In addition to having flexibility in program design and benefits offered,  states participating in SCHIP have a larger proportion of their program  expenditures paid by the federal government than for Medicaid. OIG’s Assessment of Appropriate Enrollment Would Benefit From an Expanded Selection of States

In determining whether Medicaid-eligible children were improperly  enrolled in SCHIP, the OIG reported that, based on a sample of 5 states,  SCHIP enrollees in the 13 states with separate child health programs were  generally appropriately enrolled. While States’ Evaluations Offered Limited Results, Future OIG Reviews May Benefit from Improved Data Sources

The OIG identified important limitations to states’ evaluations that made it  unable to conclude whether states were making progress in reducing the  number of uninsured children and in meeting the objectives and goals that  they established under SCHIP. The OIG also found that states set  goals without considering how to evaluate progress, and that little  emphasis was placed on evaluation by the states. This would provide a broader base for understanding  how well states are screening for Medicaid eligibility and identifying issues  related to reducing the number of uninsured children. Recommendations to the HHS Inspector General

In order to better inform the Congress on states’ efforts to implement  SCHIP, we recommend that the HHS inspector general    expand the scope of the statutorily required periodic reviews to include all  states with separate child health programs, including those with  combination programs, and    consider using its general audit authority to explore whether issues of  appropriate SCHIP enrollment also exist among states that have opted for  Medicaid expansions under SCHIP, and should therefore be included in  future OIG reviews. Appendix I: Comments from the Department of Health and Human Services’ Office of Inspector General

Related GAO Products

Medicaid and SCHIP: States’ Enrollment and Payment Policies Can  Affect Children’s Access to Care. Children’s Health Insurance Program: State Implementation Approaches  are Evolving.
What GAO Found

Congress created the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured children in families with incomes that are too high to qualify for Medicaid. Financed jointly by the states and the federal government, SCHIP encourages state participation by offering a higher federal matching rate than the Medicaid program. Concerns have been raised that states might inappropriately enroll Medicaid-eligible children in SCHIP and thus obtain higher federal matching funds than allowed under Medicaid. The Department of Health and Human Services Office of Inspector General (OIG) concluded that Medicaid-eligible children were not being enrolled in SCHIP by the 13 states that administer separate child health care programs. Furthermore, the issue of appropriate enrollment is not limited to states with completely separate child health programs but also applies to those states with combination programs and Medicaid expansions, which also receive the higher SCHIP matching rate. The OIG could not conclude whether states were reducing the number of uninsured children and meeting the objectives and goals they established in their SCHIP programs. The OIG found that some states had set program goals without considering how they might be measured and that states' staffs often lacked adequate evaluation skills.