August 05,1999

Members Urge Immediate Action on the States' Children's Health Insurance Program

Children's Health Insurance Program in Danger

WASHINGTON -- Senate Finance Committee Chairman William V. Roth, Jr. (R-DE) today released two letters urging immediate action on the States' Children's Health Insurance Program (S-CHIP).

In a letter to Health and Human Services Secretary Donna Shalala, Senators William V. Roth, Jr. (R-DE), Daniel Patrick Moynihan (D-NY), John H. Chafee (R-RI), Orrin G. Hatch (R-UT), James M. Jeffords (VT), John D. Rockefeller IV (D-WV), and Edward M. Kennedy (D-MA) urge the "Health Care Financing Administration and the states to fulfill their responsibility to collect and report accurate data."

"It is particularly important that we have basic information on the number of children enrolled in regular Medicaid, in Medicaid expansions financed with CHIP funds, and in separate state CHIP insurance programs. It is essential to ensure that these data are reliable, timely, and are collected in a uniform manner," the Senators stated.

In a letter to Chairman C. W. Bill Young of the Committee on Appropriations, House Committee on Commerce Chairman Tom Bliley (R-VA), House Committee on Commerce Ranking Minority Member John D. Dingell (D-MI), Senate Finance Committee Chairman William V. Roth, Jr. (R-DE), and Senate Finance Committee Ranking Minority Member Daniel Patrick Moynihan (D-NY), oppose the "effort of the Appropriations Committee to legislate changes in Medicaid and the States' Children's Health Insurance Program," that would reduce funding.

The concerned members stated, "Our Committees have not been consulted by your committee, nor have these proposals been subject to the regular order of the authorizing committee process."

Copies of the letters are attached.

ATTACHMENT


July 30, 1999

The Honorable Donna Shalala
Secretary of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Shalala:

The collection of accurate and timely information is essential to the successful implementation of the Children's Health Insurance Program (CHIP) and Medicaid programs and our ongoing efforts to cover uninsured children. Unfortunately, such information is not currently available. The lack of reliable data has generated unnecessary controversy about the effectiveness of CHIP and Medicaid and should be corrected without delay.

It is particularly important that we have basic information on the number of children enrolled in regular Medicaid, in Medicaid expansions financed with CHIP funds, and in separate state CHIP insurance programs. It is essential to ensure that these data are reliable, timely, and are collected in a uniform manner, which allows for comparisons across the states.

The data released by the Health Care Financing Administration last April on CHIP and Medicaid enrollment was not sufficient. The April data included information only on children's enrollment in expanded Medicaid and separate state insurance programs. CHIP was meant to be part of a broad strategy to provide coverage to uninsured children. To evaluate whether we have made overall progress in reducing the number of uninsured children, we also must know how many children are enrolled in states' regular Medicaid programs. In addition, we need average monthly enrollment data--enrollment at a given point in time--that would reflect the extent to which children are retaining their health coverage.

In its December 8, 1997, and December 4, 1998, letters to state health officials, HCFA requested this and additional enrollment information from the states. However, many states have failed to submit the data that HCFA has requested, or they have submitted only some of the required data. To date, we have not received Medicaid enrollment data for 1998 or the latest quarterly data for the period ending in March of this year.

We urge you to take additional steps to ensure that HCFA and the states fulfill their responsibility to collect and report accurate data. Title XXI clearly provides the statutory and regulatory authority to enforce reasonable data requirements. The child health law specifically requires that: "A State child health plan shall include an assurance that the State will collect the data, maintain the records, and furnish the reports to the Secretary at the times and in the standardized format the Secretary may require in order to enable the Secretary to monitor State program administration and compliance.... " (42 USC §1397gg(b)(1)). We believe states that fail to provide basic enrollment data are not in compliance with Title XXI.

In addition, in order to ensure that CHIP funds are used to provide coverage to newly eligible children, it is important for the Department to assess the extent to which states may be using CHIP funds to cover children who were eligible for Medicaid before the CHIP law was enacted. The guidance issued to states on November 23, 1998, advising states that CHIP funds cannot be used to cover children already eligible for Medicaid, needs to be re-enforced. However, the enhanced matching rate offers incentives to cover previously eligible children with CHIP funds and preliminary reports and anecdotal evidence indicate that Medicaid eligible children are in fact being enrolled in CHIP programs. We urge HCFA to put states on notice that in the course of any audit by HCFA, a sample of cases will be examined to determine whether children are being screened and enrolled in the proper program.

Thank you for considering these important issues. We look forward to working with you to ensure that reliable information is available to evaluate progress toward our goal of reducing the number of uninsured children in the nation.

Sincerely,

William V. Roth

Daniel Patrick Moynihan

John H. Chafee

John D. Rockefeller IV

Orrin G. Hatch

Edward M. Kennedy