Health insurance programs for children.

MEDICAID WAS ENACTED in 1965 as a health insurance program for the poor, including low-income persons aged 65 and older who had exhausted their Medicare benefits, the blind, the disabled, or members of families with dependent children (Missouri Department of Social Services, 2000). Before 1965, health care for the poor was financed by individual states through various charity programs. Persons could also pay for care out-of-pocket or choose to not use the formal health care system. President Lyndon B. Johnson established Medicaid as a federal-state partnership with the federal government paying the states between 20% and 80% of the cost for providing and paying for health care to poor families, the poor elderly, the blind, and the disabled. Since 1965, the eligibility levels for poor families and the elderly have remained centered around the federal poverty level. In 1997, Medicaid covered approximately 36 million low-income individuals, including 18 million children (U.S. Department of Health and Human Services, 2000). Today, however, of the approximately 11 million children currently without health insurance, 90% do not live below the poverty level, they have working parents. These parents earn too much to qualify for Medicaid, and work in jobs that do not offer insurance and they cannot afford to pay for private family health insurance (Ross, 2000). Children without health insurance suffer from health problems that could be prevented or managed with routine care. In this population, the majority of children with asthma and 1 in 3 uninsured children with recurring ear infections never receive primary or secondary preventive care. Poorly managed asthma may require emergency department visits or hospitalizations, and permanent hearing loss can follow repeated bouts of untreated otitis media. Uninsured children also have unmet needs for dental care, prescriptions, eyeglasses, and mental health services (Children’s Defense Fund, 2000c; Edmunds, Teitelbaum, & Gleason, 2000). To expand health insurance coverage for children of working parents, Congress signed the State Children’s Health Insurance Program (SCHIP) into law in 1997 as Title XXI of the Social Security Act. Eligible children are 18 years or younger in working families with low to moderate incomes. Although exact income levels vary among states, generally, children in families of four earning up to $34,100 are eligible for this coverage (Ross, 2000). The basic services provided under SCHIP include inpatient and outpatient hospital services, physician’s surgical and medical services, laboratory and X-ray services, and well baby and child care services including immunizations. Services are provided based on program guidelines rather than a given amount of coverage. States can elect to add services such as dental care, vision care, prescription drugs, and school and sports physicals. Beyond these basic services, most states will pay for the more comprehensive services needed for children with special needs such as diabetes, leukemia, and spina bifida (Ross, 2000). The SCHIP represents a unique opportunity to have a measurable impact on the health status of America’s children. In addition to improving health status, by increasing the numbers of children with full health coverage through enrollment in SCHIP, the amount of emergency department use for routine care and the need for hospitalizations, will decrease (Children’s Defense Fund, 2000b).