STATES WITH SINGLE AGENCY RESPONSIBLE FOR CHILDREN'S HEALTH

Topic:
EXECUTIVE AGENCIES; CHILD HEALTH; MEDICAID; HEALTH INSURANCE; JUVENILES; QUASI-PUBLIC AGENCIES;
Location:
INSURANCE - HEALTH;

OLR Research Report


February 14, 2008		2008-R-0124
STATES WITH SINGLE AGENCY RESPONSIBLE FOR CHILDREN'S HEALTH

By: Robin K. Cohen, Principal Analyst

You asked whether other states have a single state agency or private entity that administers their State Children's Health Insurance Program (SCHIP, in Connecticut, HUSKY) and whether this agency “integrates” other child health programs, such as Title V. You are trying to determine whether any state has been able to coordinate children's health services in such a way that it can measure health outcomes and ensure accountability across programs.

About half of the 49 states responded to our survey. For the remaining states, we were able to use information from the federal Centers for Medicare and Medicaid Services (CMS) to identify which entity administers SCHIP, and in some instances, the extent to which SCHIP is coordinated with Medicaid.

SUMMARY

Although the federal SCHIP law contemplates states coordinating their SCHIP programs with other public and private health insurance programs, it does not appear that states extend this coordination beyond coordination with Medicaid for children. A survey of states found that most use a single state agency to administer their SCHIP (and often Medicaid) program; a few use what appear to be quasi-public entities to do this.

We found no state that integrates all child health programs in such a way that families can get all services they need in one place with few barriers. But several states have large, umbrella health and human services agencies. While various divisions within these agencies administer different children's health programs, the fact that these programs reside in one agency may make it easier for families to access them.

CMS requires that states measure health outcomes in their Medicaid and SCHIP programs. The states responding to the survey said that their internal and external quality reviews address only those programs, not other children's health programs.

SCHIP AGENCY—COORDINATING HEALTH CARE

SCHIP regulations require state SCHIP plans to include procedures that the state uses to coordinate SCHIP with other public and private health insurance programs; sources of health benefit coverage for children; and relevant child health programs, such as Title V, that provide health care services for low-income children (42 CFR §457. 80). But our survey results suggest that such coordination is typically limited to coordination with the Medicaid program.

Table 1 lists each state, the agency that administers its SCHIP program, the extent to which the agency also administers other child health programs, and any other coordinating activities that occur.

