[Congressional Record Volume 144, Number 105 (Thursday, July 30, 1998)]
[Senate]
[Pages S9439-S9440]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. McCAIN (for himself and Mr. Kerry):
  S. 2382. A bill to amend title XIX of the Social Security Act to 
allow certain community-based organizations and health care providers 
to determine that a child is presumptively eligible for medical 
assistance under a State plan under that title; to the Committee on 
Finance.


  children's health assurance through the medicaid program (champ) act

 Mr. McCAIN. Mr. President, today I am proud to rise with my 
colleague and dear friend, John Kerry, to introduce legislation which 
would help provide thousands, if not millions, of children with health 
care coverage. Clearly, a bipartisan priority in the 105th Congress has 
been to find a solution for providing access to health insurance for 
the approximately 10 million uninsured children in our nation. This 
matter has been a very high priority for me since coming to Congress. 
The legislation we are introducing today, the ``Children's Health 
Assurance through the Medicaid Program'' (CHAMP), would help our states 
reach more than 3 million uninsured children who are eligible for the 
Medicaid program but not enrolled.

  The consequences of lack of insurance are problematic for everyone, 
but they are particularly serious for children. Uninsured and low 
income children are less likely to receive vital primary and 
preventative care services. This is quite discouraging since it is 
repeatedly demonstrated that regular health care visits facilitate the 
continuity of care which plays a critical role in the development of a 
healthy child. For example, one analysis found that children living in 
families with incomes below the poverty line were more likely to go 
without a physician visit than those with Medicaid coverage or those 
with other insurance. The result is many uninsured, low-income children 
not seeking health care services until they are seriously sick.
  Studies have further demonstrated that many of these children are 
more likely to be hospitalized or receive their care in emergency 
rooms, which means higher health care costs for conditions that could 
have been treated with appropriate outpatient services or prevented 
through regular check ups.
  Last year, as Congress was searching for ways to reduce the number of 
uninsured children, I kept hearing about children who are uninsured, 
yet, could qualify for health care insurance through the Medicaid 
program. I was unable to find specific information about who these 
children are, where they reside, and why they are not enrolled in the 
Medicaid program. Subsequently, I requested that the General Accounting 
Office conduct an in-depth analysis to provide Congress data on 
uninsured Medicaid eligible children. This information would provide 
the necessary tools to develop community outreach strategies and 
education programs to address this problem.
  The GAO study was completed in March. The data shows that 3.4 million 
children are eligible for the Medicaid program (under the minimum 
federal standards) but are not enrolled. It also shows that these kids 
are more likely to be part of a working family with parents who are 
employed but earning a low income. A significant number of these 
children come from two-parent families rather than single-parent 
families. The study also discovered that more than thirty-five percent 
of these children are Hispanic, with seventy-four percent of them 
residing in Southern or Western states. Finally, the GAO report 
suggested that states need to be developing and implementing creative 
outreach and enrollment strategies which specifically target the 
unenrolled children.
  It is important that we build upon these findings and develop methods 
for states to reach out to these families and educate them about the 
resources which exist for their children. The CHAMP bill is an 
important step in this process and would assist these children by 
expanding the state offices which can presume Medicaid eligibility for 
a child.
  As you know, the 1997 Balanced Budget Act provided states with the 
option of utilizing ``presumptive eligibility'' as an outreach method 
for enrolling eligible children into their state Medicaid programs. 
Presumptive eligibility allows certain agencies to temporarily enroll 
children in the state Medicaid program for a brief period if the child 
appears to be eligible for the program based on their family's income. 
Health care services can be provided to these children if necessary 
during this ``presumptive'' period while the state Medicaid agency 
processes the child's application and makes a final determination of 
their eligibility.
  Presumptive eligibility is completely optional for the states and is 
not mandatory.
  Under current law, states are only given the limited choice of using 
a few specific community agencies for presumptive eligibility 
including: Head Start Centers, WIC clinics, Medicaid providers and 
state or local child care agencies. The McCain-Kerry CHAMP bill would 
expand the types of community-based organizations which would be 
recognized as qualified entities and permitted to presume eligibility 
for children. Under our bill, public schools, entities operating child 
welfare programs under Title IV-A, Temporary Assistance to Needy 
Families (TANF) offices and the new Children Health Insurance Program 
(CHIP) offices would be permitted to help identify Medicaid eligible 
kids. Allowing more entities to participate in outreach would increase 
the opportunities for screening children and educating their families 
about the Medicaid services available to

