Children's Health Insurance: Inspector General Reviews Should Be Expanded to Further Inform the Congress.

摘要

The Congress created the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured children in families with incomes that are too high to qualify for Medicaid. To address concerns regarding inappropriate enrollment, the SCHIP statute requires states to screen all SCHIP applicants for Medicaid eligibility and, if they are eligible, enroll them in Medicaid. Even with the requirement for Medicaid screening in place, concerns remained that children who were eligible for Medicaid might have been inappropriately enrolled in SCHIP.5 Additionally, there was interest in assessing the progress states had made to reduce the number of uninsured children, including the extent to which states had met objectives and goals, which they established in their SCHIP programs. In the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), the Congress directed the Department of Health and Human Services (HHS) Office of Inspector General (OIG) to conduct a series of studies on these issues. BBRA specified that the OIG should review states that provide SCHIP coverage separately from their Medicaid programs. BBRA also directed that we review and report on the OIG's work. In response, we assessed the OIG's efforts to inform the Congress on (1) determining whether Medicaid-eligible children were improperly enrolled in SCHIP and (2) assessing states' progress in reducing the number of uninsured children, including the progress states have made in meeting the objectives and goals initially established in their SCHIP programs. To examine these issues, we reviewed the OIG's approach and methodology for selecting its sample of states for the first in its series of studies to evaluate states' performance in screening SCHIP applicants for Medicaid eligibility and to assess states' progress in reducing the number of low-income uninsured children. We examined the OIG's findings in the context of other research, including our own work. In some cases, we reviewed work released after the OIG's studies were completed and published to determine the extent to which other research corroborated the OIG's findings. Finally, we examined OIG's recommendations to the Health Care Financing Administration (HCFA) and the Health Resources and Services Administration (HRSA), which jointly oversee SCHIP. Our work was conducted from December 2001 through March 2002 in accordance with generally accepted government auditing standards.