Table 1: State Administrative Structure for SCHIP and Coordination Efforts

*State*	*SCHIP –State Entity*	*Administers All Other Children's Health Programs*	*Other Coordination Efforts and Comments*
Alabama	Dept. of Public Health (DPH)	No, but administers SCHIP-funded All Kids and All Kids Plus (authorized by departments of Mental Retardation, Rehabilitative Services, and University of Alabama). Separate agencies administer (1) Medicaid, (2) early intervention, and (3) child welfare.	All Kids Plus (children with special health care needs) services provided by two different departments through contractual arrangement in which that agency, instead of DPH, pays state match. New program (Camellia) is governor's initiative to streamline application process for state health and social services programs and improve program access—still in planning stages.
Alaska [1]	Alaska Department of Health and Social Services, Division of Medical Assistance	Unknown
Arizona [1]	Arizona Health Care Cost Containment Systems	Also administers Medicaid
Arkansas [1]	Division of Medical Assistance	Unknown	State contracts with Department of Health to provide outreach, including Help Line Service
California [1]	Managed Risk Medical Insurance Board	Unknown
Colorado [1]	Department of Health Care Policy and Financing	Unknown
Delaware	Department of Health and Social Services	No, but separate DHS divisions administer SCHIP, Medicaid, and Title V. Separate department administers child welfare and behavioral health.	Quality measuring occurs only across Medicaid and SCHIP, not other programs.
Florida	Florida Healthy Kids Corporation (private entity)	No, state is very fragmented. For example, Medicaid eligibility and administration are done through two separate agencies. But child welfare agency is same agency determining Medicaid eligibility.	Agency for Health Care Administration (administers Medicaid) is lead agency for receiving federal funds and dispersing to other programs and monitoring compliance with federal rules.
Georgia [1]	Department of Community Health	Unknown	State law mandates that any health care provider enrolled in Medicaid is deemed enrolled in SCHIP
Hawaii [1]	Department of Human Services, Med-QUEST	Unknown
Idaho [1]	Department of Health and Welfare	Unknown	Department also runs Medicaid program
Illinois [1]	Department of Public Aid	Unknown
Indiana [1]	Indiana Family and Social Services Administration, Office of Medicaid Planning and Policy	Unknown
Iowa	Department of Human Services	No, but administers Medicaid. Different DHS division administers child welfare; Title V and Birth-to-Three administered by Department of Public Health
Kansas	Kansas Department of Social and Rehabilitation Services, Division of Medical Policy	No, but also oversees Medicaid. Other programs divided among four other state agencies.
Kentucky [1]	Department for Medicaid Services	Unknown
Louisiana	Department of Health and Hospitals	Almost. Administers Medicaid, Title V, Birth-to-Three.	Children's Cabinet in Governor's Office
Maine	Department of Health and Human Services	No, but many DHHS divisions deal with children's health, such as Center for Disease Control (Title V)	Office of Integrated Access and Support automatically enrolls children in the richest benefits. Two agencies were consolidated into DHHS two years ago.
Maryland [1]	Department of Health and Mental Hygiene	Unknown
Massachusetts [1]	Division of Medical Assistance	Unknown	MassHealth uses decision trees, a system that determines and automatically enrolls individual in most comprehensive coverage (we believe only for Medicaid and SCHIP)
Michigan	Department of Community Health	Almost. Department administers most of child health, including Medicaid, other public health programs, mental health and wrap around services, Title V, Tribal Health Services, and Title X.	Department website has separate page devoted to health care for children and teens, with links to programs
Minnesota [1]	Department of Human Services	Unknown, but same as Medicaid
Mississippi [1]	State and Public School Employees Health Insurance Management Board	Unknown
Missouri [1]	Department of Social Services, Division of Medical Services	Unknown, but same as Medicaid
Montana	Department of Public Health and Human Services	Almost. Agency includes Medicaid, public health, foster care, mental health, DD services, and other public assistance	Offices co-located at local level, to extent possible
Nebraska [1]	Health and Human Services System	Unknown
Nevada [1]	Department of Human Resources	Unknown, but joint application with Medicaid
New Hampshire [1]	Department of Health and Human Services	Unknown, but same unit determines eligibility for Medicad
New Jersey [1]	Department of Human Services, Division of Medical Assistance	Unknown, but joint application (mail-in) with Medicaid
New Mexico	Department of Human Services, Division of Medical Assistance Division	No
New York [1]	Department of Health	Unknown	Common applications with Medicaid, initial screen for Medicaid eligibility, and ease in moving from one program to the other
North Carolina [1]	Department of Health and Human Services, State Employees Health Plan (benefits and claims processing), and local social services departments (eligibility)	Unknown, but coordinated with Medicaid
North Dakota [1]	Department of Human Services	Unknown
Ohio [1]	Department of Job and Family Services	Unknown, but Department of Health helps with outreach
Oklahoma [1]	Oklahoma Health Care Authority	Unknown	Authority collaborates closely with other departments for marketing and outreach of SCHIP
Oregon [1]	Department of Human Resources, Division of Medical Assistance Programs	Unknown, but single application for SCHIP and Medicaid
Pennsylvania	Department of Insurance	No, state is very fragmented with Department of Welfare administering Medicaid and Health Department administering Title V.	Health Care Cabinet meets regularly. Officials call health care “seamless” as there is web-based application for all social services that gets routed to appropriate administering agencies.
Rhode Island [1]	Department of Human Services	Unknown
South Carolina [1]	Department of Health and Human Services	Unknown
South Dakota [1]	Department of Social Services	Unknown, but department also administers Medicaid with significant coordination of two programs
Tennessee [1]	Bureau of TennCare (Medicaid expansion); also Department of Finance and Administration, Division of Insurance Administration (separate state program)	Unknown
Texas [1]	Health and Human Services Commission	Unknown, but joint application with Medicaid
Utah	Department of Health	Unknown, but initial screen of application for Medicaid eligibility
Vermont	Agency for Human Services (AHS), Office of Vermont Health Access	No, but most publicly funded child health programs in different departments within the AHS	State uses councils, task forces, and interagency coordinating groups with strong links to communities. State recently had a child cabinet. State and local planning are linked.
Virginia	Department of Medical Assistance Services	No, only Medicaid and SCHIP. Other child health fragmented among several agencies (e. g. , Title V in Department of Health)	All agencies have partnership agreements and established work groups that coordinate services. State is the in the process of strengthening these efforts.
Washington	Department of Social and Health Services, Health and Recovery Services Administration	No, but high degree of coordination among agencies.	Procedures in place to ensure that children known to a particular agency get access to coverage
West Virginia [1]	Department of Administration, Children's Health Insurance Agency; Public Employees Insurance Agency is third-party administrator	Unknown, but same agency administers Medicaid
Wisconsin [1]	Department of Health and Family Services	Unknown but SCHIP program (Badgercare) includes Medicaid
Wyoming [1]	Department of Health, Division of Community and Family Health	Unknown, but joint application with Medicaid

[1] These states did not respond to our survey. For this information we relied on Fact Sheets produced by CMS.

RC: dw