What Happens to SCHIP After March 31, 2009?

A report about the effects of the end of the State Children's Health Insurance Program (SCHIP).

ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱ ŘŖŖşǵȱ ‘›’œȱǯȱŽŽ›œ˜—ȱ ™ŽŒ’Š•’œȱ’—ȱ ŽŠ•‘ȱŠ›Žȱ’—Š—Œ’—ȱ ŽŒŽ–‹Ž›ȱŗşǰȱŘŖŖŞȱ ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ ŝȬśŝŖŖȱ    ǯŒ›œǯ˜Ÿȱ ŚŖŖŝśȱ ȱŽ™˜›ȱ˜›ȱ˜—›Žœœ Prepared for Members and Committees of Congress ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ ž––Š›¢ȱ The Balanced Budget Act of 1997 (BBA97, P.L. 105-33) created the State Children’s Health Insurance Program (SCHIP) and appropriated nearly $40 billion over the 10-year period FY1998 to FY2007. The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA, P.L. 110-173) appropriated more than $10 billion to ensure no state’s SCHIP program runs out of federal SCHIP funds before March 31, 2009. Without legislative action, three sources of federal SCHIP funds will no longer be available after March 2009: (1) states’ FY2008 federal SCHIP allotments; (2) states’ FY2009 federal SCHIP allotments; and (3) up to $275 million for eliminating FY2009 shortfalls through March 31, 2009. Only the handful of states with unspent FY2007 federal SCHIP balances could continue to draw federal SCHIP funds. Thus, under current law, 43 states are projected to have no federal SCHIP funds on April 1, 2009. If the availability of the FY2008 and FY2009 allotments was extended through the end of FY2009, shortfalls of federal SCHIP funds would still total approximately $1.9 billion in 27 states, though this could be mitigated in some states by the ability to access Medicaid funding, albeit at a reduced matching rate compared to SCHIP. ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ ˜—Ž—œȱ SCHIP Background and Projections................................................................................................ 1 FY2008 and FY2009 Original Allotments ................................................................................ 1 Shortfall Funding for FY2009’s First Two Quarters ................................................................. 1 Projected Shortfalls After March 31, 2009................................................................................ 1 Medicaid Fallback Financing for Certain States ....................................................................... 2 Federal Requirements Before Terminating SCHIP ......................................................................... 3 Separate SCHIP Programs......................................................................................................... 3 Medicaid-Expansion SCHIP Programs ..................................................................................... 4 Budget Issues................................................................................................................................... 4 Federal....................................................................................................................................... 4 State........................................................................................................................................... 5 Š‹•Žœȱ Table 1. Projected FY2009 Federal SCHIP Financing .................................................................... 6 ˜—ŠŒœȱ Author Contact Information ............................................................................................................ 