An Analysis of State Children’s Health Insurance Programs – Due Process Provisi

Executive Summary

An Analysis of State Children's Health Insurance Programs – Due Process Provisions

I. Background to this Report
 
In the United States, uninsured children in families with low incomes are at greater risk for preventable health problems because they are likely to delay or forego necessary medical care due to financial barriers.   For this reason, in 1995, the federal government created the State Children?s Health Insurance Program (SCHIP).  SCHIP offers federal funding to states to enable them to create health insurance programs for low-income children who are not eligible for Medicaid but who cannot afford private insurance.   The purpose of SCHIP is to ?provide funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective manner that is coordinated with other sources of health benefits coverage for children.?   The guarantee of due process to SCHIP applicants and enrollees – providing proper notice and the opportunity to be heard – is paramount to the success of the program, as it helps to assure widespread knowledge of procedures, the continuance of necessary health coverage and the appropriate medical treatment for SCHIP enrollees.  By incorporating due process rights into the functioning of the program, the ?system? is treating SCHIP participants ?with a dignity consonant with their self-image as human beings, [which] is fundamentally important to the control over [their] own destiny.? 
 
The National Health Law Program requested that the Northeastern University School of Law undertake this project to determine what due process protections states were providing to SCHIP applicants and enrollees throughout the country.  To do so,  we researched and analyzed the federal Medicaid and SCHIP statutes and regulations, as well as the SCHIP statutes and regulations of fifty-four states and territories.    Where applicable, we reviewed the statutes and regulations governing the states? Medicaid programs.    We also reviewed state sub-regulatory policies obtained primarily from official state program websites and communicated directly with state SCHIP program directors to determine how states were actually managing their programs.  Our analysis ? focused on whether and how each state?s program guarantees the requisite due process protections to its applicants and enrollees ? resulted in a detailed compilation of all fifty-four states? statutes, regulations, and unwritten policies.  This project is meant to serve as a guide for advocates and practitioners to aid in their efforts to ensure that due process rights of SCHIP applicants and beneficiaries are met in their states.  Because this analysis is based on documents and interviews with a limited number of personnel, however, it is important to note that actual procedures may differ from the descriptions here. 
 
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