Order Code RL30642
CRS Report for Congress
Received through the CRS Web
The State Children’s Health Insurance Program:
Eligibility, Enrollment, and Program Funding
August 18, 2000
Evelyne P. Baumrucker
Analyst in Social Legislation
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress


The State Children’s Health Insurance Program:
Eligibility, Enrollment, and Program Funding
Summary
The Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) established the State
Children’s Health Insurance Program (SCHIP) under a new Title XXI of the Social
Security Act. SCHIP represents the largest publicly funded effort to provide health
insurance to children since the enactment of Medicaid in 1965. The program offers federal
matching funds for states and territories to provide health insurance coverage to uninsured,
low-income children from families whose annual incomes are higher than Medicaid
eligibility thresholds. States may choose from three options when designing their SCHIP
programs; (1) expand their current Medicaid program, (2) create a new, separate state
insurance program, or (3) devise a combination of both approaches. A majority of states
are expanding eligibility for SCHIP to levels between 150% and 200% of the federal
poverty level (FPL). In one state, New Jersey, the upper income eligibility limit for
Medicaid expansions and separate state programs under SCHIP has reached 350% of the
federal poverty level.
The SCHIP program is nearing its third year of existence. While significant headway
has been made by the states in the development and implementation of their SCHIP
programs, given complications associated with starting a new program, enrollment numbers
have not kept pace with expectations. The Health Care Financing Administration (HCFA)
reported that nearly 2 million children (1,979,450) were enrolled in SCHIP during
FY1999 under 53 operational state programs. Over 1.2 million of these children were
served by separate programs and almost 700,000 were enrolled in Medicaid expansions.
Subsequent to the enactment of BBA 97, CBO estimated that SCHIP would cover an
average of 2.3 million children per year after 1999. The Administration’s goal is to enroll
5 million children in SCHIP by FY2002.
In the original enacting statute, Congress provided appropriations of nearly $40 billion
for the FY1998 to FY2007 period. Federal funds are allotted among the states based on
a formula that takes into account the combination of the number of low-income children
and the number of low-income, uninsured children residing in a state, as well as a state
cost factor. A total of $4.295 billion in federal funds was available to states and territories
for FY1998 and $4.307 billion was available in FY1999. In FY2000 funding levels total
$4.309 billion.
Like Medicaid, SCHIP is a federal-state matching program. In order to determine
a state’s matching payments, SCHIP uses Medicaid’s concept of “federal medical
assistance percentage,” but modifies it to provide states an “enhanced federal medical
assistance percentage” (enhanced FMAP). A state’s share of total SCHIP spending is
equal to 100% minus the enhanced FMAP. In FY2000, the state’s regular Medicaid
federal medical assistance percentages (FMAPs) range from 50% to 76.8%. Under the
SCHIP program, the FY2000 enhanced FMAPs range from 65% to 83.76% in the states.
While all age groups of children have benefited from increases in eligibility for SCHIP
coverage, many of the states have taken advantage of these enhanced matching funds to
extend eligibility to older adolescents.


Contents
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Program Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Appropriations for FY1998 through FY2000 . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Allotments Among the States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Payments to the States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
List of Tables
Table 1. Medicaid and SCHIP Income and Age Related Eligibility Criteria
as a Percent of the Federal Poverty Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Table 2. Financial Program Information for States and Territories FY1998a . . . . . . 17
Table 3. Financial Program Information for States and Territories FY1999a . . . . . . 21
Table 4. Financial Program Information for States and Territories FY2000a . . . . . . 25


The State Children’s Health Insurance Program:
Eligibility, Enrollment, and Program Funding
Background
The Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) established the State
Children’s Health Insurance Program (SCHIP) under a new Title XXI of the Social
Security Act. Proposed regulations for the program were published on November 8,
1999 (Federal Register, v. 64, no. 215). The proposed regulation specifies rules
governing the program.1 Several recent laws have made technical and funding changes to
Title XXI.2
SCHIP is a federal-state partnership intended to provide health insurance coverage
to low-income, uninsured children. SCHIP targets children in families whose annual
incomes are higher than applicable Medicaid eligibility thresholds, and who do not have
other health insurance coverage. In the original enacting statute Congress authorized and
appropriated SCHIP federal matching grants in the amount of $39.7 billion for FY1998
through FY2007. Later, Congress provided additional appropriations for SCHIP in order
to increase allocations to the territories, bringing the total of appropriations available for the
period to almost $40 billion.
States may choose from three options when designing their SCHIP programs. They
may expand their current Medicaid program, create a new, separate state insurance
program, or devise a combination of both approaches. Under limited circumstances, states
have the option to purchase a health benefits plan that is provided by a community-based
health delivery system or to purchase family coverage under a group health plan as long
as it is cost effective to do so.3 As of late 1999, HCFA approved SCHIP plans for all 50
1 An earlier proposed rule for the SCHIP program reported the allotments and grants to the
states for FY1998 and FY1999 and appears in the Federal Register, v. 64, no. 42 [Thursday,
March 4, 1999] Proposed Rule. The final rule for the State Children’s Health Insurance
Program’s allotments and payments to states appeared in the Federal Register, v. 65, no.
101 [Wednesday, May 24, 2000] Rules and Regulations. This final rule provides final SCHIP
program allotments for FY1998 through FY2000.
2 For more details, see CRS Report RL30473, State Children’s Health Insurance
Program: A Brief Overview,
by Elicia Herz and Evelyne Baumrucker. (Hereafter cited
as RL30473, State Children’s Health Insurance Program)
3 In the case of community-based health delivery systems, the cost of coverage cannot
exceed, on an average per child basis, the cost of coverage that would otherwise be
provided. In the case of family coverage, the alternative must be cost-effective relative to
the amount paid to obtain comparable coverage only of the targeted low-income children, and
(continued...)

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states, the District of Columbia and the five territories. As of July 3, 2000, 23 jurisdictions
use Medicaid expansions (ME) and another 15 use separate state programs (SSP) for
their SCHIP programs, with the remaining 18 providing health insurance coverage through
a combination approach (COMBO).
Eligibility
The federal Medicaid statute mandates that states cover certain groups of children
based on age and income criteria and gives states several options to expand coverage
beyond these federal minimum standards. Children (and families) who meet the financial
and categorical rules under the states’ former Aid to Families with Dependent Children
(AFDC) programs (in effect on July 16, 1996) are eligible for Medicaid even if they do not
qualify for cash grants under the new Temporary Assistance for Needy Families (TANF)
program. In addition, states must provide coverage to all pregnant women and children
age 5 and under living in families with incomes at or below 133% of the federal poverty
level. States also must phase in coverage to children living in families with incomes below
100% of the federal poverty level who were born after September 30, 1983, until all such
children under age 19 are covered.4 As a result of this requirement, in FY2000 states must
cover all children ages 6 to 16 whose family income is below the federal poverty
threshold.5
States that wish to cover more children at higher levels of income, have the option
of (1) making pregnant women and infants under 1 year of age up to 185% of the federal
poverty level eligible for Medicaid; (2) using more liberal income and asset standards to
determine eligibility than those required under law (as allowed under §1902(r)(2) of
Medicaid law); and (3) using research and demonstration waivers (authorized under §1115
of the Social Security Act) to cover children who would not otherwise be eligible for the
program. Forty-one states have expanded Medicaid eligibility for at least some children
beyond federal mandates.6 Table 1 shows income limits for Medicaid eligibility as a
3 (...continued)
it must not substitute for health insurance coverage that would otherwise be provided to the
children.
4 Medicaid eligibility for all low-income children born after September 30, 1983 was
mandated in the Omnibus Budget Reconciliation Act of 1990 (OBRA-90).
5 These children are commonly referred to as the “Waxman Kids” after Representative
Henry Waxman of California who spearheaded eligibility expansions for children and
pregnant women under Medicaid in the late 1980s.
6 As of October 1997, 35 states used various options available to them to exceed the federal
minimum mandate of 133% federal poverty level for pregnant women and infants. Thirteen
states expanded eligibility for children ages 1 through 5 above this same mandatory minimum
(133% FPL). Twenty-eight states moved beyond the federal mandate of 100% FPL and/or
age requirements for children ages 6 and older. See Henneberry, Joan. State Medicaid
Coverage of Pregnant Women and Children.
NGA Center for Best Practices, Health
Policy Studies Division, September 30, 1997.

