Medicaid and SCHIP

In a sample of 10 states, GAO found that Medicaid and State Children's Health Insurance (SCHIP) programs have similar outreach mechanisms but differ in the way that they enroll children and in the scope of benefits they offer. Some information that is required for determining Medicaid eligibility is not required for SCHIP. Half the states required ore documentation for Medicaid than for SCHIP, and states often required more documentation for Medicaid than was federally required. States have the flexibility under federal law to streamline requirements for Medicaid and SCHIP. All 10 states reported policies and procedures to help ensure that eligible children were appropriately enrolled in Medicaid rather than SCHIP, but the ease with which Medicaid-eligible children were enrolled varied. In some cases, persons applying for Medicaid for their children were required to fill out additional forms or appear in person in order to determine eligibility and obtain coverage. A review of the states' SCHIP programs found that they offer many of the same benefits as Medicaid for dental care, hearing, mental health, prescription drugs, and vision but impose more limits on them.

GAO noted that: (1) across GAO's sample of 10 states, Medicaid and SCHIP programs are similar in terms of their outreach mechanisms, but have differences in the way they enroll children and the scope of benefits they offer; (2) certain information that is federally required for Medicaid eligibility determination is not required for SCHIP; (3) however, half of the states GAO surveyed required more documentation for Medicaid than for SCHIP, and states often required more documentation for Medicaid than was federally required; (4) states do have the flexibility under federal law to streamline requirements for Medicaid and SCHIP; (5) while all of the states in GAO's sample reported policies and procedures to ensure that eligible children were appropriately enrolled in Medicaid rather than SCHIP, the ease with which Medicaid-eligible children were enrolled varied; (6) in some cases, persons applying for Medicaid for their children were required to fill out additional forms or appear in person in order to determine eligibility and obtain coverage; and (7) GAO's review of five optional benefits (dental, hearing, mental health, prescription drugs, and vision) shows that while states' SCHIP programs offer many of the same benefits as Medicaid, SCHIP imposes more limits on these benefits.