	Introduction

Each year, the President is required to submit a comprehensive federal budget proposal to Congress no later than the first Monday in February. The House and Senate Budget Committees then develop their respective budget resolutions after reviewing the President's budget, the views of other committees, and information from CBO. Although it is not binding, the resolution provides a framework for subsequent legislative action. This report provides information on Medicaid and the State Children's Health Insurance Program (SCHIP). It will be updated to reflect relevant activity until the FY2009 budget is passed and until the next President's FY2010 budget is released. Medicaid and SCHIP in the President's FY2009 Budget

The President's FY2009 budget contains a number of proposals that would affect Medicaid and SCHIP. Legislative Versus Administrative Proposals

As shown in Table 1 , some of the President's proposals would require legislative action, while others would be implemented administratively (e.g., via regulatory changes, issuance of program guidance, etc.). Proposal. HHS estimates that the proposal would save $950 million in FY2009, and approximately $5.5 billion over the FY2009-FY2013 period. On June 26, 2008, the Senate Appropriations Committee approved a $153.1 billion budget for the Departments of Labor, Health and Human Services, and Education, as well as the Social Security Administration. The Labor-HHS appropriations bill contained an amendment that would set aside an SCHIP requirements in an August 17, 2007, letter to state health officials that limited SCHIP and Medicaid coverage expansions for children in families with incomes greater than 250% of the FPL or $53,000 for a family of four in 2008. The budget-neutral and sense of the House provisions that would affect Medicaid and SCHIP include the following:
SCHIP. Up to an additional $198 million in FY2009 discretionary funding could be appropriated for the health care fraud and abuse control program. Conference Agreement

On May 20, the House and Senate filed a conference agreement on the budget resolution ( H.Rept. 110-659 accompanying S.Con.Res. 70 ). Medicaid provisions in the Senate and House conference agreement include:
A reserve fund up to $50 billion in outlays over five years for reauthorization of SCHIP that is deficit-neutral in the Senate and House. Sense of the Senate provision on Medicaid administrative regulations. As noted above, the administration's FY2009 budget proposal includes additional funding for SCHIP through FY2013. Other Legislation

A bill, Protecting the Medicaid Safety Net Act of 2008 ( H.R. The House passed an amended version of H.R. 2642 on June 19, 2008. 2642 without changes on June 26, 2008, and the President signed P.L. 110-252 into law on June 30, 2008. The Medicare Improvements for Patients and Providers Act of 2008 ( S. 3101 ) was introduced in the Senate on June 6, 2008. A similar but alternative bill, Preserving Access to Medicare Act of 2008 ( S. 3118 ), was introduced June 11, 2008.
Each year, the President is required to submit a comprehensive federal budget proposal to Congress no later than the first Monday in February. The House and Senate Budget Committees then develop their respective budget resolutions. House and Senate Appropriations committees then reconcile their budget resolutions and file a joint budget agreement. Although not binding, the resolution provides a framework for consideration of the 12 separate appropriations bills that would fund FY2009 government operations.
The President's FY2009 budget contained a number of proposals that would affect Medicaid and the State Children's Health Insurance Program (SCHIP). While certain proposals would require legislative action, others could be implemented administratively (e.g., via regulatory changes, issuance of program guidance, or other possible methods). One of the more notable changes from the Bush Administration's previous budget proposal is an increase in SCHIP funding—increasing federal funding for allotments by $1.5 billion in FY2009 and by $19.7 billion over the five-year period from FY2009 to FY2013. The administration's budget proposed spending reductions to other Medicaid components that would offset much of the additional funding proposed for SCHIP, so that total SCHIP and Medicaid spending would increase by $230 million in FY2009 and $1.3 billion from FY2009-FY2013 if the Administration's budget proposal were enacted without changes.
On June 4 and 5, 2008, the Senate and House, respectively, adopted the final version of the budget resolution (H.Rept. 110-659 accompanying S.Con.Res. 70). Among other provisions, the conference agreement provides a deficit-neutral reserve fund of up to $50 billion for SCHIP legislation, a variety of other deficit-neutral reserve funds, up to $198 million for health care fraud and abuse control, and a sense of the Senate provision on delaying Medicaid administrative regulations. On June 26, the Senate Appropriations Committee approved a $153.1 billion budget for the Departments of Labor, Health and Human Services, and Education, as well as the Social Security Administration. The Labor-HHS appropriations bill contained an amendment that would set aside requirements in an August 17, 2007, letter to state health officials that limited SCHIP and Medicaid coverage expansions for children in families with income above 250% of the federal poverty level (FPL).
Several legislative initiatives affecting Medicaid were introduced during the second session of the 110th Congress. After the House passed an amended version of the Supplemental Appropriations Act of 2008 (H.R. 2642) on June 19, 2008, the Senate approved the measure without amendments on June 26 and the President signed P.L. 110-252 into law on June 30, 2008. Other legislation affecting Medicaid includes the Medicare Improvements for Patients and Providers Act of 2008 (S. 3101), which was introduced June 6, 2008, and an alternative bill, the Preserving Access to Medicare Act of 2008 (S. 3118), introduced June 11, 2008.
This report will be updated to reflect relevant activity as the FY2009 budget advances and until the next President's FY2010 budget is released.