Children's Health Insurance: Inspector General Reviews Should Be Expanded to Further Inform the Congress

A letter report issued by the General Accounting Office with an abstract that begins "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.