State Children's Health Insurance Program
Since 1997, the national program known as the State Children's Health Insurance Program (SCHIP) has provided health insurance to low-income children and teenagers who do not have private health insurance coverage and are not eligible for Medicaid. SCHIP is jointly financed by federal and state governments, and each state administers its own program.
As of September 30, 1999, each state and all territories had an approved SCHIP plan in place. SCHIP has been considered the single largest expansion of health insurance coverage for children since the initiation of Medicaid in the mid-1960s. Several states cover entire families.
SCHIP is designed to provide coverage to “targeted low-in-come children” — or those who live in a family with income less than 200 percent of the federal poverty level (FPL) or whose family has an income 50 percent higher than a state's Medicaid eligibility threshold. Some states have expanded SCHIP eligibility over the years beyond the 200 percent FPL.
SCHIP gives states three options when designing their programs. The states can: use SCHIP funds to expand Medicaid eligibility to children who previously did not qualify for the program; design a children's health insurance program entirely separate from Medicaid; or combine both the Medicaid and separate program options.
Eligibility and Cost Sharing
Eligibility for SCHIP is targeted toward uninsured low-income children. However, certain groups of children cannot be covered under SCHIP. Those ineligible include: children who are covered under a group health plan or under health insurance coverage; children who are members of a family that is eligible for state employee insurance based on employment with a public agency; children who are residing in an institution for mental diseases; or children who are eligible for Medicaid coverage.
A child can remain in a state program as long as she qualifies. While no limit is placed on the amount of time a child can remain in the program, she will need to renew her coverage periodically — about every six to twelve months. As long as the child continues to meet the eligibility criteria established by her state, she can remain in the program.
States can require individuals who are enrolled in SCHIP to pay some costs. However, they may not charge cost sharing for preventive services or immunizations or impose cost sharing that exceeds 5 percent of a family's gross or net income.
For little or no cost, this insurance under SCHIP pays for: physician visits, immunizations, prescription medicines, hospitalizations, and emergency room visits. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger whose families earn up to $41,399 a year (in 2007) for a family of four are eligible.
For contact information for each state or to learn about eligibility requirements, see the state section at the site