National Alliance on Mental Illness
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Your Action Needed to Support SCHIP!

September 5, 2007

This week Congress returns from a month long August “district work period,” with legislation reauthorizing the State Children’s Health Insurance Program (SCHIP) high on the agenda.  In early August, the House and Senate passed competing bills (HR 3162 and S 1893) which must now be reconciled in a House-Senate Conference Committee.

Action Required

NAMI is currently fighting to ensure that the strongest possible bill emerges from the House-Senate Conference Committee.  Email Congress today, and urge House and Senate leaders to push to include needed funding, parity within SCHIP and important improvements to Medicare and Medicaid.

Take action today using NAMI's Legislative Action Center.

In particular, NAMI is advocating for:

SCHIP Parity – The Senate bill includes a requirement for all private sector SCHIP plans to cover mental illness treatment on the same terms and conditions as all other medical disorders (i.e., at parity).   In addition, the House bill eliminates the current allowance for SCHIP plans to cover mental illness at only 75% of the actuarial value of all other medical benefits.  NAMI supports retaining both provisions in the final bill.

SCHIP Funding – NAMI supports inclusion of an overall funding level sufficient to allow states to cover all eligible low-income children and ensure that no state is left short of funding needed to maintain eligibility for currently enrolled children. 

Medicare Part D Improvements – NAMI strongly supports the broad array of changes to the Medicare drug benefit in the House bill including:

  • Making permanent the current requirement for drug plans to include in their formularies “all or substantially all” available medications to treat mental illness (antipsychotics, antidepressants and anticonvulsants),
  • Allowing drug plans to cover benzodiazepines,
  • Eliminating cost sharing for certain non-institutionalized dual eligibles,
  • Creating new exemptions for income and assets to expand eligibility for the Low-Income Subsidy (LIS) thereby exempting nearly 2 million low-income beneficiaries from the so-called “doughnut hole” coverage gap,
  • Waiving the late enrollment penalty for the LIS and placing new limits on cost sharing for most LIS eligible beneficiaries, and
  • Allowing mid-year changes in enrollment for beneficiaries adversely impacted by mid-year formulary changes – This would permit beneficiaries to switch a different Part D plan in the middle of the year if the plan they are enrolled in removes a drug from their formulary in the middle of a plan year (avoiding “bait and switch” tactics by plans).

Medicare Cost Sharing Parity – The House bill eliminates the discriminatory 50% cost sharing requirement for outpatient mental health services, lowering it to 20% cost beginning in 2008.  NAMI strongly supports retaining this provision in the final bill.

Moratorium on Medicaid Rehabilitation Regulations – The House bill includes several proposals to curtail current efforts underway by the Bush Administration to redefine services under the Medicaid Rehabilitation Option.  These efforts – which include regulations published by CMS on August 11 – pose a significant risk to the ability of states to use Medicaid to finance intensive case management and evidence-based models such as Programs of Assertive Community Treatment (PACT).  Click here for more details on these draft rules.

Presidential Veto Threatened

The current statutory authority for the SCHIP program expires on September 30.  Resolving the differences between the House and Senate bills by the end of the month is complicated by the fact that President Bush has threatened to veto both bills as too costly and excessive.  The major differences among the parties and between Congress and the Bush Administration are over proposed increases in spending for the SCHIP program and how any increases are to be financed.  If the President and congressional leaders cannot come to an agreement, then a temporary extension is likely.

The Senate bill allocates $35 billion in additional funding for the program over the next five years, enough to expand coverage to as many as 4 million uninsured children.  The House bill adds $50 billion over the same period, with much of the funding directed toward enrollment of eligible children into Medicaid.  The House bill is projected to add 5 million additional children to the program. 

These increases are on top of the current base level spending for the program, which is projected at $25 billion over the next five years.  By contrast, the President has proposed a $5 billion increase, for a total of $30 billion.  These is growing concern that limiting the SCHIP program to the President’s request would not allow states to maintain coverage for the 6.6 million children currently enrolled in the program, let alone expanding coverage to additional eligible children. 

It is important to note that the House and Senate bills largely maintain the current eligibility guidelines for SCHIP programs.  Generally, states are able to offer coverage to uninsured children in households up to 300% of the federal poverty level.  States are allowed to go above this 300% of poverty level, but receive a lower federal match for enrolled children above that threshold.   

Click here to see a side-by-side analysis of the House and Senate SCHIP bills.