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| State Children's Health Insurance Program (SCHIP)
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At Issue
The State Children’s Health Insurance Program (SCHIP) was enacted at the federal level in 1997. It is intended to provide health insurance benefits for children with family incomes too high to qualify for Medicaid but too low to afford private health insurance coverage. SCHIP is voluntary for states and is financed jointly by the states and the federal government.
In creating their programs, states may combine SCHIP with Medicaid, create a separate program or do both. Within broad federal guidelines, each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage and administrative and operating procedures. States receive an enhanced payment from the federal government for every dollar spent on an approved SCHIP service. However, unlike Medicaid the funding is not open-ended; it is capped at a set amount. While there is no requirement that states offer a dental benefit under SCHIP, all states provide at least some level of dental coverage.
Reimbursements for SCHIP dental procedures often fail to cover the overhead costs of providing care, making it difficult for enrollees to find a dentist who can afford to take on SCHIP patients. To address this problem, providers must be adequately reimbursed for the cost of their services. Addressing administrative hassles and patient adherence with treatment regimens would also improve the program.
SCHIP provides children with much needed access to health insurance and dental benefits and the ADA urges its reauthorization in 2007.
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ADA Priorities
- The ADA urges Congress to reauthorize SCHIP.
- The ADA urges Congress to address SCHIP funding shortfalls and financial sustainability of the program in future years.
- The ADA urges Congress to establish a federal guarantee for a dental benefit within SCHIP.
- The ADA urges Congress to develop a wrap-around provision to allow children who have private medical coverage but who meet SCHIP income eligibility standards to access SCHIP for dental coverage.
- The ADA urges Congress and states to work with dentistry to create effective delivery and payment systems that will encourage participation by dentists and increase access to services for SCHIP beneficiaries.
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Additional Resources
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Contact Us
Federal Affairs
1111 14th Street NW, Suite 1100
Washington, DC 20005
202.898.2400
Fax: 202.898.2437
E-mail: govtpol@ada.org
State Government Affairs
ADA Chicago Headquarters
211 East Chicago Avenue
Chicago, IL 60611
312.440.2525
Fax: 312.440.3539
E-mail: govtpol@ada.org
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