When Given Flexibility, States Opt Not to Create Health Insurance Entitlement Through CHIP, Study Finds

In a study of separate, non-Medicaid CHIP programs, researchers found that "unlike Medicaid, none of the separate programs guarantees coverage for eligible children." Conducted by researchers at the George Washington University School of Public Health and Health Services, the study, which examined state laws authorizing and appropriating funds for non-Medicaid CHIP programs, found that "states avoid creating legal entitlements" when "given the flexibility to do so." Unlike Medicaid, which guarantees coverage for all eligible individuals, the federal CHIP statute established "a legal entitlement to funding for participating states, but do[es] not entitle eligible children to coverage." The study, called "Design of Separate SCHIP Programs and the Right to Coverage," found that while sixteen states and the District of Columbia have established an entitlement by using CHIP allocations to expand Medicaid coverage, 33 states have created separate CHIP programs without establishing them as a legal entitlement to coverage. In addition, although nine states' laws appear to require the state to enroll and serve eligible children "as long as funds remain available," 24 states have enacted legislation allowing the state to "cease spending available funds" at will. Sara Rosenbaum, co-author of the study, said that the report suggests that an entitlement to health coverage "is most likely to be created as a matter of federal law." She added, "Guaranteeing coverage for all eligible children through the creation of a legal entitlement is the only means of ensuring that coverage is there when needed. ... States with more fragile budgets simply may be unable to create such a guarantee in the absence of a national commitment to back them up" (George Washington University release, 3/12). The report is available online at http://www.gwhealthpolicy.org/brief_1.pdf. Note: You must have Adobe Acrobat Reader to view the report.