Medicaid and SCHIP:

Comparisons of Outreach, Enrollment Practices, and Benefits

HEHS-00-86: Published: Apr 14, 2000. Publicly Released: Apr 26, 2000.

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Pursuant to a congressional request, GAO reviewed the Medicaid program and State Children's Health Insurance Program (SCHIP), focusing on the differences between both programs with regard to outreach, application and eligibility determination, screening and enrollment, and benefits.

GAO noted that: (1) across GAO's sample of 10 states, Medicaid and SCHIP programs are similar in terms of their outreach mechanisms, but have differences in the way they enroll children and the scope of benefits they offer; (2) certain information that is federally required for Medicaid eligibility determination is not required for SCHIP; (3) however, half of the states GAO surveyed required more documentation for Medicaid than for SCHIP, and states often required more documentation for Medicaid than was federally required; (4) states do have the flexibility under federal law to streamline requirements for Medicaid and SCHIP; (5) while all of the states in GAO's sample reported policies and procedures to ensure that eligible children were appropriately enrolled in Medicaid rather than SCHIP, the ease with which Medicaid-eligible children were enrolled varied; (6) in some cases, persons applying for Medicaid for their children were required to fill out additional forms or appear in person in order to determine eligibility and obtain coverage; and (7) GAO's review of five optional benefits (dental, hearing, mental health, prescription drugs, and vision) shows that while states' SCHIP programs offer many of the same benefits as Medicaid, SCHIP imposes more limits on these benefits.

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