Summary: The states and the federal government have made considerable progress in getting the State Children's Health Insurance Program (SCHIP) up and running, but state design approaches are still evolving. They are now almost evenly divided between expansions of state Medicaid programs and programs with a stand-alone component: 51 SCHIP plans have been approved, two are under review, and three have not been submitted. More states will ultimately embrace a stand-alone component that provides them with greater budgetary control than Medicaid over program costs, permits them to vary benefits, and allows cost sharing. For most children, the SCHIP stand-alone benefit packages in the 15 states GAO reviewed offer coverage comparable to Medicaid, although some states have imposed limits on service. A growing number of states are exploring statutory options, such as including family coverage and subsidizing coverage through employers, but some question whether using such options would be consistent with the enabling statute's focus on children's insurance coverage. State outreach activities have sought to minimize the burden on beneficiaries and states by developing new ways for families to submit applications, increasing the number and operating hours of enrollment sites, and reducing application processing times. Publicity in some states is attracting children eligible for SCHIP and also children eligible for Medicaid but not enrolled. To prevent SCHIP from substituting for Medicaid, states with a stand-alone component must screen for Medicaid and enroll any eligible children in it. Some states are using joint applications to do this. To deter SCHIP from substituting for private insurance, states are instituting waiting periods for children with previous private coverage, requiring families to pay premiums and copayments, and studying and attempting to measure the extent of crowd-out.