[[Page S9440]]

them. By increasing the ``net'' for states, we would be helping them 
``capture'' more children who are going without health care services 
because their families are not familiar, comfortable or aware of the 
Medicaid program and its enrollment process.
  Our bill would help millions of children gain access to health care 
without creating a new government program, imposing mandates on states, 
or expanding the role of government in our communities. This is 
important to note--we would not be creating new agencies, bureaucracies 
or benefits. Instead we would be increasing the efficiency and 
effectiveness of a long-standing program designed to help one of our 
most vulnerable populations, children. We urge our colleagues to 
support this innovative piece of legislation.
  Mr. President, I ask unanimous consent that the bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2382

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Children's Health Assurance 
     through the Medicaid Program (CHAMP) Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Twenty-three percent or 3,400,000 of the 15,000,000 
     medicaid-eligible children went without health insurance in 
     1996.
       (2) Medicaid-eligible children with working parents are 
     more likely to be uninsured.
       (3) More than 35 percent of the 3,400,000 million uninsured 
     medicaid-eligible children are Hispanic.
       (4) Almost three-fourths of the uninsured medicaid-eligible 
     children live in the Western and Southern States.
       (5) Multiple studies have shown that insured children are 
     more likely to receive preventive and primary health care 
     services as well as to have a relationship with a physician.
       (6) Studies have shown that a lack of health insurance 
     prevents parents from trying to obtain preventive health care 
     for their children.
       (7) These studies demonstrate that low-income and uninsured 
     children are more likely to be hospitalized for conditions 
     that could have been treated with appropriate outpatient 
     services, resulting in higher health care costs.

     SEC. 3. ADDITIONAL ENTITIES QUALIFIED TO DETERMINE MEDICAID 
                   PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME 
                   CHILDREN.

       Section 1920A(b)(3)(A)(i) of the Social Security Act (42 
     U.S.C. 1396r-1a(b)(3)(A)(i)) is amended--
       (1) by striking ``or (II)'' and inserting ``, (II)''; and
       (2) by inserting ``eligibility of a child for medical 
     assistance under the State plan under this title, or 
     eligibility of a child for child health assistance under the 
     program funded under title XXI, or (III) is an elementary 
     school or secondary school, as such terms are defined in 
     section 14101 of the Elementary and Secondary Education Act 
     of 1965 (20 U.S.C. 8801), an elementary or secondary school 
     operated or supported by the Bureau of Indian Affairs, a 
     State child support enforcement agency, a child care resource 
     and referral agency, or a State office or private contractor 
     that accepts applications for or administers a program funded 
     under part A of title IV or that determines eligibility for 
     any assistance or benefits provided under any program of 
     public or assisted housing that receives Federal funds, 
     including the program under section 8 or any other section of 
     the United States Housing Act of 1937 (42 U.S.C. 1437 et 
     seq.)'' before the semicolon.
 Mr. KERRY. Mr. President, I want to thank my friend and 
colleague Senator McCain for his work on this important issue. I am 
honored to introduce with him this legislation, entitled the Children's 
Health Assurance Through the Medicaid Program (CHAMP), which would 
increase health coverage for eligible children and increase state 
flexibility.
  Mr. President, the Balanced Budget Act of 1997 gave States the option 
to bring more eligible but uninsured children into Medicaid by allowing 
states to grant ``presumptive eligibility.'' This means that a child 
would temporarily be covered by Medicaid if preliminary information 
suggests that they qualify. Providing health insurance for children is 
important because studies show that children without health insurance 
are more likely to be in worse health, less likely to see a doctor, and 
less likely to receive preventive care such as immunizations.
  Mr. President, the legislation Senator McCain and I are introducing 
today would strengthen the existing option and give states more 
flexibility. First, it will allow states to rely on a broader range of 
agencies to assist with Medicaid outreach and enrollment. By expanding 
the list of community-based providers and state and local agencies to 
include schools, child support agencies, and some child care 
facilities, states will be able to make significant gains in the number 
of children identified and enrolled in Medicaid. States would not be 
required to rely on these additional providers but would have the 
flexibility to choose among qualified providers and shape their own 
outreach and enrollment strategies.
  The cost of these changes to the presumptive eligibility option for 
Medicaid under last year's Balanced Budget Act are modest. Our 
understanding is that our proposal would cost approximately $250 
million over five years. This is a positive step in the right 
direction, helping ensure that the growing population of American 
children start off on the right foot. Access to affordable health care 
in the early years saves the country's financial resources in the long 
run.
  Once again, I would like to thank Senator McCain for his invaluable 
work on behalf of children. I look forward to working with him and the 
Senate to pass this important legislation.
                                 ______