8 ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ  ȱŠŒ”›˜ž—ȱŠ—ȱ›˜“ŽŒ’˜—œȱ The Balanced Budget Act of 1997 (BBA97, P.L. 105-33) created the State Children’s Health Insurance Program (SCHIP) and appropriated $40 billion for SCHIP original allotments from FY1998 to FY2007. The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA, P.L. 110-173) appropriated more than $10 billion for FY2008 and FY2009 SCHIP original allotments. Column B of Table 1 shows the amount of states’ FY2009 federal SCHIP allotments. Although SCHIP original allotments are generally available for three years, MMSEA made the FY2008 and FY2009 SCHIP allotments available only through March 31, 2009. ŘŖŖŞȱŠ—ȱŘŖŖşȱ›’’—Š•ȱ••˜–Ž—œȱȱ The SCHIP appropriation for original allotments in FY2007, the last year provided for in BBA97, totaled $5.04 billion. MMSEA provided that same amount annually for SCHIP allotments in FY2008 and FY2009, stating, however, that these funds “shall not be available for child health assistance [SCHIP expenditures] for items and services furnished after March 31, 2009.”1 By March 31, 2009, 35 states are projected to be spending funds from their FY2008 or FY2009 allotments. When these allotments are no longer available, these states will have no other available federal SCHIP funds. ‘˜›Š••ȱž—’—ȱ˜›ȱŘŖŖşȂœȱ’›œȱ ˜ȱžŠ›Ž›œȱ MMSEA provided for FY2009 up to $275 million for states that exhaust all available federal SCHIP funds (including their FY2008 and FY2009 allotments) before March 31, 2009. Based on CRS analysis of the latest projections provided by states and current as of December 11, 2008, eight states will qualify for the additional shortfall funding, totaling $258 million, as shown in column E of Table 1.2 These eight states are projected to have no federal SCHIP funds on April 1, 2009. ›˜“ŽŒŽȱ‘˜›Š••œȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşȱ Column F of Table 1 shows the 43 states projected under current law to have no federal SCHIP funds on April 1, 2009. These are the two groups of states discussed above - the 35 states projected to be spending from their FY2008 or FY2009 allotments on March 31, 2009, as well as the eight states projected to receive MMSEA shortfall funding because they will have exhausted all other available federal SCHIP funds. The only federal SCHIP funds that will be available past March 31 under current law are unspent FY2007 allotments, which are not subject to the MMSEA provisions. Seven states3 and the 1 §201(a)(2) of MMSEA. The estimates in this report differ from those in the prior version dated July 22, 2008. The prior version was based on states’ projected FY2008 SCHIP expenditures and projected FY2009 SCHIP expenditures as of July 2008. This version is based on actual FY2008 SCHIP expenditures and projected FY2009 SCHIP expenditures as of December 2008. 3 Connecticut, Delaware, Florida, Nevada, Tennessee, Vermont, and Washington. 2 ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ ŗȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ District of Columbia are projected to have unspent FY2007 allotments after March 31. Four of these states would exhaust those funds during the remainder of FY20094; only Connecticut, the District of Columbia, Nevada and Washington would be able to fund their SCHIP programs with federal SCHIP funds through the end of FY2009 under current law solely with their available FY2007 federal SCHIP funds. These are states whose SCHIP spending is well below their allotment levels. The Congressional Budget Office (CBO) “assumes in its baseline spending projections that the funding for the program in later years will continue at $5.0 billion.”5 In other words, although the FY2008 and FY2009 allotments under current law are no longer available after March 31, CBO assumes those allotments will continue to be available for purposes of estimating the cost of legislation. This means that legislation to simply extend the availability of the FY2008 and FY2009 allotments would not be “scored” by CBO as an increased cost to the federal government. Assuming the FY2008 and FY2009 allotments were available through at least the end of FY2009, 27 states (column G of Table 1) would experience shortfalls totaling $1.9 billion. Note, however, for a number of reasons that legislation to also eliminate these FY2009 shortfalls would not be scored by CBO at $1.9 billion. For purposes of its cost estimates, CBO assumes some offsets from the Medicaid fallback financing, discussed in the next section, that states would use in