Below are a series of answers that respond to some of the questions about the State Children's Health Insurance Program that have been raised by states, providers, consumers, and others. The list is not all-encompassing and there are many other questions critical to the successful implementation of this program that we also intend to answer. The Administration remains committed to providing timely responses to important issues and will issue additional guidance as it becomes available.
COVERAGE
Question 1. How does the state choose its benchmark benefit package? What requirements must be met if a state uses the benchmark-equivalent coverage package?
Answer. States have several options in choosing their benefit package under this Title:
First, under section 2103(a)(1), a state may opt for a benefit package equivalent to one of the three benchmark benefit packages described in the law -- the standard Blue Cross/Blue Shield Preferred Provider option offered under the Federal Employees Health Benefits Program (FEHBP); a health benefits plan that is offered and is generally available to State employees; and the HMO with the largest commercial enrollment in the state.
Second, under section 2103(a)(2), a state may opt for a benefit package whose aggregate actuarial value is at least equal to one of the benchmark plans enumerated in section 2103(a)(1). The benchmark equivalent coverage must also meet the following requirements:
7The package must include coverage for inpatient and outpatient hospital services, physicians' surgical and medical services, laboratory and x-ray services, and well-baby and well-child care (including immunizations);
7If the benchmark plan selected by the state for the purpose of establishing the actuarial value of benchmark-equivalent coverage includes any of the following services --prescription drugs, mental health services, vision services, or hearing services -- the actuarial value of each of these categories of service in the benchmark equivalent coverage package must be at least 75 percent of the value of such a category of service in the benchmark plans selected by the state. If the benchmark plan does not cover one of these categories of service, then the equivalent plan may, but is not required to, provide coverage for that category of service.
The Secretary of Health and Human Services (HHS) must assure that these requirements are met prior to approving the plan.
Third, three states' existing child health programs -- New York, Florida, and Pennsylvania -- were deemed to meet the benefit requirements of the law for use in these states only. The cost-sharing protections in the new law, however, would also apply in these three states.
The statute also allows a state to apply for approval by the Secretary of HHS of other benefit packages that would provide appropriate coverage for the population of targeted low-income children. The Department has not yet developed criteria for approving such packages.
Finally, states may choose to receive an enhanced federal matching rate to expand Medicaid for optional targeted low-income children. A state choosing the Medicaid option must provide the Medicaid benefit package offered in their state.
Question 2a) If the state selects a benchmark plan for coverage, and that plan has cost-sharing requirements, which cost-sharing rules apply -- those set out in Title XXI or those of the benchmark original plan?
Answer. The Title XXI limits serve as ceilings on cost-sharing regardless of the benchmark chosen. The state child health plan must include a description of the amount of premiums, deductibles, coinsurance or other cost-sharing charged, and any cost-sharing -- if any -- must be described in a schedule made available to the public. Cost-sharing may not be charged for preventive benefits and states may not favor children from families with higher incomes over families with lower incomes.
Question 2b). For purposes of determining a benchmark equivalent value, are the differences between the cost-sharing requirements of the benchmark plan and the limitations imposed by Title XXI recognized when computing the actuarial value of the benchmark plan?
Answer. Yes, cost-sharing limitations are taken into account in the calculation of the actuarial value of a benefit package. A state may design its own benefits package, however, it should adjust for the increase in actuarial value due to the limitation on cost-sharing.
Question 3. What if a child is already covered through private insurance but has extremely minimal benefits and has high premiums; is he or she eligible for Title XXI coverage?
Answer. No. In order for a child to be eligible for child health assistance (eligible for direct services) under Title XXI, the statute requires that the child not be covered under a group health plan or other health insurance, as defined in the Health Insurance Portability and Accountability Act (HIPAA) (definitions attached). Since the HIPAA definitions of group health plans and health insurance coverage define coverage broadly, most children with existing health coverage will not qualify as uninsured for purposes of Title XXI.
There are a few cases in which a child with health insurance could be defined as uninsured. For example, if a child only has coverage for a specific service (e.g. dental care or vision services), this would not be considered health insurance coverage. If a child is deemed uninsured under HIPAA and meets all other state eligibility criteria, that child could be covered under the Title XXI benefits package.
Question 4. If a state provides coverage to an uninsured child through a specific group plan which is not associated with the state (such as a plan offered by an employer), does that group coverage have to meet the standards in section 2103?
