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As Congress was finalizing bipartisan legislation to reauthorize the State Children’s Health Insurance Program (SCHIP), the Center for Medicaid and Medicare Services (CMS) circulated, on August 17, 2007, a new federal directive in the form of a letter to program directors. The directive dramatically alters rules that had governed SCHIP for the past ten years, limits states’ ability to design and finance their own programs, and gives them exactly one year to amend their individual SCHIP programs or risk corrective action by the federal government.

CMS imposed a uniform, federal gross income cap of 250 percent of the federal poverty level or $42,925 for a family of four. CMS does not have legal authority to set income caps on SCHIP, so CMS accomplished a de facto cap by limiting states’ flexibility to cover children above 250 percent of the federal poverty level, allowing the higher coverage only when states prove that they meet new federal guidelines.

The directive demands that, before raising income eligibility to higher levels, states must show that they have enrolled at least 95 percent of all uninsured children already eligible for SCHIP or Medicaid—that is, children with incomes below 200 percent of the federal poverty level. Based on estimates by the Urban Institute of the Census Bureau’s Current Population Survey, state Medicaid and SCHIP participation rates among low-income children range from a low of 51 percent in Nevada to a high of 89 percent in Vermont. Overall, enrollment rates vary widely among states and are difficult to measure. What data CMS will accept to show participation numbers among the already eligible but uninsured is still not clear.

Once the participation rate requirement is met, states are allowed to expand their programs above 250 percent of the federal poverty level only if they can show that they have reasonable procedures to prevent “crowd-out,” a process where parents move children from private coverage to the publicly funded SCHIP program. States must prove that private employer-based coverage for lower-income children has not declined by more than 2 percent over the past five years. Employer coverage has been on the decline for many years. According to a survey conducted in October 2007 by the Employee Benefit Research Institute, employer-sponsored coverage between 2000 and 2005 dropped almost 9 percent for children under 18. This is a trend that states have little control over, and once again CMS has not issued clear guidelines for “reasonable procedures” that states may use to measure such trends.

The CMS directive, effective August 2008, has already had a significantly negative impact on children’s coverage. The directive is not only slowing down the coverage of uninsured children but also leaving more children uninsured as some states pull back on SCHIP eligibility or scrap planned expansions. Congress must repudiate the CMS directive as inconsistent with CMS authority and with good policy. The focus should be on insuring all children, a goal that is within sight if CMS gets out of the way.

To learn more, contact Melissa Cubria at melissacubria@povertylaw.org or 312.263.3830 ext. 241.

The United States leads the world, but we are not boasting. We are the front-runner in both the number and percentage of residents in incarceration, according to the Washington Post (Feb. 29, 2008). Although altering decades of shortsighted policies will take time, public officials are finally beginning to question their “lock ’em up” mentality and find less costly ways to deal with people charged with crimes. Any city, county, or state can take the following steps almost immediately to reduce the growing swell of incarcerated people without endangering public safety:

  1. Provide drug treatment upon request to individuals with addictions and not wait for the behavior to place them in the criminal justice system.

2. Screen people charged with crimes for mental health problems and divert those in need of treatment to community treatment programs.

3. Make community supervision and supportive services such as transitional jobs, education, and counseling available to those charged with less serious, nonviolent crimes.

4. Classify possession of controlled substances in small amounts as a civil rather than criminal matter.

By adopting these alternative policies to imprisonment, we can move closer to being smart on crime—not soft, not tough, but smart. For more information, contact Margaret Stapleton at mstapleton@povertylaw.org or 312.368.3327.

Thirty-seven million Americans live in the state of poverty, but who cares and what are we going to do about it? As a country, we were forced to confront our progress when the Gulf hurricanes revealed places of deep poverty. Like the task of building levees and responding to an immense national catastrophe, the job of taking on the complex structural causes of poverty is well beyond what compassionate individuals can do. To address the root causes of poverty, Congress and the President must adopt the right priorities, enact needed laws, and adequately fund essential programs. This week the Shriver Center released its 2007 Poverty Scorecard to hold leaders accountable to that very task.

The 2007 Poverty Scorecard: Rating Members of Congress assigns letter grades to each member of the U.S. Senate and House of Representatives according to his or her voting records on poverty-related issues that came to a vote in 2007—legislation on affordable housing, health care, education, labor, tax policy, and immigrants’ rights. With the help of a national advisory board and other antipoverty experts, the Shriver Center identified and analyzed fourteen Senate votes and fifteen House votes.

“This Scorecard is important because it looks at a whole range of critical issues, all of which have to be addressed by the country in order to deal with millions of Americans, more than the population of California, who live in poverty every single day,” said John Edwards, the former senator, Democrat of North Carolina, during the teleconference release of the Scorecard. “We can get the congressional leadership that we need, but it’s crucial that voters be educated, that they know who’s doing the right thing and who’s not.”

Edwards noted that many of the bills—such as increasing the minimum wage and making it easier for workers to unionize—that failed in Congress last year would have easily helped pull Americans out of poverty. These policy changes reflect the view that if you are working full-time, you should not be struggling to pay the bills, Edwards said.

“People who are working ought to be able to provide for their family,” he said. “People who are working full-time should not be in poverty.”

The goal of the Shriver Center’s Poverty Scorecard is not just to identify poverty-fighting initiatives that Congress acted upon in 2007 and grade each member on how they voted. The Shriver Center also hopes that the evaluation will shine a light on how Congress is doing, that it will elevate the issue of poverty on the national agenda, and that members of Congress will be moved to pay greater attention and perform better in the fight against poverty.

For further information, contact Joanna VanderWoude at jvanderwoude@povertylaw.org or 312.263.3830 ext. 253.

The Shriver Center has launched a new newsletter, Illinois Health Matters. Each issue describes the current climate of state health care through two stories of state residents’ actual experiences. One story highlights people who are uninsured, underinsured, or on the verge of losing their medical coverage—proving the need for cost controls, insurance reforms, and expanded coverage. The other story showcases people who are covered in Illinois by All Kids, FamilyCare, or Medicaid—to give a real-life example of how these public programs help people and how the programs might be improved.

The Shriver Center sends this newsletter to health consumers, advocates, social workers, health care providers, and public officials. Our intent is to help Illinois celebrate, use, and safeguard what is already good and drive Illinois toward constant improvement and health care for all.

Although we conduct extensive outreach efforts to collect stories from health care providers, social workers, and the consumers they work with directly, we want your stories for Illinois Health Matters. We will be extremely careful about your confidentiality and will always clear your information with you first before we use it. Please click here to share with us your story or the story of someone you know, and we will follow up with you. Story banking is an essential part of creating and maintaining an information loop between health consumers and advocates to learn about glitches in the system and push for continued reform.

To sign up for Illinois Health Matters, click here. To submit stories to Illinois Health matters, contact Melissa Cubria: melissacubria@povertylaw.org; Direct line: 312.368.1168; Fax: 312.263.3846.