Editorial for July 5, 1999

Children's Health Insurance Program

Help build momentum

With only a modicum of fanfare, a broad new program aimed at providing health care coverage for uninsured children is beginning to gather momentum after an incubation period of nearly two years.

When Congress enacted the Balanced Budget Act of 1997, it included a provision establishing the Children's Health Insurance Program, a program to assist uninsured children. CHIP will be administered by individual states, which are in line to fund more than $24 billion in federal grants to fund the activity over a five-year period (the program is also known as SCHIP, with the "s" added for "state").

CHIP is the most ambitious federal venture into health care coverage since Medicare and Medicaid were launched more than 30 years ago. While it is unlikely to have the impact that those programs have had, its primary target is a large percentage of the nation's 11 million uninsured children.

CHIP will provide matching grants ranging from 65% to 80% of program costs. A state can incorporate the coverage into existing Medicaid programs (which at least half the states are doing), create a separate program or combine the two. (Only two states -- Wyoming and Washington -- have not applied to participate.)

The major beneficiaries are the estimated 2.5 million children in families with earnings of up to 200% of the federal poverty level -- $33,000 a year for a family of four. However, the federal government has given eight states permission to expand coverage to 300% of the poverty level ($49,500). If that standard were applied nationwide, another 2.7 million children might be included. Beyond that, it's expected that a large number of the children who are identified in ongoing CHIP outreach programs actually will enter state Medicaid programs.

Most states have spent the 18 months since the program was enacted developing their own version of it, obtaining federal approval and launching enrollment programs. Now that the program is under way across much of the nation, enrollment has been surprisingly slow in some areas.

The AMA is playing an active role in stimulating enrollment, working with the National Governors Assn., America's Promise and the Health Care Financing Administration to make sure that physicians and parents are aware of the program in their state. As part of this activity, a nationwide toll-free number, the "Insure Kids Now" hot line, has been established at (877) 543-7669.

That number is staffed from 8 a.m. to 7 p.m. (Central Time) Monday through Thursday and on Friday from 8 a.m. to 5 p.m. Callers are transferred to their own states' hot lines, where operators can provide assistance and answer questions to assist parents in understanding their states' specific insurance requirements.

Awareness of CHIP and the benefits it can provide to uninsured children is particularly essential to pediatricians and family physicians. But it is incumbent on all members of the profession to recognize its potential and ensure that any potential beneficiaries receive complete information and the opportunity to participate.

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