Answer. States may only use funds in this Title for family group coverage if they receive a waiver described under section 2105(c)(3). Group coverage must meet one of the requirements described in Section 2103(a), i.e., benchmark coverage, benchmark equivalent coverage, existing comprehensive state-based coverage, or Secretary-approved coverage.
STATE PLAN ISSUES
Question 5. Will the Administration have guidance for states to carry out the required coordination of their plans with others in the public and private sector?
Answer. Yes. The Department of HHS is committed to providing States with general guidance to develop all aspects of the child health plan, including the issue regarding "crowd-out" of current coverage and how best to coordinate among other coverage options in the private and public sectors. We are reviewing State strategies currently in place that have been successful in minimizing crowd-out and we will use this and other available information to help provide guidance.
Section 2102(c)(2) requires the State Child Health Plan to include a description of the coordination of the plan with other public and private health insurance programs. In terms of evaluating this section of the plan, the Department of HHS will focus on whether the plan is likely to produce the desired goals of Title XXI, such as creating a comprehensive, cohesive system of health insurance that minimizes "crowd-out" of current coverage. In addition, the Department of HHS will evaluate how Medicaid-eligible children identified through Title XXI outreach efforts will be enrolled in Medicaid.
Question 6. If a state chooses to expand coverage through its Medicaid program, must the benefit package meet all Medicaid requirements? What about the Medicaid rules which do not allow cost-sharing for kids?
Answer. Medicaid rules will apply to any expanded coverage provided under the Title XIX state Medicaid plan (section 2101(a)(2)).
Question 7. If a state decides to do a combination of Medicaid and the new Child Health Insurance Program, what approval process does the state need to go through? If a state takes the Medicaid approach, must they meet any of the Title XXI requirements? If a state initially chooses one option, can the state change to a different option later?
Answer. The Department of HHS is currently developing guidelines regarding information needed for the approval process. States choosing to expand coverage through Medicaid will be required to complete a Medicaid state plan amendment and an abbreviated plan for Title XXI. For a state selecting a joint Medicaid/Child Health Program, the state would need to submit a Title XXI plan, as well as a Medicaid state plan amendment to be consistent with the Title XXI changes.
States may expand through one option and switch to a different option at any time, if a plan amendment describing this change is approved by the Secretary.
FINANCING
Question 8. Is cost-sharing by beneficiaries considered part of the state match?('2107(d))
Answer. No. Amounts of state beneficiary cost sharing receipts would not be considered part of the state match for expenditures under Title XXI as described in section 2105(c)(5). Beneficiary cost-sharing revenues must be applied to offset, that is reduce, federally matchable Title XXI expenditures. Thus, such revenues effectively reduce both the state and federal shares of allowable Title XXI expenditures. This will have the effect that both state and federal governments would be credited with their respective portion of cost-sharing funds.
For example, if the total expenditure for a beneficiary is $1,000 and the state collects $100 in beneficiary cost-sharing, the net expenditure claimable for Title XXI against the state's allotment is $900. If the enhanced federal matching rate for that state is 65 percent, the federal government would provide $585 and the state would provide $315. As a result, the amount from the beneficiary cost-sharing is distributed proportionately between the state and federal government.
Question 9. What is the date by which a state must apply to receive its allotment under Title XXI?
Answer. For states with approved plans, the allotment under Title XXI is available for up to three years. Thus, state allotments for states with approved plans in Federal Fiscal Year (FY) 1998 remain available for expenditure on activities in FY 1998, 1999, and 2000. At the end of FY 2000, all remaining funds from states that have not fully expended their 1998 allotments will be redistributed to states that have exhausted their 1998 allotments. This process will be repeated each year of the program.
Under the law, a state must have an approved state plan for a fiscal year in order to receive an allotment that year. In order for the Department to determine allotments for FY 98, state plan applications should be submitted as soon as possible. The length of time from submission to approval will vary depending upon the quality of the plan and the extent to which requirements under the law are met. We cannot guarantee that we will be able to approve plans submitted after July 1 before the close of the fiscal year. Therefore, the sooner a state submits its plan, the more quickly HCFA will be able to approve it, and the sooner states will have access to their allotments.
It is important to note that section 2104(e) specifies that the redistributed funds will only be available to be drawn down during the year in which they are redistributed. For example, any unused 1998 funds that are redistributed to a state in 2001 must be drawn down by the end of 2001. However, the 1998 redistributed funds can be used to match: 1) previously unmatched expenditures that occurred during the previous three years, and 2) any expenditures made during the fiscal year in which the funds are redistributed. Therefore, despite only being able to draw the redistributed funds during one year, the funds can be used to match expenditures over a four year period of time.
