Bush pushes back against Medicaid expansions. Source: Source: www.whitehouse.gov

Following up on recent efforts to restrict the State Children’s Health Insurance Program (SCHIP) after states tried to broaden eligibility, the Bush administration now is imposing restrictions on the ability of states to expand eligibility for Medicaid, according to The New York Times (NYT). The administration claims that families of modest incomes may have access to private health insurance.

States had generally been free to set their own Medicaid eligibility criteria, but state officials in Louisiana, Ohio and Oklahoma have discovered in recent weeks that the Bush administration is applying the same SCHIP restrictions to Medicaid eligibility, NYT reported.

On Dec. 20, the Bush administration rejected a proposal by Ohio to expand its Medicaid program to cover 35,000 more children. Ohio now offers Medicaid to children with family incomes up to twice the poverty level, or about $41,000 a year for a family of four. The state had proposed increasing the limit to three times the poverty level, to about $62,000.

Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, said that the same concern, about the substitution of government healthcare for private insurance, is present under both SCHIP and Medicaid, and states will not be allowed to “sidestep the Aug. 17 policy directive” by expanding Medicaid, according to the NYT.

Jeff Nelligan, a spokesman for the Medicaid agency, said Ohio officials “were trying to get around the Aug. 17 policy directive.” Under that policy, states had to enroll 95 percent of eligible children below 200 percent of the federal poverty level before they could expand their programs, a criterion that many state health officials said would be impossible to meet.

Tony Fratto, a spokesman for President Bush, said that the administration wants states to focus on enrolling their neediest population before considering middle-income families.

Meanwhile, Oklahoma and Louisiana officials have faced roadblocks in their efforts to increase the income limit for Medicaid.

The new federal policy reflects a significant shift from the days of Tommy G. Thompson’s four years as the secretary of Health and Human Services. Over the past year, President Bush has battled with Congress over funding for the child health program.