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percentage of the federal poverty level by age group in each of the 50 states and the
District of Columbia, in effect on March 31, 1997.7
Under SCHIP, states may cover uninsured children in families with incomes that are
above the state’s applicable Medicaid eligibility standard but less than 200% of the federal
poverty level. However, states, in which the maximum Medicaid income level for children
was at or above 200% federal poverty level as of March 31, 1997,8 may increase this
income level by an additional 50 percentage points under SCHIP, even if the resulting
income limit exceeds 200% of the federal poverty level.
Not all targeted low-income uninsured children will necessarily receive medical
assistance under SCHIP for two reasons. First, unlike Medicaid, federal law does not
establish an individual entitlement to benefits under SCHIP. Instead, it entitles states with
approved SCHIP plans to pre-determined federal allotments based on a distribution
formula set in the law. Second, states are allowed under the law to define the group of
targeted low-income children who may enroll in SCHIP. Title XXI allows states to use
the following characteristics in determining eligibility: geography, age, income and
resources, residency, disability status, access to other health insurance, and duration of
eligibility for SCHIP coverage.
In addition to the Medicaid eligibility thresholds in effect at the start of the SCHIP
program, Table 1 shows how the states, the District of Columbia, and the territories9 will
use SCHIP funds to expand eligibility thresholds beyond those applicable under Medicaid.
The table shows the type of SCHIP program implemented as well as the targeted age
groups affected. A majority of the states are expanding eligibility to levels between 150%
and 200% FPL. In one state, New Jersey, the upper income eligibility limit for Medicaid
expansions and separate state programs under SCHIP has reached 350% of the federal
poverty level.
While expansions in coverage have been achieved for all age groups of children under
SCHIP, the most significant increases in eligibility benefit older adolescents. States are
taking advantage of the opportunity to use enhanced matching funds under SCHIP to
cover a portion of the older teens ages 16-18 in families with incomes up to 100% of the
federal poverty level sooner than required under current Medicaid law. In many cases,
states are also expanding their programs to cover children of all ages in families with
income well above the 100% FPL requirement.
At the start of the SCHIP program many states submitted Medicaid expansions as
place-holder plans to ensure their access to the enhanced matching funding available
7 The proposed rule for the SCHIP program (published in the Federal Register, v. 64, no.
215, November 8, 1999) suggests a change to the official start date of SCHIP. If approved,
the date to which income eligibility is keyed will change from March 31, 1997 to June 1,
1997. While few states will be affected by the change, the new start date will represent the
lower bounds for income eligibility in the SCHIP program.
8 Ibid.
9 The five territories are American Samoa, the Commonwealth of the Northern Mariana
Islands, Guam, Puerto Rico, and the Virgin Islands.

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through SCHIP. These early Medicaid expansions were used to create more uniformity
in income eligibility criteria (e.g., provide coverage to at least 100% FPL) for all children
under the age of 18. As the program has evolved, states have submitted amendments to
their original Medicaid expansions to define separate state programs that further expand
eligibility thresholds. Of the 29 state plan amendments that expand eligibility in some way,
10 build on their original submission to create combination programs in the states.
Fourteen eligibility-related amendments increased thresholds beyond the limits defined
in the state’s original submission. Five amendments have had the effect of expanding
eligibility under SCHIP by modifying methods of counting income through the use of
income disregards.10
Enrollment
The SCHIP program is nearing its third year of existence. While significant headway
has been made by the states in the development and implementation of their SCHIP
programs, given complications associated with starting a new program, enrollment numbers
have not kept pace with expectations. Early enrollment estimates from HCFA11 indicated
that nearly 1 million children (982,000) were enrolled in SCHIP under 43 operational state
programs as of December 1998. More recently, HCFA reported that nearly 2 million
children (1,979,450) were enrolled in SCHIP during FY1999 under 53 operational state
programs.12 Over 1.2 million of these children were served by separate programs and
almost 700,000 were enrolled in Medicaid expansions. Subsequent to the enactment of
BBA 97, CBO estimated that SCHIP would cover an average of 2.3 million children per
year after 1999.13 The Administration’s goal is to enroll 5 million children in SCHIP by
FY2002.14
10 For determining income eligibility for SCHIP and Medicaid, some states may apply
“income disregards.” These are specified dollar amounts subtracted from gross income to
compute net income, which is then compared to the applicable income criterion. Such
disregards increase the effective income level above the stated standard. SCHIP state plans
do not consistently report the use of income disregards, nor whether the stated income
standards include or exclude such disregards.
11 Health Care Financing Administration. A Preliminary Estimate of the Children’s Health
Insurance Program Aggregate Enrollment Numbers Through December 31, 1998
(background only). April 20, 1999.
12 Health Care Financing Administration. The State Children’s Health Insurance
Program. Annual Enrollment Report, October 1, 1998-September 30, 1999.
(no date)
13 U.S. Congressional Budget Office. Expanding Health Insurance Coverage for
Children Under Title XXI of the Social Security Act
(CBO Memorandum). February
1998.
14 For more detail on the state by state enrollment patterns in SCHIP, see CRS Report
RL30556, Reaching Low-Income, Uninsured Children: Are Medicaid and SCHIP Doing
the Job?
by Elicia Herz, Evelyne Baumrucker, and Jennifer Gillespie and CRS Report
RL30473, State Children’s Health Insurance Program: A Brief Overview, by Elicia Herz
and Evelyne Baumrucker.

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Program Funding
Appropriations for FY1998 through FY2000
The original enacting statute provided appropriations for SCHIP for FY1998 through
FY2007. The statute authorizes and appropriates these funds in advance of any
appropriations act so that the SCHIP program operates like a mandatory spending
program. The appropriation committees do, however, have the authority to increase,
defer, or rescind funding for the SCHIP program and on several occasions have
considered proposals to do so. On three occasions, Congress has increased
appropriations for SCHIP, and on two occasions considered proposals to reduce funding
for the program.15
The law16 sets forth methodologies and procedures to determine state-specific
allotments of federal funds for each federal fiscal year; these are described below. DHHS
issues final rules in the Federal Register that enumerate specific state allotments.
A total of $4.295 billion in federal matching funds was available to the states and
territories for FY1998.17 Of this total appropriation, the amount available for allotment to
the 50 states and the District of Columbia was $4.224 billion. An additional $10.738
million was set-aside for allotment to the territories, as was another $60 million for Special
Diabetes Grants.18
For FY1999, $4.307 billion in federal matching funds was appropriated for the states
and territories. For this year, an additional $32 million was appropriated for allotment to
the territories under the FY1999 Omnibus Appropriations Act, (P.L. 105-277). These
new funds brought the FY1999 federal funds available to the territories for SCHIP to
$42.690 million. The states and the District of Columbia will share $4.204 billion, and $60
million is available for diabetes grants for FY1999.
For FY2000, SCHIP appropriations total $4.309 billion. The amount of federal
funds available for distribution to the states and the District of Columbia is $4.204 billion.
The territories will receive $44.890 million, consisting of their original FY2000 allotment
15 For more information see CRS Report RS20628, State Children’s Health Insurance
Program (SCHIP): FY2000 and FY2001 Appropriations,
by Evelyne Baumrucker.
16 Federal Register, v. 65, no. 101, May 24, 2000.
17 P.L. 105-100, §162(8)(a), struck out “$4,275,000,000" and substituted “$4,295,000,000,”
effective as if included in the enactment of P.L. 105-33, August 5, 1997.
18 The original authorizing legislation for SCHIP requires that .25% of the program’s total
authorization be set-aside for the territories. In addition, the law requires that the amount
available to the 50 states and the District of Columbia be further reduced (after the set-aside
to the territories) by $60,000,000; $30,000,000 each for a special diabetes research program
for Type I diabetes and for special diabetes programs for Native Americans. The diabetes
programs are funded for FY1998 through FY2002 only.