Question 10. Who determines the amount of the enhanced Medicaid FMAP and how is it determined? ('2104(d)(2))?
Answer. The formula used to calculate the enhanced FMAP is clearly specified in statute. For a given year, the enhanced FMAP is equal to the sum of :
770 percent of a state's current FMAP percentage in that year, plus
730 percentage points.
No enhanced FMAP rate can exceed 85%.
So, if a state's current FMAP is 50%, the enhanced FMAP rate will be 65%.
The Health Care Financing Administration published the official 1998 enhanced FMAP rates in the September 10, 1997 edition of the Federal Register. In the future, the Assistant Secretary for Planning and Evaluation within the Department of Health and Human Services will publish the enhanced FMAP rate and the regular FMAP rate together in a Federal Register notice.
Question 11. What "counts" as the Title XXI state share? When must states have their matching funds available (e.g. at the time they apply, at the time they draw down the dollars, by the end of the year)?
Answer. Title XXI includes three specific limitations on what can be used as state share:
7Section 2105(c)(4) indicates that "amounts provided by the federal government, or services assisted or subsidized to any significant extent by the federal government, may not be included in determining the amount of non-federal contributions..."
7Section 2105(c)(5) establishes that a state must offset the amount of expenditures it can claim against its allotment by any premiums or other cost-sharing receipts that it collects. Cost-sharing revenue cannot be counted for the state share.
7Section 2107(e)(1)(C) imposes the same limitations on the use of provider taxes and donations as state share as are imposed under Section 1903(w) of Title XIX.
Additionally, Section 2107(d) requires the state child health plan to include details on the sources of the non-federal share of plan expenditures.
All Government-wide and Departmental requirements for drawing down federal funds will be applicable to Title XXI. The state matching funds must be available at the time the state draws down the federal funds.
We will provide further guidance, including regulations regarding the state share, as soon as they are available.
Question 12. With respect to the maintenance of effort for ‘comprehensive state-only programs,' does this only apply to Florida, New York, and Pennsylvania? In these three states, must the recent levels of funding be maintained? Can this funding then be used to draw down the enhanced match? If not, can the new funding be used only for covering "new children"?
Answer. We believe that the statutory requirement for maintenance of effort for state-only health programs applies only to three states -- Florida, Pennsylvania, and New York. If these three states obtain an approved State Child Health Plan under Title XXI, then the State funds thatare used to fund their existing programs can be used to draw an enhanced federal match for expenditures under their new plans. These states must continue to spend --at least-- the same level of state funding for child health insurance as was spent in 1996, but they can draw an enhanced match on this spending under an approved state plan.
The limited maintenance of effort requirements on spending should not be confused with the more extensive requirements on maintaining Medicaid eligibility levels. In order to receive federal matching funds for a previously state-only child health program under Title XXI, states must continue to maintain their Medicaid eligibility standards and the methodologies that were effective as of June 1, 1997. If a state wants to expand Medicaid and draw down Title XXI funds at the enhanced matching rate, it must maintain the Medicaid eligibility requirements that were effective as of April 15, 1997.
One of the Administration's main objectives is to make sure that federal dollars are used to cover children who have no insurance coverage and are not covered by Medicaid. We are concerned that singling out only three states for the maintenance of effort on current state programs is inconsistent with this intent. We will work with Congress to clarify whether this provision should apply to all states.
Question 13. Can states use any state-only health program spending to draw down match?
Answer. Yes, subject to the maintenance of effort requirements specified under law and discussed in Question 12 above. A state may convert money that was previously used under a state-only child health program into a Title XXI child health program provided the state meets all of the requirements of Title XXI and has an approved child health plan. State funds previously used to finance the state-only program would be eligible for an enhanced match under an approved Title XXI plan.
However, if the state share of Title XXI spending is reduced below the level of its FY 1996 state-only health spending, its allotment will be reduced proportionately. It is important to note that the statute applies this provision only to Florida, New York and Pennsylvania. (See Question 12 above.)
Question 14(a) If a state has expanded its Medicaid coverage, would the expenditures for "low-income targeted children" covered under the expansion qualify for the enhanced matching rate? What are some examples of different groups of children who would and would not qualify for the enhanced match?
