SCHIP Requirements Regarding
Medicaid Substitution
In addition to concerns regarding substitution of SCHIP for private coverage, there is
also a concern that States may favor enrollment of children in SCHIP rather than
Medicaid because of the enhanced matching rate available to States for children
covered under SCHIP. Therefore, Title XXI contains three provisions to prevent substitution
of SCHIP for current Medicaid coverage:
- State plans must include assurances that the State will coordinate its SCHIP program with
other public and private programs, including Medicaid.
- States choosing to create a non-Medicaid SCHIP program must maintain Medicaid eligibility
efforts, and, more specifically, the State cannot adopt more restrictive income and resource
methodologies for Medicaid eligibility.
- Children who apply for SCHIP must be screened for Medicaid eligibility and, if found
eligible, enrolled in Medicaid.
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