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plus an additional sum of $34.200 million provided by P.L. 106-113, the Balanced Budget
Refinement Act. Again, $60 million is set aside for diabetes grants.19

Allotments Among the States
For each fiscal year, the states and the District of Columbia are allotted a
“proportion” of the total amount of title XXI dollars available for that year. A state’s
proportion refers to the amount of the allotment for a state for a given fiscal year divided
by the total amount available nationally for all states for that fiscal year. The state
proportions are determined by a two-step process described below.
Under the first step, each state’s proportion is calculated as the product of two
components: the Number of Children Factor and the State Cost Factor. In general, the
Number of Children Factor is the combination of the number of low-income children
regardless of insurance status, and the number of low-income, uninsured children residing
in a state for a given fiscal year.20 The State Cost Factor is the sum of .85 multiplied by
the ratio of the annual average wages per employee in the health services industry for the
year to the national average wages per such employee for the year, and .15. For each
fiscal year and state, counts of children are 3-year averages taken from recent March
Supplements of the Current Population Survey. Employee wages are 3-year averages as
reported by the Bureau of Labor Statistics.
The definition of the Number of Children Factor in this formula varies across fiscal
years. For FY1998 and FY1999 only, this factor is defined as the 3-year average of
uninsured children in families with income below 200% FPL. For FY2000 only, for each
state this factor is the sum of 75% of the number of low-income uninsured children, and
25% of the number of low-income children. For FY2001 through FY2007, for each
state this factor is the sum of 50% of the number of low-income, uninsured children and
50% of the number of low-income children.
In the second step, floors, ceilings, and a reconciliation process are applied to the
“preadjusted” proportions determined in step one. The SCHIP statute specifies three
minimum proportions that must be applied when determining each state’s allotment: (1) the
program floor for every state is $2 million; (2) for each fiscal year, the floor will not be less
than 90% of a state’s allotment proportion for the preceding year; and (3) the floor is set
at 70% of the proportion for FY1999. The state’s proportion must not go below any of
19 The Balanced Budget Refinement Act provided additional funding for SCHIP-related
issues. For each of the FY2000 through FY2007, $10 million is provided to the Secretary of
Commerce to make appropriate adjustments to the annual Current Population Survey (CPS)
to improve the reliability of state-specific estimates of the number of low-income uninsured
children. In addition, for FY2000, $10 million is provided for a new federal evaluation of the
SCHIP program. For more details on changes made to the Medicaid and SCHIP programs
by P.L. 106-133, see CRS Repor t RL30400, Medicaid and the State Children’s Health
Insurance Program (SCHIP): Provisions in the Consolidated Appropriations Act for
FY2000
by Jean Hearne and Elicia Herz. (Hereafter cited as CRS Report RL30400,
Medicaid and the State Children’s Health Insurance Program)
20 Low-income is defined as a family with income below 200% of the federal poverty level.

CRS-7
these three floors. Comparably, each state’s proportion for a fiscal year is also limited
by a maximum ceiling. The ceiling is equal to145% of a state’s allotment proportion for
FY1999. Finally, the sum of the “preadjusted” proportions for all states must be equal to
one. If they are not, the allotment proportions will be subject to a reconciliation process.
Under the reconciliation process, if the application of the floors and ceilings across states
results in a surplus for a given year, HCFA must apply a pro-rata increase for all states
below the ceiling. If the distribution creates a deficit in a given year, there will be a ceiling
in the maximum increase permitted in that year to ensure budget neutrality.
A state’s final annual allotment is then calculated by multiplying the state’s “adjusted”
proportion for that fiscal year by the national total appropriated in that year. Final
allotments are published in the Federal Register.
Payments to the States
To receive federal funds, states must submit a plan describing their program to the
Health Care Financing Administration (HCFA) for approval. In order to access FY1998
allotments, states must have received such approval prior to October 1, 1999. All states
had approved plans by the deadline. Funds not drawn down from a state’s federal
allotment by the end of each fiscal year will continue to be available for 2 additional fiscal
years, giving each state a total of 3 years to spend its allotment of federal matching funds
from a given fiscal year. A state must draw down its entire allotment from a given fiscal
year before it may access the next year’s funding. FY1998 money not spent by the end
of FY2000 (as of September 30, 2000) will be redistributed by a method, to be
determined by the Secretary of HHS, to states that have fully expended their existing
FY1998 allotments, and are able to provide matching funds. These states will have 1 year
to spend the redistributed funds. Redistributed funds not spent by the end of the fiscal year
in which they are reallotted will officially expire.
Federal law limits the funds available to pay for the administrative costs of SCHIP
to 10% of spending for benefits in any given year. Activities included in the 10% cap
consist of (1) costs incurred through data collection, assessment of the state plan, quality
assurance activities, eligibility determination, performance measurements, outreach and
coordination initiatives, and public involvement, (2) health benefit coverage of specialty
and sub-speciality care, and (3) special initiatives for improving the health of children.
Many states are concerned that the 10% administrative cap will limit their ability to
fund outreach initiatives necessary to find and enroll eligible children. Because the 10% cap
is applied to the total benefit payments made to a state in any year (10% of the money a
state actually draws down, as opposed to its full allotment), states have questioned whether
there will be sufficient funds available to pay the substantial start-up costs of their SCHIP
programs. In response to these concerns, HCFA has published guidance that gives states
some flexibility on the 10% cap.
States that chose Medicaid expansions can claim federal matching funds for
administrative and outreach expenditures either through the regular Medicaid program at
the applicable Medicaid federal matching rate or under SCHIP at the enhanced matching
rate. This allows states to spread out their administrative costs across two programs.