Answer. If a state uses its Title XXI allotment to expand coverage through a separate child health program, then the state must maintain the eligibility criteria and standards for Title XIX (Medicaid) that are no more restrictive than those in effect on June 1, 1997. As a result, expenditures for children who meet these criteria would not be matchable under Title XXI. Thisis true regardless of whether the child is eligible under mandatory Medicaid levels, OBRA-93, an 1115 waiver demonstration, or a 1902(r)(2) expansion. Simply put, any child who meets the eligibility requirements of a state's Medicaid program in effect on June 1, 1997 is not eligible for an enhanced match under a new child health program.
If a state uses its allotment to expand coverage through Medicaid, then there is a different eligibility cut-off date. If a state chooses to expand Medicaid under Title XXI, then any child in that state who meets the eligibility requirements for Title XIX that are no more restrictive than those in effect on April 15, 1997 is not eligible for an enhanced match under Title XXI. The statute does not differentiate between children eligible under mandatory Medicaid levels, OBRA-93, an 1115 waiver demonstration, or a 1902(r)(2) expansion.
Examples
1. If a state expanded Medicaid eligibility through an 1115 waiver during May, 1997 then the children who are newly eligible in May would qualify for an enhanced match only if the state uses its Title XXI allotment to expand coverage through Medicaid, using Medicaid rules. If this same state used its allotment to expand coverage through a new child health program, then the children who become eligible for Medicaid in May would not qualify for the enhanced match.
2. If a State expanded Medicaid eligibility to all children up to 250% of poverty in 1995, none of the children under 250% of poverty would be eligible for an enhanced match under Title XXI. However, if the state now wants to expand coverage to children from 250% to 300% under Title XXI, the children in this higher-income range would be eligible for an enhanced match. These rules apply to both Medicaid and non-Medicaid child health expansions.
3. If a State expanded eligibility to all children up to 250% of poverty in August 1997, the expansion children would be eligible for an enhanced match. These rules apply to both Medicaid and child health expansions.
4. Some states may choose both to expand coverage through Medicaid and through a child health program. The cut-off date for children covered by the Medicaid program would be April 15. Children covered by the children's health program would have a cut-off date of June 1.
For instance, a state which had expanded eligibility to all children below 200% of poverty in May, 1997 from a prior level of 185%, may decide to cover all children up to 225% of poverty through Medicaid and children from 225 to 250%, through the child health program. In this case, the state would receive an enhanced Medicaid match for all children whose income level was between 185% and 225%.
For all these examples, please note that a state needs to have an approved plan under Title XXI to receive an enhanced match, and the enhanced match would be limited to the amount of the allotment.
Question 14(b). May a state apply for a '1115 waiver of the Title XXI requirements?
Answer. Title XXI was written to provide a broad range of options to allow states maximum flexibility in designing the program that best meets the needs of their children. While the law provides that Section 1115 under the Social Security Act, pertaining to waivers, applies to Title XXI, we believe it would be reasonable for states to have experience in operating their new Title XXI programs before designing and submitting demonstration proposals. Without experience in implementing Title XXI, it would be very difficult for HCFA to review and evaluate the merits of any waiver proposal.
Question 15(a). What are permissible uses for the 10 percent limit on expenditures not used for Medicaid or health insurance assistance?
Answer. States may use up to 10 percent of their allotment for the following activities:
1) Direct purchase of services to provide child health assistance (as defined in Section 2110 (a)) for targeted low-income children.
2) Health services initiatives, including public health as well as other health services, for improving the health of targeted low-income children and other low-income children. Any such services must not cover other low-income children unless they include targeted low-income children.
3) Outreach activities to enroll children in Title XXI programs or other public or private health coverage programs, and
4) Reasonable costs incurred by the state to administer the plan.
Question 15(b). How is the 10 percent limit on expenditures not used for Medicaid or health insurance assistance calculated?
Answer. Under the statute, the 10 percent limit is calculated as 10 percent of total federal payments under Title XXI or for targeted low income children under Medicaid. For example, if a states' total expenditure in a fiscal year quarter is $100,000 and the State has an enhanced federal matching rate of 65 percent, the Federal government would pay $65,000 and the State would provide $35,000. The 10 percent limit would apply to the Federal payments of $65,000 and the resulting limit on State expenditures not used for child health insurance would be $6,500.
