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Children's Health Insurance: Recent HHS-OIG Reviews Inform the Congress on Improper Enrollment and Reductions in Low-Income, Uninsured Children

GAO-06-457R Published: Mar 09, 2006. Publicly Released: Mar 09, 2006.
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Highlights

The Congress passed legislation creating the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured children in families with incomes that are too high to qualify for Medicaid. For SCHIP, the Congress appropriated $40 billion over 10 years, with funds allotted annually to the 50 states, the District of Columbia, and the U.S. commonwealths and territories. States' participation in SCHIP is voluntary. States that do participate have three options in designing their SCHIP programs: expand the Medicaid program to include SCHIP-eligible children, develop a separate child health insurance program, or maintain a program that combines both of these options. Financed jointly by the states and the federal government, SCHIP offers a strong incentive for states to participate by offering a higher federal matching rate--that is, the federal government pays a larger proportion of program expenditures--than the Medicaid program. While this incentive encourages efforts to reduce the number of uninsured children through state participation in SCHIP, there have been concerns that states might inappropriately enroll Medicaid-eligible children in SCHIP and thus obtain higher federal matching funds than allowed under Medicaid. In addition, there has been interest in assessing the progress states made to reduce the number of uninsured children, including the extent to which states met the objectives and goals established in their SCHIP programs. In particular, states must report their progress in reducing the number of low-income, uninsured children and may rely on certain national data sets, such as the Current Population Survey (CPS), or conduct their own surveys, to do so. In the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), the Congress directed the Department of Health and Human Services (HHS) Office of Inspector General (OIG) to conduct a series of studies on two issues--determining the number of children who were enrolled in separate SCHIP programs but were eligible for Medicaid and assessing states' progress in reducing the number of low-income, uninsured children--every 3 years, beginning in fiscal year 2000. This provision required the OIG to only include in its studies states with separate SCHIP programs. BBRA directed that we review and report on the OIG's work. The OIG issued its initial reports in February 2001, and our assessment of the OIG's work was published in March 2002. The OIG's most recent set of reports on these issues was published in 2004 and 2005. This report reflects our evaluation of the OIG's recent reports. Specifically, we assessed the OIG's efforts to inform the Congress on (1) the number of Medicaid-eligible children enrolled in separate SCHIP programs and (2) states' progress in reducing the number of uninsured children, including the progress they have made in meeting the objectives and goals initially established in their SCHIP programs.

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Topics

ChildrenDisadvantaged personsstate relationsHealth care programsHealth insuranceMedicaidPerformance measuresReporting requirementsState-administered programsStatistical dataProgram goals or objectives