State Children's Health Insurance Program

Memorandum of February 4, 2009

State Children's Health Insurance Program

Memorandum for the Secretary of Health And Human
Services

The State Children's Health Insurance Program (SCHIP)
encourages States to provide health coverage for
uninsured children in families whose incomes are too
high to qualify for Medicaid but too low to afford
private insurance. Since 1997, when SCHIP was enacted,
States have had the authority to set their SCHIP income
eligibility levels, subject to available funding. In
recent years, as the cost of private insurance has
increased, States have raised eligibility levels to
offer health care coverage to more families, with
families paying a share of the cost based on their
income.

On August 17, 2007, the Centers for Medicare &
Medicaid Services (CMS) issued a letter to State health
officials limiting the flexibility of States to set
income eligibility standards for their SCHIP programs.
On May 7, 2008, CMS issued a subsequent letter
restating the policy set forth in the August 17, 2007,
letter.

The August 17, 2007, letter imposes additional
requirements that States must meet in order to cover
children under SCHIP plans, including plans that CMS
had previously approved. These requirements have
limited coverage under several State plans that
otherwise would have covered additional, uninsured
children. As a result, tens of thousands of children
have been denied health care coverage. Unless the
August 17, 2007, letter is withdrawn, many more
children will be denied coverage.

By this memorandum, I request that you immediately
withdraw the August 17, 2007, and May 7, 2008, letters
to State health officials and implement SCHIP without
the requirements imposed by those letters.

This memorandum does not create any right or benefit,
substantive or procedural, enforceable at law or in
equity by any party against the United States, its
departments, agencies, or entities, its officers,
employees, or agents, or any other person.

You are hereby authorized and directed to publish this
memorandum in the Federal Register.

THE WHITE HOUSE,

Washington, February 4, 2009