Question 16(a). Can a state implement a child health plan before the plan is approved? Can a state receive matching funds on expenditures made under an implemented plan that has not yet been approved?
Answer. Only states with approved plans will receive allotments for federal matching funds for Title XXI expenditures. After the plan is approved, states can submit an estimate of their expenses for the first quarter of operation and receive these funds prospectively from HCFA.
States may implement a child health assistance plan prior to approval of that plan. However, any state that implements an unapproved child health plan risks the possibility that the plan will not be approved as implemented. In the event that the plan is not approved as it was implemented, the federal government would not match the state's prior expenditures. If a state does implement a plan prior to approval, provided that plan is approved, the state could receive federal matching funds on a retroactive basis (but not for expenses incurred earlier than October 1, 1997 or the beginning of the fiscal year in which the state plan was approved).
Question 16(b) May a state expand Medicaid eligibility now, and be reimbursed retroactively for the Medicaid services at the enhanced rate?
Answer. A state must submit a Title XXI plan and a Medicaid state plan amendment to be eligible for the enhanced FMAP for a Medicaid expansion. A Title XXI plan may be approved retroactive to its submission date but no earlier than October 1, 1997 or the beginning of the FY in which the state plan was approved. When the Title XXI plan is approved, a state which has expanded Medicaid is eligible to receive federal funds for the difference between its regular FMAP and the enhanced rate for the services provided for the expanded eligibility group retroactive to the beginning of the fiscal year. Federal funds are available until the state's allotment is exhausted, then the Medicaid expenditures are matched at the regular State matching rate.
Question 17: Why do the HHS state allotments differ from the state allotments published by General Accounting Office?
Answer. The law explicitly provides a formula to calculate state allotments which are based, in part on the last three March supplements to the Current Population Survey as reported and defined by the U.S. Census Bureau. In fiscal years 1998 - 2000, each state with an approved Child Health Plan will receive an allotment based on the state's proportion of the total number of low-income (less than 200 percent of poverty) uninsured children multiplied by a geographic cost factor. From FY 2001 - 2007, states will receive an allotment based on a proportion of a blended number of low-income uninsured and insured children again multiplied by a geographic cost factor.
The are four primary reasons why the HHS draft reserved allotments differ from the GAO's published allotments/formula:
1.As prescribed by law, HHS used the U.S. Census Bureau information to determine the allotments. The GAO did not. The GAO did not use the standard methodology employed by the U.S. Census Bureau in calculating the number of children below 200 percent of poverty. OMB sets government-wide standards for calculating the number of children in poverty. Census, using these standards, has a very specific set of criteria for calculating the number of children at or below 200 percent of poverty and the number of uninsured children at or below 200 percent of poverty. As a result, the official U.S. Census Bureau count of the number of children was lower than the GAO's by approximately 500,000 children in the count of low-income uninsured children and 1.8 million in terms of low-income children.
2.GAO did not follow the final formula specified in law for calculating the reserved allotments. In the statute, Congress included specific instructions on how to calculate the allotments. However, the final formula in the statute was not provided to the GAO for their calculations. As a result, GAO used a different calculation methodology and this difference resulted in different final allotments.
3.Even though the statute calls for the formula to be based on the number of children "at or below" 200 percent of poverty; GAO staff only calculated the number of children "below" 200 percent of poverty. Typically, most grant programs specify eligibility as being below a certain poverty level. In absence of a final draft of the bill to review, GAO assumed that this was true of the child health program. However, the child health bill clearly specifies that the formula is based on a count of those "at or below" 200 percent of poverty.
4.The base allotments used by the GAO differ from what is specified in law. Section 4921 specifies the $60 million for diabetes programs is to be transferred from the total amount of money available for the state allotments ($30 million from 1998-2002 to the Indian Health Services, and $30 million to the Public Health Service for research on diabetes). The GAO staff did not remove this $60 million from their calculations. As a result, the state allotments provided GAO are inflated by a total of $60 million.
ELIGIBILITY ISSUES
Question 18. If a state's Medicaid eligibility varies depending on the age of the child, can a state choose to go up to 200 percent of poverty for one age category and 50 percent above the current level for another age category?
Answer. Yes, but with limitations. For purposes of Title XXI, there are two limitations on financial eligibility standards:
7Eligibility is generally limited to "targeted low-income children." A "targeted low-income child" is generally defined in section 2110(b)(1) as a child whose family income exceeds the Medicaid applicable income level, but not by more than 50 percent; or 200 percent of the poverty line, whichever is higher.
