GAO Highlights Serious Flaws Affecting Children’s Access to Care Under Medicaid and SCHIP Enrollment and
Payment Policies

Washington, D.C. – Congressman John D. Dingell, D-Mich., today released a General Accounting Office (GAO) report, Medicaid and SCHIP: States’ Enrollment and Payment Policies can Affect Children’s Access to Care, that highlights the disparity in payment and enrollment policies in Medicaid and SCHIP that can adversely affect access to and continuity of health care for children.

"There should be no barriers to quality health care for children, yet time and time again unnecessary state administrative road blocks are all that stand between the nation’s children and critical services," Dingell said. "As some states have demonstrated, CHIP and Medicaid can work together to provide seamless coverage to all children, all the time. This is what we should be striving for in every state."

The GAO report, initiated by Congressman Dingell, found poor coordination between CHIP and Medicaid offices that often results in inappropriate denial, delay or discontinuation of coverage, with children in Medicaid being forced go through additional red tape that results in reduced care access to care. Additional concerns about provider networks are also highlighted in the report as many states have difficulty discerning which provider participates in which program leaving children, particularly those with disabilities, vulnerable to having gaps in accessing needed care.

Other areas of concern highlighted by the GAO are low provider payments and beneficiary cost sharing requirements. The report found that Medicaid rates to physicians for children’s preventive services were significantly lower than the rates physicians were paid for the same services in CHIP. This translates into reduced access to care for children in Medicaid as providers are less likely to participate when payment rates fall below the norm. Likewise, cost-sharing requirements can also act as a barrier to maintaining coverage. Approximately ten percent of children enrolled in CHIP in California and Michigan lost coverage due to failure to pay a premium.

"We must act quickly to correct these findings and ensure that benefits designed to help America’s children, elderly and disabled do just that and are not bogged down by endless, and possibly pointless, bureaucratic red tape," said Dingell.

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