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States also have the option to delay the submission of claims for administrative
expenditures to HCFA for up to 2 years from the date of the expenditure. This process
allows states with low benefit expenditures in the early years of their program to maximize
reimbursement for administrative expenditures at the enhanced federal matching rate.
Tables 2, 3, and 4 provide SCHIP program funding information for the states and
territories for FY1998, FY1999 and FY2000 respectively. The second column of each
table shows total allotments of federal funds. Allotment amounts for FY2001 (and
beyond) will be published in the Federal Register.
Like Medicaid, SCHIP is a federal-state matching program. For each dollar of state
spending, the federal government will make a matching payment. The third and fourth
columns of Tables 2, 3, and 4 provide Federal Medical Assistance Percentages
(FMAP)21 and Enhanced Federal Medical Assistance Percentages (Enhanced FMAP).
Under Medicaid, a state’s share of program spending is equal to 100% minus the FMAP
for the state. Under SCHIP, the Enhanced FMAP is equal to the state’s Medicaid FMAP
increased by the number of percentage points that is equal to 30% multiplied by the
number of percentage points by which the FMAP is less than 100%. For example, if a
state has a Medicaid FMAP of 50%, under Medicaid the state must spend 50 cents for
every 50 cents that the federal government contributes. The Enhanced FMAP would be
equal to the Medicaid federal matching percentage increased by 15 percentage points,
(50% + (30% multiplied by 50%) = 65%). The state share under SCHIP would be equal
to 100% - 65% = 35%.
Compared with Medicaid FMAPs, which ranged from 50% to 76.8% in FY2000,
the Enhanced FMAP for the SCHIP programs ranged from 65% to 83.76%. The
Enhanced FMAP applies to all SCHIP assistance for targeted low-income children,
including child health coverage provided through a Medicaid expansion. The FMAP and
Enhanced FMAP are subject to ceilings of 83% and 85%, respectively.
The totals in the fifth, sixth, and final columns of Tables 2, 3, and 4 are estimates of
the required state match necessary to claim the maximum federal SCHIP allotments;
estimates of the ratio of federal dollars spent to each state dollar; and estimates of potential
total program expenditures (state share + federal share), respectively. Because states have
3 years to draw down a given year’s funding and the Enhanced FMAPs are variable from
year to year, it is not possible to report a precise dollar amount in these columns. The
Enhanced FMAP used to determine the required state match is based on the date the state
makes a payment to cover a SCHIP claim.22 The state then submits claims for these
payments to HCFA on a quarterly expenditure report. Once state claims have been
approved by HCFA, the federal portion is paid to the state using the oldest open allotment
and the Enhanced FMAP applicable to the date the state made specific payments to
providers. For example, assume a state makes a payment to a provider in April of
FY2000. If the state then submits its corresponding claim to HCFA on its FY2000, third
21 FMAP is a measure of the 3-year average per capita income in each state squared,
compared to that of the nation as a whole.
22 Federal Register, v. 65, no. 101, May 24, 2000 and Federal Register, 45 CFR Parts 92
and 95, May 24, 2000.

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quarter expenditure report and the state’s FY1998 allotted funds are still available, then
the federal dollars paid to the state for that claim will be paid out of the FY1998 allotment
and the amount will be based on the state’s FY2000 Enhanced FMAP.
Spending
Spending projections in the first 2 years of the program are consistent with HCFA’s
enrollment figures and fall well below total federal appropriation levels. Federal spending
in FY1998 totaled less than $500 million. CBO estimates that federal SCHIP spending
will total approximately $1 billion for FY1999 and $2 billion for FY2000.23 For each of
these years, total annual federal appropriation levels are approximately $4.3 billion. Based
on actual spending and projections through February 2000, HCFA estimates that about
$1.9 billion may remain unspent from the FY1998 allotments by the end of FY2000 and
will be subject to redistribution in early FY2001.24 At that point in time, only 12 states and
three territories were expected to claim their full FY1998 allotments. It is to early to
determine whether states will ultimately claim their full FY1999 and FY2000 federal
SCHIP funding.25
For more information about SCHIP, see CRS Report 97-92, The State Children’s
Health Insurance Program: Guidance on Frequently Asked Questions, CRS Report
RL30400, Medicaid and the State Children’s Health Insurance Program (SCHIP):
Provisions in the Consolidated Appropriations Act for FY2000,
CRS Report
RL30556, State Children’s Health Insurance Program: A Brief Overview and CRS
Report RS20628, State Children’s Health Insurance Program (SCHIP): FY2000 and
FY2001 Appropriations.

23 U.S. Congressional Budget Office. The Budget and Economic Outlook: Fiscal Years
2001-2010.
Washington, GPO, March 2000.
24 HCFA’s FY1998 SCHIP spending projections are based on state submitted actual
expenditures through FY1999 and state submitted expenditure estimates for FY2000 through
February of this year (HCFA, unpublished data, April 4, 2000).
25 For more information on SCHIP in the FY2000 and FY2001 appropriations process, see
CRS Report RS20628, State Children’s Health Insurance Program (SCHIP): FY2000
and FY2001 Appropriations,
by Evelyne P. Baumrucker.

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Table 1. Medicaid and SCHIP Income and Age Related Eligibility Criteria as a Percent of the Federal Poverty Level
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
Alabama
133
133
100
15




100
200




Alaska
133
133
100
100
200









American














Samoag
Arizona
140
133
100
30





200




Arkansash
133
133
100
18




100





(born
after
9/30/82
and
before
10/1/83)
California
200
133
100
82




100
250




Colorado
133
133
100
37





185




(0-17)
Connecticut
185
185
185
100




185
300i





CRS-11
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
Delaware
133
133
100
100





200




District of
185
133
100
50
200









Columbia
Florida j
185
133
100
28




100
200




Georgia
185
133
100
100





200




Guam k














Hawaii l
185
133
100
100


185







(1-6)
Idaho
133
133
100
100
150









Illinois
133
133
100
46

200

133

185




(6-18)
(1-18)
Indiana
150
133
100
100
150




200




(1-18)
Iowa
185
133
100
37




133
185




(6-18)
(1-18)
m
Kansas
150
133
100
100





200




(0-18)

CRS-12
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
Kentucky
185
133
100
33
150




200




(1-18)
Louisiana
133
133
100
10
150









Maine
185
133
125
125
150




185




(1-18)
(1-18)
Maryland
185
185
185
100
200 n









Massachusetts
185
133
114
86
150




200




(1-18)
Michigan
185
133
100
100




150
200




Minnesota
275
275
275
275

280








(0-2)
Mississippi
185
133
100
34




100
200




Missourio
185
133
100
100
200









Montana
133
133
100
40.5





150




Nebraska
150
133
100
33
185









Nevada
133
133
100
31





200





CRS-13
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
New
185
185
185
185
300



300




Hampshire
(0-1
(1-18)p
only)
New Jersey
185
133
100
41



133

350


(6-18)
New Mexico
185
185
185
185
235









New Yorkj
185
133
100
51




100
192




North Carolina
185
133
100
100





200




Northern














Marianasq
North Dakota
133
133
100
100 (thru




100
140




age 17)
(18 only)
Ohio
133
133
100
33
200









Oklahoma
150
133
100
48
185









(0-17
and
preg.
teens)
Oregon
133
133
100
100





170




Pennsylvania j
185
133
100
41





200r





CRS-14
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
Puerto Ricos




200









(0-18)s
Rhode Island
250
250 (thru
100 (ages
100



250






age 7)
8 thru 14)
(8-18)t
u
u
u
South Carolina
185
150









(1-18)u
South Dakota
133
133
100
100
140









Tennesseev



16




100





(17-18)v
Texas
185
133
100
17




100
200




Utah
133
133
100
100 (thru





200




age 17)
Vermont
225
225
225
225





300




(0-17)w
Virginia
133
133
100
100





185




Virgin Islandsx




Family









of four
<$8,500
annually

CRS-15
SCHIP (In Effect 7/7/00)c
Medicaid Standards in Effect 3/31/97 (lower
income boundary for SCHIP)a/b
Medicaid expansion
Separate state plan
Children
Children
age 6 and
ages 6
over
and over
Preg.
Preg.
teens
Children
(Through
All
teens
Children
(Through
Age 0
Ages 1
Ages 6
Ages 15
All ages
and
below
upper age
Children
ages
and
below
upper age
Children
States
to 1d
thru 5e
thru 14 a
thru 18f
0-18
infantsd
age 6e
limit)
16-18
0-18
infantsd
age 6e
limit)
16-18
Washington
200
200
200
200