7Under section 2102(b)(1)(B), eligibility standards may not, within any defined group of covered targeted low-income children, "cover such children with higher income without covering children with a lower family income."
Under the Medicaid approach, normal eligibility requirements apply. It appears that a state may define eligibility groups and apply different income standards to those groups, as long as those income standards are below the maximum income levels in the definition of "targeted low-income children" and do not favor children with higher incomes over others. As a result, a state may cover children in certain age groups with incomes above 200 percent of poverty if its current eligibility standards for such children is above 150% of poverty.
Question 19(a). Is the Children's Health Insurance Program a "federal means-tested public benefit", meaning that certain legal immigrant children cannot be covered?
Answer. The Children's Health Insurance Program must be considered a "means-tested benefit" according to the interpretation of the term as published in the Federal Register on August 26, 1997. The Children's Health Insurance Program meets the essential elements included in this definition:
7It is a mandatory spending program as defined in section 2101(c) of Title XXI.
7The program meets the Department of HHS' definition of "means-tested" -- eligibility is based on an individual's family income and resources.
7While the statute does not explicitly require verification of income, the purpose of the program is to enable states to provide coverage to "uninsured, low-income children". The eligibility standards define a "low-income child" as one whose family income is at or below 200 percent of the Federal Poverty Level.
Therefore, many legal immigrant children who arrived in the United States after August 22, 1996 (the date of enactment of the welfare reform legislation) will not be eligible for any state health insurance program funded through Title XXI for the first 5 years of residency. However, qualified legal immigrant children in one of the excepted groups will be eligible for the program, including refugees, children of veterans or active duty service members, etc.
It is important to note that legal immigrant children who were in the United States on August 22, 1996 may be eligible for the Children's Health Insurance Program, at state option.
Undocumented immigrant children are not eligible for coverage regardless of their date of entry into the United States.
A sixty day period is available for comments on the August 22, 1997 Federal Register notice regarding the definition of "means-tested" benefit.
Question 19(b).What about emergency services for undocumented children? Can children's health insurance funds (including the 10 percent for non-insurance related items) be used to pay for undocumented children?
Answer. The only federal funds that are available for these undocumented immigrants to cover the cost of emergency services (services related to a medical condition which would place the patient's health in serious jeopardy, or would result in serious impairment of bodily functions), regardless of age, are funds provided through Medicaid These services are available to all undocumented immigrants, provided they would otherwise meet the Medicaid eligibility requirements.
We have not yet determined whether the 10 percent non-insurance related allotment can be used to provide such emergency services to legal immigrants, for example, with incomes at a higher percentage of poverty than Medicaid allows. We will provide guidance on this issue as soon as it is available.
Question 20. What children are excluded from participation in Title XXI?
Answer. Several groups of children are explicitly excluded from participation:
7A child who is found to be eligible for Medicaid;
7A child who has health insurance coverage;
7A child who is covered under a group health plan;
7A child who is an inmate of a public institution or a patient in an institution for mental diseases; or
7A child who is a member of a family that is eligible for health benefits coverage under a state health benefits plan on the basis of a family member's employment with a public agency in the State.
ADMINISTRATION
Question 21. What part of the Department of Health and Human Services will administer the program? Will there be a designated part of an agency or a specific person in charge? Who should states call with questions?
Answer. The Center for Medicaid and State Operations (CMSO) within the Health Care Financing Administration (HCFA) will have primary responsibility for administering the federal aspects of Title XXI. In addition, there will be a team from other offices within the Department of Health and Human Services working together to provide support for this program.
Within HCFA, the implementation effort will be led by Debbie I. Chang, Director of the Office of Legislation. Debbie is working in cooperation with the Health Resources and Services Administration (HRSA) and other parts of the Department. Her phone number is 202-690-5960. Within HRSA, Earl Fox, MD, Administrator, is the lead on this effort. His number is 301-443-2216. Rick Fenton, Deputy Director of the Family and Children's Health Programs Group, will be the Center for Medicaid and State Operations' coordinator for policy and implementation activities. His phone number is 410-786-5920.
Question 22. What will be the role of Governors, providers and children's advocacy and other interested groups in implementing the program?
Answer. We plan to work with a range of interested parties to get input on the process and to make sure that implementation occurs as smoothly as possible. In particular, we will work closely with the states through the National Governors Association.
Last updated January 16, 1998