the absence of federal SCHIP shortfall funding. Additionally New Jersey, for example, currently covers parents using federal SCHIP funds permitted under a Section 1115 waiver. Such waivers permit states to expand eligibility to groups that might not otherwise be eligible, among other things. The New Jersey SCHIP waiver is scheduled to expire on January 17, 2009. Recent administration policy has generally been to terminate adult coverage when SCHIP waivers come up for renewal. New Jersey submitted its projected spending assuming SCHIP coverage of parents would continue for the entirety of FY2009; CBO may exclude those amounts for its purposes. Ž’ŒŠ’ȱŠ••‹ŠŒ”ȱ’—Š—Œ’—ȱ˜›ȱŽ›Š’—ȱŠŽœȱ When states have no federal SCHIP funds, some have the ability to draw down federal Medicaid funds as a fallback option. This can occur in one of two ways. First, states that have an SCHIP-financed expansion of Medicaid may access federal Medicaid funds at the regular Medicaid matching rate, although this match rate is lower than the SCHIP matching rate.6 States that have an SCHIP program entirely separate from Medicaid cannot revert to Medicaid funds when their SCHIP funds are exhausted, except as discussed below. Column A in Table 1 shows whether a state’s SCHIP program is a Medicaid expansion (M), is separate from Medicaid (S), or consists of both (C, for combination). Most SCHIP enrollees are in a separate SCHIP program,7 although historical analyses have shown that “states that were projected to have 4 Delaware, Florida, Tennessee and Vermont. Congressional Budget Office, “Fact Sheet for CBO’s March 2008 Baseline: State Children’s Health Insurance Program,” March 12, 2008, available at [http://www.cbo.gov/ftpdocs/90xx/doc9053/schip.pdf]. 6 The federal government matching rate for Medicaid expenditures—the Medicaid federal medical assistance percentage (FMAP)—ranges across states from 50% to 77.3% in FY2008. The enhanced SCHIP FMAP ranges from 65% to 83.4%. The difference between the percentages results from the states’ share of expenditures being 30% smaller in SCHIP compared to Medicaid. 7 See Table 1 of CRS Report RL30473, State Children's Health Insurance Program (SCHIP): A Brief Overview, by Elicia J. Herz, Chris L. Peterson, and Evelyne P. Baumrucker. 5 ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ Řȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ shortfalls [in FY2005, FY2006, or FY2007] ... were more likely to have a Medicaid component to their SCHIP program.”8 This is also true among the states projected to face a shortfall in FY2009 even if the FY2008 and FY2009 funds are available for the entirety of FY2009.9 As previously mentioned, Section 1115 of the Social Security Act provides the Secretary of Health and Human Services (HHS) with broad authority to waive certain statutory requirements in Medicaid and/or SCHIP. Some states have approval under Section 1115 waiver authority, in the event of a shortfall, to draw federal Medicaid funds for the portion of their SCHIP program that is not a Medicaid expansion. Arizona, Hawaii, Massachusetts, Oregon, and Rhode Island are known to have such provisions in their approved waivers. ŽŽ›Š•ȱŽšž’›Ž–Ž—œȱŽ˜›ŽȱŽ›–’—Š’—ȱ ȱ There are laws and regulations that pertain to states’ ability to terminate SCHIP-financed coverage. None addresses doing so as a result of the absence of federal funding. HHS may issue guidance for states terminating coverage because of the absence of federal funding. However, no federal statute or regulation prohibits states from continuing to operate their SCHIP programs at 100% state cost, with the potential to receive a federal match from future SCHIP funds.10 This section briefly discusses some of the pertinent laws and regulations for states terminating individuals’ SCHIP-financed coverage, which vary for Medicaid-expansion programs (in which case Medicaid limitations apply, based on Title XIX of the Social Security Act) and separate SCHIP programs (in which case SCHIP