250




West Virginia
150
133
100
100


150





150

(1-5)
Wisconsin
185
185
100
45


185







(6-18)y
Wyoming
133
133
100
55








133

Source: CRS analysis of submitted state plans and amendments.
a Title XXI contains a provision that a child’s family income must exceed the applicable Medicaid income level that was in effect on March 31, 1997 in order for that child to be eligible for SCHIP-
funded coverage. If approved, the proposed rule (published in the Federal Register, vol. 64, no. 215, Monday November 8, 1999) will change that date from March 31, 1997 to June 1, 1997-a change
that will affect income eligibility in a few states. These percentages represent the lower income boundary for the SCHIP program. Information for the Medicaid eligibility portion of this table comes
from the Health Care Financing Administration, The State Children’s Health Insurance Program; Annual Enrollment Report; October 1, 1998 through September 30, 1999; January 2000.
b In 34 states, children may also qualify for Medicaid through medically needy programs (data not shown). In most cases, income criteria for medically needy programs are above AFDC-related standards
but less than 133% of the federal poverty level.
c The 2000 federal poverty guideline for a family of three is $14,150 per year; for Alaska $17,690; and for Hawaii $16,270.
d To be eligible as an infant, a child is under age 1 and has not yet reached his or her first birthday.
e To be eligible in this category, the child is age 1 or older, but has not yet reached his or her 6th birthday.
f Federal law requires states to provide Medicaid to children in families with incomes that meet the state’s former Aid to Families with Dependent Children (AFDC) income eligibility standards in effect
on July 16, 1996. In addition, since July 1, 1991, states (under OBRA 1990) have been required to cover all children under age 19, who were born after September 30, 1983, and whose family income
is below 100% of the federal poverty level. The 1983 start date means that the mandatory coverage is extended to children by one age cohort each year until reaching those under age 19 in FY2002.
If a state has expanded eligibility to older children beyond the OBRA 1990 mandate, the former AFDC standard as it applies to Medicaid eligibility is not applicable. The data in this column reflect
the federal minimum requirements of states for children ages 15 and older on March 31, 1997 (see footnote “a”). The eligibility levels recorded in this column were in effect at the start of the SCHIP
program and thus represent the lower income boundary for SCHIP.

CRS-16
g In American Samoa, eligibility for Medicaid and SCHIP are determined based on a system of presumptive eligibility. American Samoa does not use a system of individual eligibility determinations. Each
year the percentage of the population that falls below the American Samoan poverty level is estimated and, after approval of the estimate, HCFA pays a capitated amount for Medicaid based on
that percentage.
h Arkansas increased Medicaid eligibility to 200% FPL effective September 1997 through a §1115 demonstration authority.
i State-sponsored health insurance will be available to all uninsured children in Connecticut. If the family’s income is above 300% federal poverty level, the family will be expected to pay premiums and
cost-sharing to access services. For children with family incomes greater than 300% federal poverty level, only state dollars will be used for funding.
j These states had state-funded programs that existed prior to SCHIP. Title XXI permitted children in these state-funded programs to be covered under SCHIP and required these states to maintain their
previous levels of state spending.
k In Guam, Medicaid and SCHIP eligibility determinations are made by the Department of Public Health and Social Services. The Medicaid program claims federal financial participation (FFP) only for
covered services to the categorically needy.
l Hawaii’s coverage of pregnant women and children is through Hawaii QUEST, a §1115 waiver managed care program.
m On January 3, 2000, the state submitted an amendment to its approved Title XXI plan which allows for a 20% deduction to earned income in determining eligibility for the Hawk-I program and includes
an additional managed health care plan, Unity Choice, from Wellmark Health Plan of Iowa.
n Maryland submitted an amendment January 3, 2000 that amends its §1115 demonstration waiver to implement state legislation enacted in the 1999 legislative session. It imposes a premium on children
whose families have incomes above 185% FPL enrolled in the Maryland Children’s Health Program by July 1, 2000.
o Missouri will use Title XXI funds to expand its Medicaid program to children up to age 18 with family incomes up to 200% federal poverty level; Missouri will cover children with family incomes
between 200-300% of the federal poverty level at its regular Medicaid FMAP through an §1115 Medicaid Waiver. The §1115 waiver allows the state to charge cost sharing payments to eligible
families between 185-300% of the federal poverty level for children between the ages 0-18.
p New Hampshire will apply an income disregard to determine eligibility for SCHIP.
q The Northern Mariana Islands do not have an AFDC or TANF program. However, it is the only U.S. Territory that does have Supplemental Security Income (SSI), and its entire Medicaid program
is based on SSI requirements. All individuals receiving SSI cash payments are eligible for Medicaid. All other individuals who meet the income and resource standards for SSI, with the standard
exemptions and deductions, are also eligible. In addition, although the Northern Mariana Islands do not have a medically needy program, anyone can spend down to become eligible for any month
in which medical costs reduce income to the appropriate level.
r Pennsylvania uses state funds to extend coverage up to 235% of the federal poverty level for all children up to their 19th birthday.
s Puerto Rico’s Medicaid program extends covered services to both the categorically needy (TANF) and the medically needy. There is no SSI, rather the former mainland classifications of Old Age
Assistance, Aid to the Blind, Aid to the Permanently and Totally Disabled, exist. Although mandated on the mainland, the Commonwealth has not opted to cover poverty level groups, and
is exempt from requirements linking the “medically needy” income levels to “categorically needy” (formerly AFDC) income levels. The medically needy income level for a family of four is
$8,220 with a resource level of $900. The yearly categorically needy standard for a family of four is $1,536.
t Rhode Island expanded Medicaid eligibility up to 250% federal poverty level through a §1115 waiver. Benefits for children age 8 thru age 18 under this waiver will be financed by Title XXI funds
and are considered the state’s Medicaid Expansion under SCHIP. HCFA approved eligibility up to 300% FPL as submitted in the state’s original plan submission, but the Rhode Island state
legislature has not approved this expansion.
u In August of 1997, the South Carolina state legislature approved an expansion of the state’s Medicaid program to cover all children in families with incomes less than 150% federal poverty level up to
age 19. Because Title XXI was created just months later (October of 1997) HCFA approved the use of Title XXI funds for this expansion. Cells were left blank in the Medicaid columns to
underscore that the expansion to Medicaid in the state is funded by Title XXI.
v TennCare offers health insurance for uninsured families at any income level. Premiums are charged on a sliding fee scale based on family size and income. Uninsured enrollees from families with incomes
above 400% federal poverty level are charged a monthly premium based on a higher sliding fee scale than for those below 400% federal poverty level. Through SCHIP, the state will extend eligibility
to uninsured children born before October 1, 1983, who are under age 19 in families with incomes at or below 100% of the federal poverty level and who could not have been enrolled under the
operating rules for the state’s Medicaid demonstration program before April 1, 1997. TennCare’s eligibility for this population was officially closed on March 31, 1997 because they had exhausted
state and federal dollars at the regular Medicaid FMAP. The state can cover this population with Title XXI enhanced matching funds since this group was not covered by Medicaid at the date
specified in the SCHIP legislation, and therefore would be eligible for SCHIP.
w In Vermont Title XXI funds are used to cover children through their 17 birthday up to 300% FPL. Vermont also covers under-insured children through age 17 up to 300% FPL using a §1115 Medicaid
waiver with §1902(r)(2) cost-sharing requirements.

CRS-17
x The Virgin Islands cover the medically needy, and persons in families with an annual income less than $8,500. There is an income disregard of $1,800 for specified resources. HCFA approved a state
plan amendment on February 4, 2000 that permits the use of SCHIP monies to pay any medical expenses incurred after the Virgin Islands runs out of Medicaid federal dollars. Previously, SCHIP
payments were restricted for payments to hospitals and clinics. The amendment allows the Virgin Islands to pay inpatient pediatric medical bills incurred by an approved medical provider for
children less than age 19 in the territory’s hospitals.
y Once a family is enrolled, eligibility is maintained until income exceeds 200% federal poverty level. Wisconsin may receive enhanced Title XXI FMAP to cover both parents and children if the cost-
effectiveness of family coverage is demonstrated. Also, Wisconsin may cover families through employer-sponsored insurance when it is demonstrated to be cost-effective.

