| The Honorable George W. Bush
President
White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Mr. President,
I write to express my grave concern regarding the Center for Medicare and Medicaid Services (CMS) August 17, 2007 letter, which would have the effect of denying health care coverage to as many as 10,000 children in New Jersey. We have provided health coverage to 122,000 children through our successful State Children's Health Insurance Program (SCHIP), FamilyCare, and I am deeply concerned about the devastating impact that this misguided policy will have on our efforts to address the growing problem of the uninsured.
New Jersey has been at the forefront of enrolling children in the SCHIP program since its inception. Through the SCHIP program, we have been able to protect and improve the health of our most vulnerable children, who would otherwise have no access to quality medical care. Ensuring that children have this access to health insurance will give them a healthy start in life and reduce health care expenditures later in life. I have made children's health a top priority, and in the last year and a half we have already enrolled over 100,000 additional children in both the Medicaid and SCHIP program.
In the letter, CMS indicates that you will deny State requests to extend eligibility under the State Children's Health Insurance Program (SCHIP) to children in families with effective family income levels above 250 percent of the Federal poverty level (FPL). This is in direct opposition to the position that CMS has consistently taken in recent years. In fact, SCHIP was designed with bipartisan support to provide states with the tools and the flexibility to address the distinct needs of each of our populations. In New Jersey, where we face a high cost of living, this has allowed us to expand coverage up to 350% of poverty to insure more children in need since 1998. We have undertaken this coverage pursuant to multiple approvals from CMS - most recently just last year.
Although the letter purports to clarify existing requirements, the simple fact is that it sets forth entirely new and unreasonable conditions for the SCHIP program. Not only are these onerous conditions contrary to the existing statutory and regulatory framework, but there can be no doubt that the imposition of these conditions will curtail the ability of New Jersey to design and operate health care programs to best serve our children. Although the letter was issued under the guise of preserving employer sponsored insurance, the practical effect of the new policy would be that thousands of innocent children will lose or be denied health insurance coverage and will be forced to join the growing ranks of the uninsured. The letter imposes specific conditions that would harm our children and that would make the administration of the program practically impossible, including: * the requirement that children lack coverage for at least one year before enrollment in the program without allowing any exceptions - a harsh and unnecessarily long wait that is four times longer than our current "crowd out" requirement, which was approved by your CMS in November 2005;
* the condition that would bar the provision of coverage to children in families above 250 percent of the FPL, unless there has been less than a 2 percent decrease in employer-based coverage over the past five years - an unreasonable and unattainable requirement given the current negative national trend in employer-based coverage; and,
* the condition that SCHIP expansion is allowed only where the State has been able to enroll 95 percent of all eligible low-income children in SCHIP or Medicaid - a requirement that no state will be able to meet. These restrictions will effectively gut our successfully FamilyCare program and will only increase the ranks of the uninsured.
Since the conditions imposed by the letter contravene the fundamental objectives underlying SCHIP, violate the terms of its statutory and regulatory framework, and overstep CMS's authority by altering regulations without utilizing appropriate procedural safeguards, New Jersey will continue to provide health care to children in families with income up to 350 percent of the FPL in accordance with terms of its State Plan Amendments and Waiver approved by the federal government in 1998, 2005 and 2006. We will vigorously continue our commitment to enrolling all children eligible for our current program.
I ask you to reconsider your position given the critical importance of this issue. Please also know that I am prepared, if necessary, to pursue legal action to further the goal of protecting our most vulnerable children.
Sincerely,
Jon S. Corzine
Cc: Health and Human Services Secretary Michael Leavitt |
