Health coverage for children whose parents are leaving the welfare rolls was the subject of a May 16 hearing held by the House Ways and Means Subcommittee on Human Resources.
Subcommittee Chair Nancy Johnson (R-CT) stated that providing health coverage for children was a major focus during the crafting of the 1996 welfare reform law (P.L. 104-193). Previous to the passage of P.L. 104-193, a family’s eligibility for Medicaid was linked to eligibility for welfare cash assistance. However, under the welfare reform law, Medicaid and welfare officially were “delinked,” so that families no longer receiving cash assistance can still qualify for Medicaid benefits.
The welfare reform law also established the State Children’s Health Insurance Program (S-CHIP) to focus specifically on providing health care for poor children. States were given greater flexibility with eligibility criteria, so that more children could qualify for health coverage.
Funds also were provided to increase public awareness about the availability of coverage. However, statistics gathered since 1996 have shown that the number of children enrolled in Medicaid has declined, despite their increased eligibility. “The problem of declining Medicaid enrollment is very, very important and…can be solved,” said Rep. Johnson.
Dr. Barbara Lyons of the Henry J. Kaiser Family Foundation cited a study by her organization, which found that between 1995 and 1997, “total annual Medicaid enrollment fell by 5.5 percent for adults and 1.4 percent for children.” She added, “The number of children and parents who had health insurance through the Medicaid program fell by about 1 million, while the number of uninsured increased.”
Cindy Mann of the Department of Health and Human Services—which oversees the Medicaid program—supplied similar statistics, but offered a different interpretation. She said the numbers indicate that Medicaid enrollment “has fluctuated slightly…and is now about the same as it was before welfare reform.” In addition, she said two million children have been enrolled in S-CHIP programs.
Ms. Mann described the federal government’s efforts to increase awareness and access to health coverage for children. She was congratulated by Rep. Johnson for “the administration’s varied efforts,” although the Chair repeated her call for more adequate action on the matter.
Marilyn Ellwood of Mathematics Policy Research, Inc. described her research on child health coverage. Although Medicaid and welfare have been delinked, she said, the Medicaid program remains “incredibly dependent on welfare staff to educate families.” However, many welfare staff face difficulty because the goal of maximizing Medicaid enrollment “can seem to conflict with the objectives of reducing welfare dependency.”
In addition, according to Ms. Ellwood, “Medicaid rules have become incredibly complicated,” and the program has “a host of administrative problems.” For example, access to Medicaid is affected by “lengthy application forms, face-to-face meeting requirements, and office hours that do not fit the schedules of working families.”
Ms. Ellwood recommended that the federal government require states to track child enrollment in Medicaid as an indicator of success for welfare reform. “Medicaid needs to be part of the welfare reform agenda,” she said.
Several other witnesses described many of the same problems mentioned by Ms. Ellwood. Jean Hearne of the Congressional Research Service stated that Medicaid access is complicated by “an unfathomably large number of eligibility ‘pathways’ onto the Medicaid program.” Ronald Pollack of Families USA told the subcommittee that states should “turn their attention to simplifying [the Medicaid program] and streamlining outreach [to eligible families].”
Rep. Pete Stark (D-CA) testified about a bill (H.R. 4390) he has introduced, the MediKids Health Insurance Act. “Providing health coverage to children impacts much more than their health—it impacts their ability to learn, their ability to thrive, and their ability to become productive members of our society,” Rep. Stark said.
H.R. 4390 would automatically enroll American children in the MediKids program from birth through age 23. The program’s benefits would mirror those available under Medicaid, with the addition of prescription drug coverage. Premiums for the coverage—equaling one-fourth of the program’s annual average cost per child—would be collected through a parent’s federal income tax filing. No premium would be charged for periods of the child’s life when alternative coverage were available through a parent’s employer, Medicaid, S-CHIP, or any other source. Families earning up to 150 percent of the federal poverty limit would not be subject to any premiums and costs would be graduated for those earning 150 percent to 300 percent.
