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States Could Use SCHIP to Cover Young Adults Through Broader Medicaid Coverage

By Susannah Crepet, CQ Staff

August 15, 2007 – States should be allowed to use the State Children's Health Insurance Program (SCHIP) to cover young, childless adults if they extend their regular Medicaid programs to cover low-to-moderate-income children, according to Sara Rosenbaum, a health law professor at George Washington University's School of Public Health and Health Services.

Young adults who have grown out of child health insurance programs are the most uninsured group, according to the Commonwealth Fund. In 2006, more than 10 million young adults ages 19–26 were uninsured, according to Rosenbaum, whose paper, "SCHIP Reconsidered," was published in Health Affairs on Tuesday.

According to Rosenbaum, SCHIP's reauthorization is an opportunity for policymakers to reassess and alter SCHIP to address the "staggering" number of young adults who are uninsured, while also taking into account developments in Medicaid policy that have changed the interaction between Medicaid and SCHIP.

"Despite Medicaid's broad coverage, financing medical assistance for children is so inexpensive—even with comprehensive coverage, children cost Medicaid $719 each, on average, in 2001—that many states might respond to this opportunity to secure funding for older children, pregnant women, and parents," Rosenbaum said.

Because Medicaid is an entitlement program, it would give child health financing a "more secure financial base," Rosenbaum said. In addition, covering children through Medicaid and young adults through SCHIP would make sense, partly because Medicaid coverage includes Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefits, she said. These benefits are essential to monitoring children's health and not necessary for young adults, or available through SCHIP.

Children covered through Medicaid could also take advantage of the 100 percent federal funding contribution rate for vaccines through Medicaid's Vaccines for Children program, as well as the 90 percent federal funding rate for family planning services and supplies, Rosenbaum said.

Mary Kahn, a spokeswoman at the Centers for Medicare & Medicaid Services, said "As always, we are quite concerned that every child who is eligible for either Medicaid or SCHIP receives these benefits. We recognize the particular importance of early regular medical care in early childhood development and are always ready to assist states in improving outreach strategies." She said CMS hadn't yet reviewed the report and could not comment on its findings.

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