limitations apply, based on Title XXI). Ž™Š›ŠŽȱ ȱ›˜›Š–œȱ Under Title XXI, “An approved [SCHIP program] shall continue in effect unless and until the State amends the plan,” with such an amendment contingent on approval by the Secretary.11 Thus, even in the absence of any federal SCHIP funding, a state would ultimately need to submit a State Plan Amendment (SPA) to terminate coverage in its separate SCHIP program. The law states that “[a]ny plan amendment that eliminates or restricts eligibility or benefits under the plan may not take effect unless the State certifies that it has provided prior public notice of the change, in a form and manner provided under applicable State law.”12 Federal regulations also require that if “eligibility is denied, suspended or terminated,” a state “must provide enrollees and applicants timely written notice.”13 In addition, if eligibility is suspended or terminated, the state must provide “sufficient notice to enable the child’s parent or caretaker to take any appropriate 8 Kathryn G. Allen, “Children’s Health Insurance: States’ SCHIP Enrollment and Spending Experiences and Considerations for Reauthorization,” Government Accountability Office, statement before the House Energy and Commerce Subcommittee on Health, March 1, 2007, p. 32, at [http://www.gao.gov/new.items/d07558t.pdf]. 9 Of these 27 states (that is, the states with amounts shown in column G of Table 1), approximately 78% have a Medicaid component; however, among the states not projected to face shortfalls in FY2009 if the FY2008 and FY2009 allotments are available for all of FY2009, 50% have a Medicaid component. 10 States may receive federal reimbursement for SCHIP claims even if the expenditures were incurred before a particular SCHIP allotment was available (42 CFR § 457.614(a)). 11 § 2106(e). 12 § 2106(b)(3)(B)(i). 13 42 CFR § 457.340(e)(2) and 42 CFR § 457.1180. ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ řȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ actions that may be required to allow coverage to continue without interruption.”14 Neither federal statute nor regulation provides a specific length of time for “sufficient notice” to affected families. Having met these requirements, the state may terminate individuals’ eligibility without prior Secretary approval, as long as the SPA is transmitted to the Secretary within 60 days of the state having implemented the policy.15 A SPA is considered approved unless the Secretary notifies the state in writing within 90 days after receiving the SPA that it is disapproved (and the reasons for disapproval) or that specified additional information is needed.16 Ž’ŒŠ’Ȭ¡™Š—œ’˜—ȱ ȱ›˜›Š–œȱ Under Title XIX, the effective date of a SPA that terminates or suspends coverage to an enrollment group, such as SCHIP-financed enrollees, “may be a date requested by the State if CMS approves it.”17 Enrollees must receive “timely and adequate notice of proposed action to terminate, discontinue, or suspend their eligibility.”18 Regulations require that the state “must mail a notice at least 10 days before the date of” terminating coverage.19 žŽȱ œœžŽœȱ ŽŽ›Š•ȱ Under current law, SCHIP has no federal appropriations past FY2009. However, for budget enforcement purposes, funding for SCHIP is assumed to continue in congressional budget projections and for purposes of the budget resolution (for FY2009, H.Rept. 110-659 accompanying S.Con.Res. 70). As previously mentioned, the Congressional Budget Office (CBO) “assumes in its baseline spending projections that the funding for the program in later years will continue at $5.0 billion.”20 The FY2009 budget resolution also assumes that level of annual funding for SCHIP in later years. In addition, the FY2009 budget resolution permits legislation providing “up to $50,000,000,000 in outlays over the period of the total of fiscal years 2008 through 2013 for reauthorization of SCHIP.” Under the budget resolution, which requires any SCHIP reauthorization legislation to comply with PAYGO rules, the permissible $50 billion is the amount in excess of the baseline level of outlays over the FY2008-FY2013 budget window.21 The FY2009 budget resolution will 14 42 CFR § 457.340(e)(2). § 2106(b)(3)(B)(ii). 