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GAO-04-166R 1 (2004-01-05)

handle is hein.gao/gaocrptapsv0001 and id is 1 raw text is: SGAO Accountability * Integrity Reliability United States General Accounting Office Washington, DC 20548 January 5, 2004 The Honorable Charles Grassley Chairman The Honorable Max Baucus Ranking Minority Member Committee on Finance United States Senate Subject: SCHIP: HHS Continues to Approve Waivers That Are Inconsistent with Program Goals States provide health care coverage to about 60 million low-income uninsured adults and children largely through two federal-state programs-Medicaid and the State Children's Health Insurance Program (SCHIP). Medicaid, established in title XIX of the Social Security Act, generally covers low-income families and elderly and disabled individuals, and SCHIP, established in title XXI of the act, covers children in families whose incomes, although low, are above Medicaid's eligibility requirements. In 2001, the Secretary of Health and Human Services announced a new initiative-the Health Insurance Flexibility and Accountability Initiative (HIFA)-under which states could expand coverage to uninsured populations using Medicaid and SCHIP funds. HIFA encourages states to develop coordinated public and private health insurance coverage options and to target program resources to uninsured individuals with incomes below 200 percent of the federal poverty level (FPL). Authority for this initiative comes from section 1115 of the Social Security Act, which allows the Secretary to waive many of the statutory requirements of Medicaid or SCHIP in the case of experimental, pilot, or demonstration projects that promote program objectives. Within the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) has the lead role in reviewing HIFA waiver applications.1 'Although CMS has lead responsibility for administering Medicaid and SCHIP, throughout this report we refer to HHS as the primary program entity because section 1115 waiver authority resides with the Secretary, and other HHS entities are also involved in the review process. GAO-04-166R HHS Waiver Approvals

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