CRS-18
Table 2. Financial Program Information for States and Territories FY1998a
Estimated state
Estimated
Estimated total program
Total federal
Enhanced
match for maximum
federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state share
State (or other territory)
dollars FY1998b
FY1998c
FY1998c
dollars FY1998d
dollard
FY1998)d
Alabama
85,975,213
69.32
78.52
23,519,455
3.66
109,494,668
Alaska
6,889,296
59.80
71.86
2,697,812
2.55
9,587,108
American Samoa
128,850
50.00
65.00
69,381
1.86
198,231
Arizona
116,797,799
65.33
75.73
37,431,435
3.12
154,229,234
Arkansas
47,907,958
72.84
80.99
11,244,972
4.26
59,152,930
California
854,644,807
51.23
65.86
443,024,198
1.93
1,297,669,005
Colorado
41,790,547
51.97
66.38
21,165,987
1.97
62,956,534
Connecticut
34,959,075
50.00
65.00
18,824,117
1.86
53,783,192
Delaware
8,053,463
50.00
65.00
4,336,480
1.86
12,389,943
District of Columbia
12,076,002
70.00
79.00
3,210,076
3.76
15,286,078
Florida
270,214,724
55.65
68.96
121,627,973
2.22
391,842,697
Georgia
124,660,136
60.84
72.59
47,071,695
2.65
171,731,831
Guam
375,813
50.00
65.00
202,361
1.86
578,174
Hawaii
8,945,304
50.00
65.00
4,816,702
1.86
13,762,006
Idaho
15,879,707
69.59
78.71
4,295,248
3.70
20,174,955
Illinois
122,528,573
50.00
65.00
65,976,924
1.86
188,505,497
Indiana
70,512,432
61.41
72.99
26,093,174
2.70
96,605,606

CRS-19
Estimated state
Estimated
Estimated total program
Total federal
Enhanced
match for maximum
federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state share
State (or other territory)
dollars FY1998b
FY1998c
FY1998c
dollars FY1998d
dollard
FY1998)d
Iowa
32,460,463
63.75
74.63
11,034,731
2.94
43,495,194
Kansas
30,656,520
59.71
71.80
12,040,583
2.55
42,697,103
Kentucky
49,932,527
70.37
79.26
13,065,867
3.82
62,998,394
Louisiana
101,736,841
70.03
79.02
27,011,376
3.77
128,748,217
Maine
12,486,977
66.04
76.23
3,893,683
3.21
16,380,660
Maryland
61,627,358
50.00
65.00
33,183,962
1.86
94,811,320
Massachusetts
42,836,231
50.00
65.00
23,065,663
1.86
65,901,894
Michigan
91,585,508
53.58
67.51
44,076,628
2.08
135,662,136
Minnesota
28,395,980
52.14
66.50
14,304,742
1.99
42,700,722
Mississippi
56,017,103
77.09
83.96
10,701,695
5.23
66,718,798
Missouri
51,673,123
60.68
72.48
19,619,817
2.63
71,292,940
Montana
11,740,395
70.56
79.39
3,047,859
3.85
14,788,254
Nebraska
14,862,926
61.17
72.82
5,547,574
2.68
20,410,500
Nevada
30,407,067
50.00
65.00
16,373,036
1.86
46,780,103
New Hampshire
11,458,404
50.00
65.00
6,169,910
1.86
17,628,314
New Jersey
88,417,899
50.00
65.00
47,609,638
1.86
136,027,537
New Mexico
62,972,705
72.61
80.83
14,934,885
4.22
77,907,590
New York
255,626,409
50.00
65.00
137,644,989
1.86
393,271,398

CRS-20
Estimated state
Estimated
Estimated total program
Total federal
Enhanced
match for maximum
federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state share
State (or other territory)
dollars FY1998b
FY1998c
FY1998c
dollars FY1998d
dollard
FY1998)d
North Carolina
79,508,462
63.09
74.16
27,703,596
2.87
107,212,058
North Dakota
5,040,741
70.43
79.30
1,315,805
3.83
6,356,546
Northern Marianas
118,113
50.00
65.00
63,599
1.86
181,712
Ohio
115,734,364
58.14
70.70
47,963,463
2.41
163,697,827
Oklahoma
85,699,061
70.51
79.36
22,288,667
3.84
107,987,728
Oregon
39,121,663
61.46
73.02
14,454,978
2.71
53,576,641
Pennsylvania
117,456,521
53.39
67.37
56,888,916
2.06
174,345,437
Puerto Rico
9,835,550
50.00
65.00
5,296,065
1.86
15,131,615
Rhode Island
10,684,422
53.17
67.22
5,210,285
2.05
15,894,707
South Carolina
63,557,819
70.23
79.16
16,732,503
3.80
80,290,322
South Dakota
8,541,224
67.75
77.43
2,489,674
3.43
11,030,898
Tennessee
66,153,082
63.36
74.35
22,822,146
2.90
88,975,228
Texas
561,331,521
62.28
73.60
201,347,176
2.79
762,678,697
Utah
24,241,159
72.58
80.81
5,756,563
4.21
29,997,722
Vermont
3,535,445
62.18
73.53
1,272,722
2.78
4,808,167
Virginia
68,314,915
51.49
66.04
35,129,838
1.94
103,444,753
Virgin Islands
279,175
50.00
65.00
150,325
1.86
429,500
Washington
46,661,213
52.15
66.51
23,495,475
1.99
70,156,688

CRS-21
Estimated state
Estimated
Estimated total program
Total federal
Enhanced
match for maximum
federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state share
State (or other territory)
dollars FY1998b
FY1998c
FY1998c
dollars FY1998d
dollard
FY1998)d
West Virginia
23,606,744
73.67
81.57
5,333,729
4.43
28,940,473
Wisconsin
40,633,039
58.84
71.19
16,443,852
2.47
57,076,891
Wyoming
7,711,638
63.02
74.11
2,694,027
2.86
10,405,665
Source : CRS analysis of submitted state plans, and Federal Register, v. 65, no. 101, May 24, 2000 and Federal Register, 45 CFR Parts 92 and 95, May 24, 2000.
a Financial information for FY1998 is published in the Federal Register, v. 65, no. 101, May 24, 2000. FMAP and Enhanced FMAP figures for FY1998 can be found in the Federal Register, v. 62, no.
177, September 12, 1997.
b Allotments recorded in this column account for the funding changes described in the Federal Register, v. 64, no. 25, February 8, 1999. These changes include a recalculation of state allotments across
all years of the program due to a change in the method of counting uninsured children from the Current Population Survey (Section 707 of P.L. 105-277). In particular, children who had access
to services through the Indian Health Service (IHS), but no other health insurance coverage are now classified as uninsured which resulted in an increase in the counts of uninsured children in 11 states.
The total amount of federal funding available for allotment to the 50 states and the District of Columbia for FY1998 is $4,224,262,500, determined by reducing the FY1998 appropriation ($4.295
billion) by the total amount available for allotment to the territories ($10,737,500) and amounts for the Special Diabetes Grants ($60,000,000) under Sections 4921 and 4922 of BBA. The total
amount of federal funds available to the territories is determined by multiplying .25% by the FY1998 authorization ($4.295 billion).
c These numbers represent the Federal Medical Assistance Percentage (FMAP) and the Enhanced Federal Medical Assistance Percentage (Enhanced FMAP). They are effective from October 1, 1997
to September 30, 1998 and are published in the Federal Register, v. 62, no. 226, November 24, 1997.
d The totals in these columns are: (1) estimates of the required state match necessary to claim maximum federal SCHIP allotments; (2) estimates of the ratio of federal dollars spent to each state dollar;
and (3) estimates of potential total program expenditures (state share + federal share). Because states have 3 years to draw down a given year’s funding and the Enhanced FMAP rates (Enhanced
FMAP) are variable from year to year – it is not possible to report a precise dollar amount in these columns.

