R.I. may get more federal dollars for RIte Care

PROVIDENCE - A prospective major expansion of federal support for children's health insurance will mean more money for Rhode Island. The state stands to get $20 million more this fiscal year, on top of the $55 million already included in this year's budget, officials here said Friday.

The money comes through the State Children's Health Insurance Program, or S-CHIP, and pays part of the cost of coverage for the 90,000 children enrolled in RIte Care, the subsidized health-insurance program for poor people.

Each year, Rhode Island spends its entire S-CHIP allotment by March or April, and supplements that money with state general revenues and federal Medicaid money, said John Young, associate director of the state Department of Human Services. The additional S-CHIP money will free up state general revenue funds - about $4 million - for other uses, Young said.

In the context of a state budget that totals $7 billion and includes $1.8 billion for the Department of Human Services alone, $4 million may not sound like much, but every little bit helps, Young said.

Both chambers of Congress passed bills to expand S-CHIP last week, the House on Wednesday and the Senate on Thursday. The bills are not identical, so they will now go to a conference committee that irons out the differences and sends a final version to the president.

Young deemed the bills - which each span hundreds of pages - "more confusing than Medicaid." That's saying a lot.

But he said the two bills include about the same amount of money for Rhode Island, so he's confident that whatever else they include, Rhode Island will get $75 million in the federal fiscal year that starts Oct. 1.

One thing could stand in the way: a presidential veto. President Bush has voiced opposition to the bills and proposed a much smaller expansion of S-CHIP - $5 billion over five years, for a total five-year cost of $30 billion. The House and the Senate bills call for adding $50 billion and $35 billion, respectively, over five years.

All four members of Rhode Island's congressional delegation voted yes on the bills in their respective chambers. The Senate bill passed by a veto-proof margin, but the House bill did not.

If the president vetoes the compromise bill and that bill doesn't make it through the House on an override, Congress may be forced to approve an emergency reauthorization that continues the program under its current rules.

Congress is scheduled to be in recess through Labor Day; the current S-CHIP bill expires Sept. 30.

Rhode Island has more riding on the reauthorization than the additional $20 million. The new bill drastically reworks the program's formula so Rhode Island would rely less on getting money that other states don't spend. Last year, the appropriation for Rhode Island was only $13 million; the other $42 million the state received was originally designated for other states, but taken back and redistributed to Rhode Island when those states didn't spend it.

Rhode Island's coverage guidelines are broader than the federal guidelines. For instance, the state offers coverage to children in families with income up to 250 percent of the federal poverty level - or $42,925 a year for a family of three - versus the federal guideline of 200 percent.

Still, a recent report from Rhode Island Kids Count found an estimated 18,680 uninsured children in Rhode Island. The organization's executive director, Elizabeth Burke Bryant, said reauthorizing S-CHIP in an expanded form is "absolutely essential to our continued progress" toward getting those children insured.

In all, RIte Care costs $478 million a year - $223 million in state money, $255 million in federal - including benefits for both children and adults, according to Young.