Speaker Pelosi’s mammoth health legislation, H.R. 3962, includes the largest Medicaid expansion in history, adding as many as 18 million people to the program. Not only will childless adults become eligible for Medicaid for the first time in the history of the program, approximately 5 million children who have been served under the successful and popular State Children’s Health Insurance Program (SCHIP) will also be transferred into Medicaid. Speaker Pelosi’s bill preempts the decisions previously made by the elected women and men in state capitols.

For more than 10 years, states have made the choice whether to run their SCHIP programs as a separate non-Medicaid program or as a Medicaid expansion. A majority of states including California which serves the most children under SCHIP have chosen to run separate SCHIP programs. A separate SCHIP program provides states with greater flexibility in managing benefits, service delivery, and eligibility. Under the current SCHIP program, there is no individual entitlement and eligibility is reserved only to those who were previously uninsured. States had the flexibility to impose a waiting period to protect against families dropping their private coverage. All of this will be overridden under the new legislation. State SCHIP programs will be dismantled.

Families will not have a choice between Medicaid and ability to use the new credits for private coverage. Families may be split as children will be forced into Medicaid.