Children's Health Insurance:

Inspector General Reviews Should Be Expanded to Further Inform the Congress

GAO-02-512: Published: Mar 29, 2002. Publicly Released: Mar 29, 2002.

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Congress created the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured children in families with incomes that are too high to qualify for Medicaid. Financed jointly by the states and the federal government, SCHIP encourages state participation by offering a higher federal matching rate than the Medicaid program. Concerns have been raised that states might inappropriately enroll Medicaid-eligible children in SCHIP and thus obtain higher federal matching funds than allowed under Medicaid. The Department of Health and Human Services Office of Inspector General (OIG) concluded that Medicaid-eligible children were not being enrolled in SCHIP by the 13 states that administer separate child health care programs. Furthermore, the issue of appropriate enrollment is not limited to states with completely separate child health programs but also applies to those states with combination programs and Medicaid expansions, which also receive the higher SCHIP matching rate. The OIG could not conclude whether states were reducing the number of uninsured children and meeting the objectives and goals they established in their SCHIP programs. The OIG found that some states had set program goals without considering how they might be measured and that states' staffs often lacked adequate evaluation skills.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: In order to better inform Congress on states' efforts to implement SCHIP the Department of Health and Human Services (HHS) Inspector General (IG) should expand the scope of the statutorily required periodic reviews to include all states with separate child health programs, including those with combination programs.

    Agency Affected: Department of Health and Human Services: Office of Inspector General

    Status: Closed - Implemented

    Comments: The OIG just released its report "Determining if Children Enrolled in Separate SCHIPs Were Eligible for Medicaid" (OEI-07-03-00220). In keeping with GAO's recommendation, this report collects sample information from all states with separate SCHIP programs.

    Recommendation: In order to better inform Congress on states' efforts to implement SCHIP the HHS IG should consider using its general audit authority to explore whether issues of appropriate SCHIP enrollment also exist among states that have opted for Medicaid expansions under SCHIP, and should therefore be included in future OIG reviews.

    Agency Affected: Department of Health and Human Services: Office of Inspector General

    Status: Closed - Implemented

    Comments: In October 2005, The Office of Inspector General in the Department of Health and Human Services released a report, "Determining if Children Classified as SCHIP Medicaid Expansion Meet Eligibility Criteria" (OEI-07-03-00221). In keeping with GAO's recommendation, this report determined if children classified as Medicaid expansion met the state's criteria for Medicaid-expansion eligibility criteria.

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