CRS-22
Table 3. Financial Program Information for States and Territories FY1999a
Required state
Potential total program
Total federal
Enhanced
match for maximum
Federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state
State (or other territory)
dollars FY1999b
FY1999c
FY1999c
dollars FY1999d
dollar FY1999d
share FY1999)d
Alabama
85,569,176
69.27
78.49
23,450,032
3.65
109,019,208
Alaska
6,856,760
59.80
71.86
2,685,071
2.55
9,541,831
American Samoa
512,250
50.00
65.00
275,827
1.86
788,077
Arizona
116,246,196
65.50
75.85
37,011,808
3.14
153,258,004
Arkansas
47,681,702
72.96
81.07
11,133,769
4.28
58,815,471
California
850,608,561
51.55
66.09
436,437,227
1.95
1,287,045,788
Colorado
41,593,182
50.59
65.42
21,985,513
1.89
63,578,695
Connecticut
34,793,973
50.00
65.00
18,735,216
1.86
53,529,189
Delaware
8,015,429
50.00
65.00
4,316,000
1.86
12,331,429
District of Columbia
12,018,971
70.00
79.00
3,194,916
3.76
15,213,887
Florida
268,938,576
55.82
69.07
120,432,462
2.23
389,371,038
Georgia
124,071,402
60.47
72.33
47,463,787
2.61
171,535,189
Guam
1,494,063
50.00
65.00
804,495
1.86
2,298,558
Hawaii
8,903,057
50.00
65.00
4,793,954
1.86
13,697,011
Idaho
15,804,712
69.85
78.89
4,229,148
3.74
20,033,860
Illinois
121,949,905
50.00
65.00
65,665,333
1.86
187,615,238
Indiana
70,179,422
61.01
72.71
26,340,207
2.66
96,519,629

CRS-23
Required state
Potential total program
Total federal
Enhanced
match for maximum
Federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state
State (or other territory)
dollars FY1999b
FY1999c
FY1999c
dollars FY1999d
dollar FY1999d
share FY1999)d
Iowa
32,307,161
63.32
74.32
11,163,185
2.89
43,470,346
Kansas
30,511,738
60.05
72.03
11,848,026
2.58
42,359,764
Kentucky
49,696,709
70.53
79.37
12,917,262
3.85
62,613,971
Louisiana
101,256,366
70.37
79.26
26,495,799
3.82
127,752,165
Maine
12,428,004
66.40
76.48
3,822,001
3.25
16,250,005
Maryland
61,336,309
50.00
65.00
33,027,243
1.86
94,363,552
Massachusetts
42,633,928
50.00
65.00
22,956,730
1.86
65,590,658
Michigan
91,152,976
52.72
66.91
45,079,240
2.02
136,232,216
Minnesota
28,261,873
51.50
66.05
14,526,731
1.95
42,788,604
Mississippi
55,752,550
76.78
83.75
10,817,659
5.15
66,570,209
Missouri
51,429,086
60.24
72.17
19,831,945
2.59
71,261,031
Montana
11,684,948
71.73
80.21
2,882,996
4.05
14,567,944
Nebraska
14,792,733
61.46
73.02
5,465,735
2.71
20,258,468
Nevada
30,263,463
50.00
65.00
16,295,711
1.86
46,559,174
New Hampshire
11,404,289
50.00
65.00
6,140,771
1.86
17,545,060
New Jersey
88,000,326
50.00
65.00
47,384,791
1.86
135,385,117
New Mexico
62,675,303
72.98
81.09
14,615,735
4.29
77,291,038
New York
254,419,158
50.00
65.00
136,994,931
1.86
391,414,089

CRS-24
Required state
Potential total program
Total federal
Enhanced
match for maximum
Federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state
State (or other territory)
dollars FY1999b
FY1999c
FY1999c
dollars FY1999d
dollar FY1999d
share FY1999)d
North Carolina
79,132,966
63.07
74.15
27,587,150
2.87
106,720,116
North Dakota
5,016,935
69.94
78.96
1,336,833
3.75
6,353,768
Northern Marianas
469,563
50.00
65.00
252,842
1.86
722,405
Ohio
115,187,783
58.26
70.78
47,552,798
2.42
162,740,581
Oklahoma
85,294,328
70.84
79.59
21,872,814
3.90
107,167,142
Oregon
38,936,902
60.55
72.38
14,858,210
2.62
53,795,112
Pennsylvania
116,901,807
53.77
67.64
55,927,594
2.09
172,829,401
Puerto Rico
39,101,750
50.00
65.00
21,054,788
1.86
60,156,538
Rhode Island
10,633,962
54.05
67.83
5,043,411
2.11
15,677,373
South Carolina
63,257,653
69.85
78.89
16,926,975
3.74
80,184,628
South Dakota
8,500,886
68.16
77.71
2,438,357
3.49
10,939,243
Tennessee
65,840,660
63.09
74.16
22,941,244
2.87
88,781,904
Texas
558,680,510
62.45
73.72
199,160,659
2.81
757,841,169
Utah
24,126,675
71.78
80.25
5,937,718
4.06
30,064,393
Vermont
3,518,748
61.97
73.38
1,276,493
2.76
4,795,241
Virginia
67,992,282
51.60
66.12
34,839,360
1.95
102,831,642
Virgin Islands
1,109,875
50.00
65.00
597,625
1.86
1,707,500
Washington
46,440,845
52.50
66.75
23,133,455
2.01
69,574,300

CRS-25
Required state
Potential total program
Total federal
Enhanced
match for maximum
Federal dollars
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
for each state
(federal share +state
State (or other territory)
dollars FY1999b
FY1999c
FY1999c
dollars FY1999d
dollar FY1999d
share FY1999)d
West Virginia
23,495,256
74.47
82.13
5,112,142
4.60
28,607,398
Wisconsin
40,441,141
58.85
71.20
16,358,214
2.47
56,799,355
Wyoming
7,675,218
64.08
74.86
2,577,544
2.98
10,252,762
Source : CRS analysis of submitted state plans, and Federal Register, v. 65, no. 101, May 24, 2000 and Federal Register, 45 CFR Parts 92 and 95, May 24, 2000.
a Financial information for FY1999 is published in the Federal Register, v. 65, no. 101, May 24, 2000. FMAP and Enhanced FMAP figures for FY1999 can be found in the Federal Register, v. 62, no.
226, November 24, 1997.
bThe amount of federal funding available for allotment to the states and the District of Columbia for FY1999 is $4,204,312,500, determined by reducing the FY1999 appropriation ($4,275,000,000) by
the total amount available for allotment to the Commonwealths and territories ($10,687,500) and amounts for the Special Diabetes Grants ($60,000,000) under Sections 4921 and 4922 of BBA 97.
P.L. 105-277 increased amounts available to the territories by $32,000,000 for FY1999. The total amount of federal funds available to the territories in FY1999 is therefore $42,687,500. Allotments
for FY1999 come from Federal Register, v. 64, no. 25, February 8, 1999.
c These numbers represent the Federal Medical Assistance Percentage (FMAP) and the Enhanced FMAP. They are effective from October 1, 1998 to September 30, 1999 and are presented in the Federal
Register, v. 62, no. 226, November 24, 1997.
d The totals in these columns are: (1) estimates of the required state match necessary to claim maximum federal SCHIP allotments; (2) estimates of the ratio of federal dollars spent to each state dollar;
and (3) estimates of potential total program expenditures (state share + federal share). Because state have 3 years to draw down a given year’s funding and the Enhanced FMAP rates are variable
from year to year – it is not possible to report a precise dollar amount in these columns.

