Revised March 14,
2006
ADMINISTRATION'S FISCAL YEAR 2007 BUDGET IS LIKELY STILL TO LEAVE SCHIP COVERAGE FOR LOW-INCOME CHILDREN IN JEOPARDY
By Matt Broaddus
The State Children’s Health Insurance Program
(SCHIP), jointly financed by states and the federal government, provides
comprehensive health insurance coverage to more than 4 million low-income
children who would otherwise be uninsured.[1]
In fiscal year 2007, under current law, 18 states will have insufficient federal
funding under SCHIP to sustain their existing enrollment of low-income children.
To address this issue, the Administration's
budget proposes to redistribute $635 million in already available federal SCHIP
funds. These funds would be redistributed from states now holding them to meet
needs in future years to the states that are projected to face federal funding
shortfalls in their SCHIP programs in 2007.
New analyses by the Congressional Research
Service (CRS) and the Center on Budget and Policy Priorities (CBPP) indicate,
however, that federal SCHIP funds available under current law are approximately
$1 billion less than states’ needs for such funds in 2007. Thus, the
Administration’s proposal will fall short of fully funding states’ needs for
SCHIP funding in 2007. Our analysis suggests that more than 200,000 children
could go without SCHIP coverage next year as a result.[2]
The CRS and
CBPP estimates show that these 18 shortfall states will face an aggregate
federal financing shortfall in SCHIP in 2007 of about $1 billion, or about $355
million more than the additional expenditures projected under the
Administration’s proposal.[3]
(See Table 1 for a complete list of shortfall states and the estimated remaining
shortfalls after implementation of the Administration’s proposal). The
Administration’s proposal thus would appear to leave the 18 states with
inadequate federal SCHIP funds in fiscal year 2007. The 18 states would either
have to increase their own state funding to make up for the shortfall of federal
SCHIP funds, or cut back their SCHIP programs by reducing eligibility,
eliminating benefits, or cutting provider payments. In states that cut back
their programs, SCHIP beneficiaries would be at significant risk.
Background
The federal government, on average, covers 70
percent of the cost of serving children in SCHIP. Federal funding for SCHIP is
capped annually, with each state receiving a portion of an annual national
allotment that is available for three years. In the early years of SCHIP, the
combination of annual allotments and redistributions of unspent federal funds
from lower-utilization states enabled the higher-utilization states to have
sufficient federal funding to sustain and grow their programs. Since then,
however, most states’ SCHIP programs have matured and have reached more
children, resulting in higher levels of state usage of federal SCHIP funds,
greater need for federal funds, and fewer unspent federal funds available for
redistribution to meet the needs of other states. In addition, overall federal
SCHIP funding declined significantly in 2002, 2003, and 2004. Finally, $1.4
billion in unspent SCHIP funds was allowed to revert to the Federal Treasury
over the last two years, rather than being redistributed to states that could
use these funds.
As a result, beginning in 2005, a number of
states began facing federal financing shortfalls in their low-income children’s
health insurance programs. In 2005 and 2006, these shortfalls were largely or
entirely eliminated through legislative and administrative action. But states
now face more serious federal financing shortfalls in 2007.
Congressional Research Service Projects
Shortfalls for 2007
Based on states’ estimates of future SCHIP
spending in fiscal year 2007, more aggressive action will need to be taken to
prevent the health care needs of significant numbers of eligible low-income
children from going unmet next year. The Congressional Research Service
projects that the need for federal SCHIP funds will exceed available federal
SCHIP funds in 18 states in 2007 by a collective $1.04 billion. Assuming that
the unspent funds expected to be available for redistribution in 2007 are
targeted only to these 18 shortfall states (as was done in 2005 and is expected
to be done in 2006), a collective $946 million shortfall will remain. Analysis
using the CBPP SCHIP financing model, which is similar to CRS’ model, results in
an estimate of the aggregate shortfall of $1.07 million, and a net shortfall
after the regular redistribution of funds of $990 million among the same 18
states. Our analysis indicates that net shortfalls of this amount represent the
annual cost of providing health care to up to 730,000 children.[4]
The
Administration’s FY2007 Budget Proposal
The Administration’s budget proposes to spend an
additional $635 million in the SCHIP program by redistributing existing SCHIP
funds in fiscal year 2007 to shortfall states, beyond the funds that normally
would be redistributed. The budget states that this would be accomplished
through “better targeting SCHIP funds in a more timely fashion.”[5]
The method by which the Administration would accomplish the enhanced
redistribution is not entirely clear from Health and Human Services budget
documents.[6]
Whatever the
approach, however, it is clear that this provision, while helpful, will not fill
states’ shortfalls completely. Assuming that $635 million in additional funds
are made available to the shortfall states in 2007, the 18 shortfall states will
be left with an aggregate shortfall of $311 million under the CRS estimates and
$355 million under the CBPP estimates. (This assumes that the $635 million in
redistributed funds will be made available to all 18 shortfall states in
proportion to each state’s share of the overall shortfall.)
Implications for Affected States and
Low-income Children
Under CBPP estimates, the shortfalls that would
remain among the 18 states — of $311 million to $355 million after
implementation of the Administration proposal — represent the annual cost of
providing health care coverage to up to 230,000 low-income children. The 18
states would be forced either to reduce eligibility or limit benefits in their
SCHIP programs or to increase the share of the costs that states bear,
potentially compromising other state budget priorities.
