Health Group Commentary to
HHS Secretary Thompson: September 2001 GAO Report on Medicaid
and SCHIP Enrollment and Payment Policies
October 10, 2001
The Honorable Tommy Thompson
Secretary Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Thompson:
The undersigned organizations, representing a wide spectrum
of patient advocacy and health provider organizations, are
encouraged by the release of the General Accounting Office
(GAO) report, “Medicaid and SCHIP: States’ Enrollment and
Payment Policies Can Affect Children’s Access to Care.” The
report highlights the numerous successes of the State Children’s
Health Insurance Program (SCHIP), as well as the need for
improvements that could lead to better coverage for many of
our nation’s children.
Below are key issues raised in the report that we believe
illustrate opportunities for improvements in the Medicaid
and SCHIP programs:
-
States should redouble their efforts to ensure that
the Medicaid and SCHIP application processes are conducive
to the enrollment of all eligible individuals. The
report indicates that states utilizing a joint application
for the Medicaid and SCHIP programs are generally more
successful at enrolling those eligible for services. In
addition, the report shows that without coordination between
the agencies or departments that process applications,
those applications may be lost upon transfer from the
Medicaid to the SCHIP offices and vice-versa. This can
lead to an unnecessary delay in care.
-
The redetermination process needs to be simplified.
Some states make the redetermination process more difficult
than the application process, or require redetermination
less often than the 12-month maximum as allowed by law
for most eligibility groups. We believe children should
receive guaranteed coverage for the maximum period allowed
by law, regardless of changes in family circumstance,
income, or resources.
-
Presumptive eligibility should be utilized for all
Medicaid and SCHIP programs. Medicaid and SCHIP presumptive
eligibility is an incentive for qualified families to
seek care for their children in a coordinated manner as
their health care needs arise. Every eligible child should
have a relationship with a primary care provider to ensure
that health challenges are addressed at the earliest possible
opportunity. We believe presumptive eligibility would
assist in that process.
-
Medicaid and SCHIP payment rates should be set at
levels that encourage wide healthcare provider participation
in both programs. The lack of adequate provider payment
rates, particularly in the Medicaid program, creates an
access problem for many families. A number of physicians
and health plans accept SCHIP or Medicaid patients, but
not both, due to payment rates. Often, the result of inadequate
payment rates is uncoordinated care, especially among
families who may have one child enrolled in Medicaid and
another child in SCHIP (due to eligibility requirements).
This creates a hardship for families, who are often managing
multiple healthcare provider appointments for children
with chronic conditions. Care that is uncoordinated is
often more costly, requiring greater funding that could
be spent on covering additional children and/or ensuring
full enrollment for all those eligible.
-
States should not increase cost-sharing requirements
on Medicaid and SCHIP beneficiaries. The recent economic
downturn may tempt states to raise cost sharing requirements
for SCHIP beneficiaries, and/or reduce optional Medicaid
services in order to generate savings. Such a move would
create barriers for enrollment and access to care. We
should do everything possible to ensure that children’s
health status improves. The Medicaid and SCHIP programs
are an integral part of such efforts.
Thank you for your commitment to ensuring the best possible
outcomes for our most vulnerable population – our nation’s
children. We look forward to working with you to strengthen
both the Medicaid and SCHIP programs.
Sincerely,
American Hospital Association
American Academy of Pediatrics
Association of American Medical Colleges
Catholic Health Association
Children’s Defense Fund Families, USA
Federation of American Hospitals
National Association of Public Hospitals and Health Systems
Kaiser Permanente
March of Dimes
National Association of Children’s Hospitals
National Association of Urban Hospitals
Premier, Inc.
VHA Inc.
|