16 § 2106(c)(2). 15 17 42 CFR 430.20(b)(3). 18 42 CFR 435.919(a). 19 42 CFR 431.211. 20 Congressional Budget Office, “Fact Sheet for CBO’s March 2008 Baseline: State Children’s Health Insurance Program,” March 12, 2008, available at [http://www.cbo.gov/ftpdocs/90xx/doc9053/schip.pdf]. 21 §306(a) of S.Con.Res. 70, which also requires that “such legislation would not increase the deficit over either the (continued...) ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ Śȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ remain in effect in the 111th Congress until a new budget for FY2010 is agreed to by both chambers or, if they cannot come to agreement, until the House or Senate deems its own version as in effect for itself.22 Regardless, any applicable points of order against a bill’s spending amounts can be waived according to the rules of each chamber. ŠŽȱ State governments do not know for certain whether federal SCHIP funds will be extended past March 31, 2009—and if so, by how much. State SCHIP directors often cite the need for “a 23 predictable and stable funding stream.” This is often raised in the context of states wanting sufficient time to adjust their plans in response to the resources made available.24 For example, there are at least six states whose legislatures are scheduled to meet only once every other year. Most state legislatures that meet annually convene their sessions in January, often with limitations 25 on the length of those sessions. Crafting state legislation or recommendations before knowing what federal SCHIP funds will be available could be a challenge for state legislatures and administering agencies. In addition, concerns have been raised that in the current economic downturn, declining state revenues and increased public-program enrollment will exacerbate states’ fiscal challenges.26 (...continued) period of the total of fiscal years 2008 through 2013 or the period of the total of fiscal years 2008 through 2018.” 22 For further information on what procedural tools may be used when the House and Senate do not agree to a budget resolution, see CRS Report RL31443, The "Deeming Resolution": A Budget Enforcement Tool, by Robert Keith. 23 Anita Smith, Chief of the Bureau of Medical Supports, Iowa Department of Human Services (DHS), testimony before U.S. Senate Finance Committee, February 1, 2007, p. 3, available at [http://finance.senate.gov/hearings/testimony/2007test/020107astest.pdf]. 24 For example, see David Bergman, “Perspective on Reauthorization: SCHIP Directors Weigh In,” National Academy for State Health Policy, June 2005, p. 8, available at [http://www.allhealth.org/BriefingMaterials/PerspectivesonReauthorizationSCHIPDirectors-538.pdf]. 25 The Council of State Governments, “The Book of the States,” Lexington, Ky., volume 39, 2007, Table 3.2. 26 The National Association of State Budget Officers and the National Governors Association jointly publish a spring and fall survey of state fiscal conditions at [http://www.nasbo.org/publications.php]. The Center on Budget and Policy Priorities also provides information at [http://www.cbpp.org/pubs/sfp.htm]. ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ śȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ ȱ Table 1. Projected FY2009 Federal SCHIP Financing In millions of dollars, unless specified otherwise State and SCHIP Program Type A FY2009 SCHIP original allotment (excluding all other available funds) B Alabama (S) Alaska (M) Arizona (S) Arkansas (C) California (C) Colorado (S) Connecticut (S) Delaware (C) DC (M) Florida (C) Georgia (S) Hawaii (M) Idaho (C) Illinois (C) Indiana (C) Iowa (C) Kansas (S) Kentucky (C) Louisiana (C) Maine (C) Maryland (M) Massachusetts (C) Michigan (C) Minnesota (C) Mississippi (S) Missouri (C) Montana (S) Nebraska (M) Nevada (S) New Hampshire (C) $71.1 $10.4 $149.1 $50.4 $799.2 $71.5 $37.7 $13.1 $12.3 $303.0 $175.6 $14.6 $23.9 $198.7 $94.5 $34.1 $37.9 $67.4 $84.1 $14.7 $70.2 $72.4 $146.2 $48.6 $64.1 $81.9 $14.5 $22.5 $52.1 $10.6 All available SCHIP allotments and redistributions for FY2009 C ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ $80.4 $10.4 $205.9 $50.4 $799.2 $160.3 $116.4 $34.2 $34.6 $785.5 $175.6 $26.2 $49.1 $198.7 $204.7 $34.1 $46.1 $108.2 $84.1 $14.7 $70.2 $83.4 $164.0 $48.6 $64.1 $95.9 $19.5 $22.5 $155.2 $24.8 Projected federal SCHIP spending for all of FY2009 D $126.9 $20.3 $122.9 $94.2 $1,297.3 $82.8 $29.0 $10.9 $10.0 $319.4 $267.5 $13.9 $41.2 $262.1 $98.3 $62.2 $53.2 $108.7 $188.8 $33.1 $165.8 $302.4 $86.5 $45.6 $167.0 $117.6 $29.5 $38.0 $29.6 $14.5 Additional funding for projected shortfalls before March 31, 2009 E Projected Current law: FY2009 State shortfalls projected to assuming have no FY2008-09 federal SCHIP allotments funds on April available all 1, 2009 year F G=D-C-E Alabama Alaska Arizona Arkansas California Colorado $10.0 $1.8 $12.5 $67.4 $19.2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska $46.5 $9.8 $43.8 $498.1 $91.9 $63.4 $28.2 $7.1 $0.5 $94.6 $16.6 $83.1 $151.6 $83.7 $21.7 $10.0 $15.5 New Hampshire Ŝȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ ȱ State and SCHIP Program Type A FY2009 SCHIP original allotment (excluding all other available funds) B New Jersey (C) New Mexico (M) New York (S) North Carolina (C) North Dakota (C) Ohio (M) Oklahoma (M) Oregon (S) Pennsylvania (S) Rhode Island (C) South Carolina (M) South Dakota (C) Tennessee (C) Texas (S) Utah (S) Vermont (S) Virginia (C) Washington (S) West Virginia (S) Wisconsin (C) Wyoming (S) $102.2 $52.0 $318.0 $136.1 $7.9 $157.3 $70.8 $61.3 $167.0 $13.2 $70.8 $10.9 $99.7 $549.6 $41.5 $5.2 $96.9 $79.9 $25.0 $69.6 $6.4 State totals All available SCHIP allotments and redistributions for FY2009 C $5 billion $124.8 $56.0 $766.8 $136.1 $7.9 $157.3 $76.1 $119.0 $280.5 $16.2 $206.5 $11.6 $297.0 $1,420.6 $72.9 $12.6 $121.3 $237.8 $37.2 $75.6 $13.7 Projected federal SCHIP spending for all of FY2009 D $452.5 $178.4 $355.6 $223.4 $15.5 $267.0 $131.1 $75.8 $284.1 $58.8 $141.8 $15.4 $125.8 $859.7 $59.5 $4.8 $159.7 $40.6 $36.9 $71.7 $10.2 $7.8 billion Additional funding for projected shortfalls before March 31, 2009 E $100.8 $33.0 $13.1 Projected Current law: FY2009 State shortfalls projected to assuming have no FY2008-09 federal SCHIP allotments funds on April available all year 1, 2009 F G=D-C-E New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota $226.9 $89.4 $87.2 $7.6 $109.7 $55.0 $3.6 $29.5 $3.8 Texas Utah Virginia $258 million West Virginia Wisconsin Wyoming 43 states $38.4 $1.9 billion in 27 states Source: Congressional Research Service (CRS) analysis of data from the Centers for Medicare and Medicaid Services (CMS). On December 11, 2008, CMS provided the following data for each state: FY2008 SCHIP expenditures, projected federal SCHIP balances available at the beginning of FY2009, and projected FY2009 and FY2010 SCHIP expenditures. Notes: S = Separate child health program. M = Medicaid expansion program. C = Combination program. The results are based on projected expenditures submitted by states. Their actual expenditures may vary. For example, New Jersey’s SCHIP waiver permits coverage of certain parents of dependent children, up to 115% of poverty. However, this waiver is scheduled to expire on January 17, 2009. Recent administration policy has generally been to terminate adult coverage when SCHIP waivers come up for renewal. However, the FY2009 projected SCHIP spending provided by the state assumed that parental coverage through SCHIP would continue. ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ ŝȱ ȱ ‘Šȱ Š™™Ž—œȱ˜ȱ ȱŽ›ȱŠ›Œ‘ȱřŗǰȱŘŖŖşǵȱ ž‘˜›ȱ˜—ŠŒȱ —˜›–Š’˜—ȱ Chris L. Peterson Specialist in Health Care Financing cpeterson@crs.loc.gov, 7-4681 ˜—›Žœœ’˜—Š•ȱŽœŽŠ›Œ‘ȱŽ›Ÿ’ŒŽȱ Şȱ