CRS-26
Table 4. Financial Program Information for States and Territories FY2000a
Federal
Required state
dollars for
Potential total program
Total federal
Enhanced
match for maximum
each state
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
dollar
(federal share +state share
State (or other territory)
dollars FY2000b
FY2000c
FY2000c
dollars FY2000d
FY2000d
FY2000)d
Alabama
77,012,259
69.57
78.70
20,843,216
3.69
97,855,475
Alaska
7,730,025
59.80
71.86
3,027,037
2.55
10,757,062
American Samoa
538,650
50.00
65.00
290,042
1.86
828,692
Arizona
130,213,077
65.92
76.14
40,804,886
3.19
171,017,963
Arkansas
53,754,360
72.85
80.99
12,617,241
4.26
66,371,601
California
765,547,705
51.67
66.17
391,393,061
1.96
1,156,940,766
Colorado
46,890,416
50.00
65.00
25,248,686
1.86
72,139,102
Connecticut
39,225,273
50.00
65.00
21,121,301
1.86
60,346,574
Delaware
9,036,260
50.00
65.00
4,865,678
1.86
13,901,938
District of Columbia
10,817,074
70.00
79.00
2,875,425
3.76
13,692,499
Florida
242,044,718
56.52
69.57
105,870,645
2.29
47,915,363
Georgia
132,381,325
59.88
71.91
51,711,743
2.56
184,093,068
Guam
1,571,063
50.00
65.00
845,957
1.86
2,417,020
Hawaii
10,036,935
51.01
65.71
5,237,658
1.92
15,274,593
Idaho
17,817,572
70.15
79.1
4,704,956
3.79
22,522,528
Illinois
137,481,231
50.00
65.00
74,028,355
1.86
211,509,586

CRS-27
Federal
Required state
dollars for
Potential total program
Total federal
Enhanced
match for maximum
each state
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
dollar
(federal share +state share
State (or other territory)
dollars FY2000b
FY2000c
FY2000c
dollars FY2000d
FY2000d
FY2000)d
Indiana
63,161,480
61.74
73.22
23,101,126
2.73
86,262,606
Iowa
32,382,884
63.06
74.14
11,295,136
2.87
43,678,020
Kansas
30,320,974
60.03
72.02
11,779,795
2.57
42,100,769
Kentucky
56,025,995
70.55
79.38
14,553,490
3.85
70,579,485
Louisiana
91,130,730
70.32
79.22
23,904,274
3.81
115,035,004
Maine
13,978,005
66.22
76.36
4,327,397
3.23
18,305,402
Maryland
56,869,698
50.00
65.00
30,622,145
1.86
87,491,843
Massachusetts
48,063,710
50.00
65.00
25,880,459
1.86
73,944,169
Michigan
102,762,059
55.11
68.58
47,080,547
2.18
149,842,606
Minnesota
31,861,256
51.48
66.04
16,384,135
1.94
48,245,391
Mississippi
58,036,226
76.80
83.76
11,252,487
5.16
69,288,713
Missouri
57,979,004
60.51
72.36
22,146,762
2.62
80,125,766
Montana
13,173,122
72.30
80.61
3,168,674
4.16
16,341,796
Nebraska
16,576,269
60.88
72.62
6,249,769
2.65
22,826,038
Nevada
30,526,393
50.00
65.00
16,437,289
1.86
46,963,682
New Hampshire
10,263,860
50.00
65.00
5,526,694
1.86
15,790,554
New Jersey
96,858,666
50.00
65.00
52,154,666
1.86
149,013,332

CRS-28
Federal
Required state
dollars for
Potential total program
Total federal
Enhanced
match for maximum
each state
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
dollar
(federal share +state share
State (or other territory)
dollars FY2000b
FY2000c
FY2000c
dollars FY2000d
FY2000d
FY2000)d
New Mexico
56,407,772
73.32
81.32
12,957,417
4.35
69,365,189
New York
286,821,535
50.00
65.00
154,442,365
1.86
441,263,900
North Carolina
89,211,202
62.49
73.74
31,769,544
2.81
120,980,746
North Dakota
5,655,883
70.42
79.29
1,477,278
3.83
7,133,161
Northern Marianas
493,763
50.00
65.00
265,872
1.86
759,635
Ohio
129,857,897
58.67
71.07
52,860,405
2.46
182,718,302
Oklahoma
76,764,895
71.09
79.76
19,479,958
3.94
96,244,853
Oregon
43,895,837
59.96
71.97
17,096,017
2.57
60,991,854
Pennsylvania
128,956,235
53.82
67.67
61,610,094
2.09
190,566,329
Puerto Rico
41,116,950
50.00
65.00
22,139,896
1.86
63,256,846
Rhode Island
9,570,566
53.77
67.64
4,578,704
2.09
14,149,270
South Carolina
71,314,037
69.95
78.96
19,002,626
3.75
90,316,663
South Dakota
7,951,348
68.72
78.11
2,228,332
3.57
10,179,680
Tennessee
74,226,011
63.10
74.17
25,849,506
2.87
100,075,517
Texas
502,812,459
61.36
72.95
186,443,825
2.70
689,256,284
Utah
27,199,406
71.55
80.08
6,765,886
4.02
33,965,292
Vermont
3,966,889
62.24
73.57
1,425,104
2.78
5,391,993

CRS-29
Federal
Required state
dollars for
Potential total program
Total federal
Enhanced
match for maximum
each state
expenditures in dollars
allotments in
FMAP %
FMAP %
federal allocation in
dollar
(federal share +state share
State (or other territory)
dollars FY2000b
FY2000c
FY2000c
dollars FY2000d
FY2000d
FY2000)d
Virginia
73,580,365
51.67
66.17
37,618,615
1.96
111,198,980
Virgin Islands
1,167,075
50.00
65.00
628,425
1.86
1,795,500
Washington
52,355,470
51.83
66.28
26,635,885
1.97
78,991,355
West Virginia
21,145,730
74.78
82.35
4,532,145
4.67
25,677,875
Wisconsin
45,591,653
58.78
71.15
18,486,566
2.47
64,078,219
Wyoming
7,068,749
64.04
74.83
2,377,662
2.97
9,446,411
Source : CRS analysis of submitted state plans, and Federal Register, v. 65, no. 101, May 24, 2000 and Federal Register, 45 CFR Parts 92 and 95, May 24, 2000.
a Financial information for FY2000 is published in the Federal Register, v. 65, no. 101, May 24, 2000. FMAP and Enhanced FMAP figures for FY2000 can be found in the Federal Register, v. 64, no.
7, January 12, 1999.
b The amount of federal funding available for allotment to the states for FY2000 is $4,204,312,500, determined by reducing the FY2000 appropriation ($4,275,000,000) by the total amount available for
allotment to the Commonwealths and Territories ($10,687,500) and amounts for the Special Diabetes Grants ($60,000,000) under sections 4921 and 4922 of BBA 97. P.L. 106-113 increased
amounts available to the territories by $34,200,000 for FY2000. The total amount of federal funds available to the Commonwealths and territories in FY2000 is therefore $44,887,500. Total
appropriations available to states and territories is $4.309 billion. Allotments for FY2000 come from Federal Register, v. 65, no. 101, May 24, 2000.
c These numbers represent the Federal Medical Assistance Percentage (FMAP) and the Enhanced FMAP. They are effective from October 1, 1999 to September 30, 2000 and are presented in the Federal
Register, v. 64, no. 7, January 12, 1999.
d The totals in these columns are: (1) estimates of the required state match necessary to claim maximum federal SCHIP allotments; (2) estimates of the ratio of federal dollars spent to each state
dollar; and (3) estimates of potential total program expenditures (state share + federal share). Because state have three years to draw down a given year’s funding and the Enhanced FMAP
rates are variable from year to year – it is not possible to report a precise dollar amount in these columns.