As Congress prepares to craft a fiscal year 2007
budget resolution, it is important that the budget include adequate federal
SCHIP funding to fully address the funding shortfalls in the 18 states. As this
analysis demonstrates, the level of additional SCHIP spending proposed by the
Administration's budget, while well-intended, is not sufficient and needs to be
increased by up to another $355 million to avert federal SCHIP funding
shortfalls in 2007.[7]
TABLE 1 |
18 States Project Federal SCHIP Financing Shortfalls in FFY2007 |
(all figures in thousands of dollars) |
|
Federal SCHIP Funding Shortfall |
Shortfall After Regular Redistribution* |
Redistribution Under Administration Proposal** |
Remaining Shortfall Under Administration Proposal |
STATE |
CBPP |
CBPP |
CRS |
|
CBPP |
*** |
Nation |
$1,069,096 |
$988,785 |
$946,000 |
$635,000 |
$353,785 |
$311,000 |
|
|
|
|
|
|
|
Alaska |
13,941 |
12,894 |
15,000 |
8,281 |
4,613 |
4,931 |
Georgia |
41,839 |
38,696 |
40,000 |
24,851 |
13,845 |
13,150 |
Illinois |
171,764 |
158,861 |
149,000 |
102,021 |
56,840 |
48,984 |
Iowa |
29,288 |
27,088 |
28,000 |
17,396 |
9,692 |
9,205 |
Louisiana |
22,526 |
20,834 |
21,000 |
13,379 |
7,454 |
6,904 |
Maine |
280 |
259 |
100 |
166 |
93 |
33 |
Maryland |
100,882 |
93,304 |
92,000 |
59,920 |
33,384 |
30,245 |
Massachusetts |
111,570 |
103,189 |
102,000 |
66,268 |
36,921 |
33,533 |
Minnesota |
40,768 |
37,705 |
37,000 |
24,215 |
13,491 |
12,164 |
Mississippi |
83,635 |
77,352 |
72,000 |
49,676 |
27,676 |
23,670 |
Missouri |
53,106 |
49,117 |
46,000 |
31,543 |
17,574 |
15,123 |
Nebraska |
13,122 |
12,136 |
12,000 |
7,794 |
4,342 |
3,945 |
New Jersey |
170,684 |
157,862 |
148,000 |
101,379 |
56,483 |
48,655 |
North Carolina |
124,408 |
115,063 |
115,000 |
73,894 |
41,169 |
37,807 |
North Dakota |
6,071 |
5,615 |
6,000 |
3,606 |
2,009 |
1,973 |
Rhode Island |
51,819 |
47,926 |
45,000 |
30,778 |
17,148 |
14,794 |
South Dakota |
7,276 |
6,730 |
7,000 |
4,322 |
2,408 |
2,301 |
Wisconsin |
26,117 |
24,155 |
9,000 |
15,513 |
8,643 |
2,959 |
* Assumes that unspent FFY2004 federal SCHIP funds are redistributed to shortfall states in proportion to each state’s share of the total shortfall.
** Assumes that $635 million are redistributed to shortfall states in proportion to each state's share of the total shortfall.
*** Estimates based on CRS's national shortfall projection. CBPP uses CRS' estimates of states' shortfalls after regular redistribution
(third column) and then assumes that $635 million are redistributed to shortfall states in proportion to each state's share of the total shortfall.
Source: Center on Budget and Policy Priorities' SCHIP financing model based on an original model created by the Office of the Actuary at the Centers for Medicare and Medicaid Services. The model incorporates SCHIP provisions of the Deficit Reduction Act and states' estimates, made in November 2005, of federal SCHIP funding need for FFY2007. CRS presentation given at NASHP meeting on February 22, 2006. |
End Notes:
[1] The most recent data available indicate that more than 4
million children are enrolled in SCHIP at any given point in time. The
Department of Health and Human Services reports that the number of children
enrolled at any point over the course of a year stood at more than 6 million in
2004.
[2] Under SCHIP, some states have elected to use SCHIP funds to
expand Medicaid coverage to more low-income children as opposed to creating a
separate state program. In the event of a federal SCHIP funding shortfall,
these states can decide to continue to cover their SCHIP children in Medicaid.
However, the federal contribution to the cost of these children’s care would be
reduced to the regular Medicaid matching rate. States would thus be responsible
for generating additional state funds to compensate for the lost federal
matching funds. The SCHIP enrollment reduction in 2007 due to funding
shortfalls would be less than estimated if states choose to cover some of their
SCHIP children in Medicaid at the lower Medicaid matching rate.
[3] Evelyne Baumrucker and Chris Peterson, Reconciliation and
Financing Issues for SCHIP, presentation before the National Academy of State
Health Policy, Congressional Research Service, February 22, 2006. The Center on
Budget and Policy Priorities’ SCHIP financing model is based on a model created
by the Office of the Actuary at the Centers for Medicare and Medicaid Services.
[4] We use per capita cost figures in SCHIP as estimated by the
Office of the Actuary at the Centers for Medicare and Medicaid Services.
Assuming the CRS projected net shortfall of $946 million, we would estimate that
this shortfall represents the cost of serving roughly 700,000 children in SCHIP
for a full year.
[5] The Department of Health and Human Services Budget in Brief
for Fiscal Year 2007, page 68.
[6] The Administration’s 2006 budget included a proposal to
shorten the initial availability of states’ annual SCHIP allotments from three
to two years and to target funds unspent after two years to shortfall states.
[7] Congress also should increase accordingly the five year level
of additional SCHIP funding to account for the future year budget effects of
fully filling in the state shortfalls in 2007. |