Covering All Children: Issues and Experience in State Policy Development

This State Health Policy Briefing describes some of the most common strategies states use to achieve universal children’s coverage, including expanding public programs and creating other opportunities for families with uninsured children, such as through buy-in programs and premium assistance programs. It is based primarily on interviews conducted with senior administrators from eight state Medicaid or State Children’s Health Insurance Programs (SCHIP) in California, Illinois, Louisiana, Massachusetts, New York, Oregon, Pennsylvania, and Washington. These states have been among those in the vanguard of pursuing the goal of covering all children and youth. The focus of the research for the paper was on identifying key federal and state policy challenges that state executive branch agencies have faced in attempting to obtain state authority or federal approval for new policies or programs that move toward universal children’s coverage. The research showed that each state must develop programs that reflect the culture of the state, the history of programs around children and children’s health care, the political configuration of the state, and the leadership in place at the time. State informants consistently cautioned against attempting to import one state’s program into another state environment without significant analysis and detailed state-to-state discussions about the approach. There also were consistent policy issues that arose in all states, although the specific nature of the issues varied from state to state. Since states are so different in their current program configurations and political goals, informants urged states considering universal health coverage for children to look to other states with similar backgrounds and history and assess specific policies that have worked in those states.

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