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Pennsylvania

Public Health Insurance for Children


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The two major federal funding sources for low-income children’s public health insurance are Medicaid and the State Children’s Health Insurance Program (SCHIP). States enjoy some flexibility in their Medicaid programs for children, but federal requirements establish minimum benefit packages and strictly limit cost-sharing. SCHIP funds allow states to increase coverage for children through expanding their Medicaid programs (“Medicaid SCHIP”) and/or creating separate SCHIP programs. Medicaid expansions must meet regular Medicaid requirements; states have greater flexibility in designing separate programs. [More detail and national data...]

Federal decisions are italicized.

Eligibility Criteria

Income eligibility criteria

Federal rules or guidelines1Medicaid rules require states to offer coverage to children < 6 yrs up to at least 133% FPL and < 19 yrs up to 100% FPL. With SCHIP funds, states may extend coverage for children < 19 yrs who are not eligible for Medicaid up to 200% FPL or up to 50 percentage points above regular Medicaid income limits.
Medicaid income eligibility limit as % of FPL for children under 1 year in family of 32185% (2009)
Medicaid income eligibility limit as % of FPL for children ages 1-5 in family of 32133% (2009)
Medicaid income eligibility limit as % of FPL for children ages 6-19 in family of 32100% (2009)
SCHIP (separate program) income eligibility as % of FPL for children in family of 33300% (2009)

Asset eligibility criteria

Assets disregarded for Medicaid eligibility4Yes (2009)
Assets disregarded for SCHIP (separate program) eligibility3Yes (2009)

Immigrant eligibility criteria

Federal restrictions on lawful permanent residents' (LPRs) access to benefitsNone (2009)

Benefits

Cost to family

Federal rules or guidelines5In Medicaid (including SCHIP-funded expansions), nearly all cost-sharing is prohibited for children covered based on family income. In separate SCHIP plans, states may impose premiums, deductibles or other cost-sharing, but fees may not exceed 5% of income (additional limits apply for children with income of 100 - 150% FPL).
Premium for family of 3 with 2 children at 151% FPL3$0/year (2009)
Premium for family of 3 with 2 children at 200% FPL6$960/year (2009)

Participants

Number of recipients

Number of children in Medicaid (including Medicaid SCHIP)71,040,611 children (FY 2008)
Number of children in Medicaid SCHIP8No Medicaid SCHIP (FY 2008)
Number of children in separate SCHIP8256,627 children (FY 2008)

Benefit coverage

Percent of children without health insurance coverage97% (2007)
Percent of low-income children without health insurance coverage1015% (2007)

Spending

Total spending

Total spending on children in Medicaid (state and federal)11$1,554.2 million (FY 2004)
Total spending in Medicaid SCHIP (state and federal)12No Medicaid SCHIP (FY 2004)
Total spending in separate SCHIP (state and federal)13$185.3 million (FY 2004)
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Data Notes and Sources

Data on Public Health Insurance for Children were compiled by NCCP in April 2009. Some state policy decisions may have changed since these data were collected.

  1. Cynthia Pernice, Kirsten Wysen, Trish Riley, and Neva Kaye. Charting SCHIP: Report of the Second National Survey of the State Children's Health Insurance Program, National Academy for State Health Policy, 2001.
  2. Limit includes SCHIP-funded Medicaid expansions, where applicable.
    Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
  3. Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
  4. Rule applies to SCHIP-funded Medicaid expansions, where applicable.
    Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
  5. Donna Cohen Ross and Laura Cox, Enrolling Children and Families in Health Coverage: The Promise of Doing More, Kaiser Commission on Medicaid and the Uninsured, 2002.
  6. Premium payment amount at 201% of the Federal Poverty Line or 200% of Federal Poverty Line, if maximum eligibility.
    Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
  7. Figure reflects "Medicaid Eligibles" (i.e., persons enrolled in Medicaid during the year, whether or not they received health care services).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual Statistical Enrollment Report FY2008, http://www.cms.hhs.gov (accessed April 9, 2009).
  8. Figure reflects number of persons enrolled during the year. Data are based on state enrollment data submitted in the Statistical Enrollment Data System (SEDS).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual Statistical Enrollment Report FY2008, http://www.cms.hhs.gov (accessed April 9, 2009).
  9. Figure reflects the percent of children under age 18 who did not have health insurance coverage at any point during the year.
    Current Population Survey, 2008 Annual Social and Economic Supplement, "Health Insurance Coverage Status and Type of Coverage by State and Age for All People" http://pubdb3.census.gov (accessed September 3, 2008).
  10. Figure reflects the percent of children under age 19 at or below 200% of the poverty level who were not covered by a health plan at any time in the year.
    Current Population Survey, 2008 Annual Social and Economic Supplement, "Number and Percent of Children Under 19 at or below 200% of Poverty by Health Insurance Coverage and State: 2007 (SCHIP allocation formula)" http://pubdb3.census.gov (accessed September 30, 2008).
  11. Figure reflects Medicaid payments for persons whose "Basis of Eligibility" is "Child" or "Foster Care Child"; payments for children who are blind/disabled are not included. Data are based on states' eligibility and claims data submitted through the Medicaid Statistical Information System (MSIS), and they include spending on children enrolled in SCHIP-funded Medicaid expansions, where applicable (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicaid Statistical Information System (MSIS) State Summary FY2004, http://www.cms.hhs.gov (accessed August 9, 2007).
  12. Data are based on the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (Form CMS-64) submitted by states (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
    Centers for Medicare and Medicaid Services, "Net Reported Medicaid and SCHIP Expenditures," http://www.cms.hhs.gov (accessed August 10, 2007).
  13. Figure may also include administration costs associated with expanding children's coverage in an SCHIP-funded Medicaid expansion. Data are based on the Quarterly State Children's Health Insurance Program Statement of Expenditures for Title XXI (Form CMS-21) submitted by states (for more information about these data, see http://www.cms.hhs.gov).
    Centers for Medicare and Medicaid Services, "Net Reported Medicaid and SCHIP Expenditures," http://www.cms.hhs.gov (accessed August 10, 2007).