Although none of the six study states had SCHIP programs for parents in place at the time of our site visits, CMS approved California's Section 1115 demonstration application to expand SCHIP coverage to parents in January 2002. California submitted its application to CMS in December 2000, requesting approval to use SCHIP funds to cover parents of SCHIP-enrolled children with incomes between 100 and 200 percent of the FPL, as well as parents with incomes below 100 percent of the FPL who do not qualify for Medicaid because of excess assets.70 In Louisiana, the Governor has signed legislation authorizing the Medicaid agency to seek approval to use SCHIP funds to cover parents with family incomes under 100 percent of the FPL (mostly parents of children covered under Title XIX) and pregnant women with incomes between 185 percent and 200 percent of the FPL. Louisiana also needs approval from its legislature for enrollment targets and its plan for covering the state's share of the expansion costs.
In both states, similar reasons were given by state officials for pursuing the coverage expansions for parents:
- First, it was believed that parents of Medicaid- and SCHIP-eligible children would be more likely to enroll their children if coverage also was available to them.
- Second, it was felt that when parents themselves are covered, they are more likely to seek appropriate care for their children.
- The expansion to parents would allow the state to access a greater portion of its federal SCHIP allotment.
- In Louisiana, the expansion for pregnant women was also seen as a way to reduce future program costs by preventing poor birth outcomes and childhood disabilities.
Two other study states, Missouri and New York, had already covered some low-income parents under their Section 1115 Medicaid demonstrations. Missouri sought approval to cover parents under SCHIP when it submitted its SCHIP plan in 1997; but when that request was denied, the state revised the proposal to cover parents under Title XIX. New York's Title XIX parental coverage program was approved in June 2001. In neither state does the target population covered under the demonstrations include the parents of SCHIP-eligible children, because the income thresholds are lower for the Medicaid demonstrations than they are for SCHIP. 71 At the time of the visits, neither state thought it would be feasible to extend coverage to parents under SCHIP; New York cannot do so because it has spent its full Title XXI allotment, and Missouri does not have the financial capacity to support additional expansions at this time.
One challenge that states with parent coverage face is minimizing confusion about the different SCHIP rules governing eligibility for children and parents. In Missouri, for example, different SCHIP income thresholds for parents and children have confused families and front-line eligibility staff, adding to the difficulties for outreach and enrollment staff. California anticipates similar problems, since the income threshold for its parent coverage component will be lower than the threshold for children (200 versus 250 percent of the FPL).
70. Medicaid already covered parents under 100 percent of the FPL under a Section 1931(b) waiver.
71. Missouri's program, however, includes a small number of parents of SCHIP-eligible children.