Citation URL: http://www.urban.org/RuthAAlmeida

This brief examines the experience of four states -- Minnesota, New Jersey, Rhode Island, and Wisconsin -- which have used waivers to cover parents under their State Children's Health Insurance Program (SCHIP). The brief explores the reasons that these states chose to cover parents, and their early experiences with parental coverage. The experience of these initial four states shows that, once offered, the demand for such coverage is high and SCHIP waivers can be a relatively straightforward way to implement family coverage.

The authors found that virtually all of the 18 states studied included dental benefits in their SCHIP programs and that the scope of benefits provided is quite broad, although not as comprehensive as Medicaid. Co-payments on dental services were nominal in most separate SCHIP programs. Several states used SCHIP to test new delivery systems - particularly managed care arrangements - to deliver dental services. Under separate SCHIP programs, some states raised dental payment levels above Medicaid's and simplified administrative and billing procedures. While improvements in access may be occurring under separate SCHIP dental programs, the authors conclude that widespread improvements in oral health for low-income children may be seen only if these improvements are extended to Medicaid.

Develop a typology categorizing state efforts to provide health insurance coverage for children to examine cross-state variation in insurance coverage.

This paper examines changes in states' average income eligibility thresholds for children, pre- and post-CHIP. The report finds that states with the lowest level of coverage prior to CHIP have expanded income eligibility thresholds the most. States with a higher proportion of low-income uninsured children have increased their income eligibility thresholds to a greater degree than states with smaller percentages of uninsured children. States with higher per capita personal income have raised eligibility thresholds more than states with lower per capita income. States that experienced the greatest increase in federal matching rates expanded eligibility the most. And, states in the Northeast have increased eligibility more than states in other regions of the country.

This survey of Medicaid and CHIP agencies in all 50 states and DC finds that the effective Medicaid eligibility levels are generally higher than commonly believed because most state Medicaid programs disregard some portion of family income in determining eligibility. By contrast, standard CHIP provisions generally do not use disregards in establishing eligibility. State variation is also larger than generally thought. The authors cite the need for policymakers to more closely examine the use of income disregards and to consider the simplicity and consistency of rules as they establish Medicaid and CHIP eligibility criteria.

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