Medicaid presumptive eligibility for children would no longer count against SCHIP allotments.

Provides increased federal Medicaid and SCHIP matching rates for (1) states that experience increased enrollment of eligible children receive an additional federal matching percentage equal to the percentage increase in enrollment and (2) states for which the participation rate of low income children exceeds 90 percent and the state meet conditions requiring continuous eligibility, no waiting lists, no assets test, and reporting of quality measures, receive an additional federal matching percentage equal to the difference between the participation rate and 90 percent. Federal matching rate capped at 85 percent.

Coverage Expansions
Provides for new expansion option for states to cover children in families with incomes up to 300% of FPL, or 50 percentage points above state's applicable income limit prior to enactment, if higher. (Current eligibility generally limited to 200% of FPL, but is higher in some states.)

Eligibility levels higher than those provided under the expansion option permitted under a plan amendment or a waiver if a state's rate of uninsured children is lower than the national average and the state does not impose any cap on enrollment or waiting list, meets requirements for annual reporting of quality measures, and provides for at least 3 of the following outreach and enrollment procedures: simplified application and renewal process, no asset test, 12 months continuous eligibility, and presumptive eligibility.

Also provides states the option of coverage for pregnant women meeting SCHIP income eligibility requirements with automatic enrollment of newborns and the option to cover legal immigrant pregnant women and children under Medicaid and SCHIP.

Other changes to SCHIP or Medicaid coverage for children
Requires coverage of dental and mental health services under SCHIP.

Makes changes to SCHIP benchmark plans. Eliminates option for Secretary-approved plans except those approved before March 1, 2007. State employee plan benchmark set at the most popular plan for dependent coverage.

Certain existing requirements for Medicaid managed care plans would be extended to SCHIP, including those relating to provision of information to enrollees, beneficiary protections, and quality assurance.

Permits coverage of children of state employees under SCHIP under specified circumstances. Changes cost effectiveness premium assistance standard to permit use of SCHIP funds to permit purchase employer-based family coverage when cost to state is less than enrolling family in the child health plan or when aggregate funds on family premium assistance are less than cost of family coverage under SCHIP.

Outreach and 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 for 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. Increases federal matching rate to 75 percent for language services provided to applicants or enrollees under Medicaid or SCHIP. Provides for 75% federal matching rate for state expenditures attributed to information technology related to eligibility determinations. State option to modify documentary evidence requirements for proof of citizenship.

Other provisions
Creates permanent "Medicaid and CHIP Payment and Access Commission" to review policies affecting children's access including payment policies, interaction with health care delivery generally and other policies and make annual recommendations to Congress. Requires the Secretary to contract with the Institute of Medicine to study health insurance coverage for children in the US and analyze the relationship between coverage and access to health care Requires the Secretary of HHS to develop core pediatric quality measures for children in Medicaid and SCHIP and encourage voluntary reporting by states and development of model electronic health records for children. Provides 75% matching rate for collecting and reporting child health measures. Establishes childhood obesity demonstration project and authorizes $25 million annually for grants from 2008-2012. Increases funding for data collection to determine state numbers on uninsured children and Medicaid and SCHIP enrollees. Puts moratorium on application of payment error rate measurement requirements on state eligibility reviews under Medicaid and CHIP.

Financing
No provision.

Effective date
Generally 10/1/2007.