S. 1364 (Durbin)

Reauthorization of SCHIP and State Allotments
Reauthorizes SCHIP permanently. Funding for 2008 and beyond at $7.5 billion multiplied by the growth in national health expenditures per capita and child population. Makes state allotments available for two years, with unused state allotments reallocated to states with shortfalls. Costs of Medicaid presumptive eligibility for children would no longer count against SCHIP allotments.

The Secretary would increase state allotments to account for higher than projected enrollment resulting from outreach to eligible but previously unenrolled children. A cap on aggregate allotment increases for this purpose would be set at 20% of the annual total SCHIP allotment, with the Secretary directed to seek supplemental appropriations if the limitation is reached.

Coverage Expansions
Provides for new state option to cover pregnant women meeting SCHIP income eligibility requirements with automatic enrollment of newborns. Also provides state 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 Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) services, including dental services. Additionally, includes a state option to provide supplemental coverage limited to dental services under SCHIP to children who have other health insurance coverage.

Prohibits states from imposing a cap on SCHIP enrollment, a waiting list, or other procedures to delay consideration of enrollment or limit enrollment.

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 implementing five specific policies to remove enrollment barriers in Medicaid and SCHIP would receive an increase in the federal matching rates to be determined by the Secretary, up to a maximum matching rate of 83 percent for Medicaid and 85 percent for SCHIP. The policies are 1) presumptive eligibility, 2) 12-month continuous eligibility, 3) automatic renewal, 4) elimination of asset test, and 5) self-certification of income.

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.

Increases federal matching rate to 85% for language services provided to applicants or enrollees under Medicaid or SCHIP.

Provides for 75% federal matching rate for state expenditures attributed to mechanized claims processing and administrative systems consistent with model outreach and enrollment practices.

Grants for innovative outreach and enrollment efforts would be provided to eligible entities including local governments, nonprofit organizations, Indian tribes, and safety net health care providers. Authorizes $50 million in appropriations for fiscal years 2008 and 2009 for these grants, with 10 percent set aside for outreach to Indian children.

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 3-year Commission on Children’s Health Coverage to study and develop recommendations on improving children’s health coverage with respect to federal and state policy and in the private sector.

Establishes demonstration projects regarding health information technology systems, disease management for children with chronic conditions, evidence based quality improvement and pilot testing of quality and performance measures of children’s health care services. Authorizes $10 million in annual appropriations for 2008-2012 for these projects. Additionally establishes demonstration projects on medical homes and disease prevention and treatment for ethnical and racial minority children. Comptroller General to develop recommendations for a demonstration project to evaluate quality and performance measures for children’s inpatient hospital services.

Requires Secretary to establish a program to ensure that evidence based pediatric quality and performance measures are developed and available for use. Authorizes $10 million in annual appropriations for 2008-2012.

Financing
No provision.

Effective date
Generally 10/1/2007.