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Kerry Weems Acting Administrator Centers
for Medicare and Medicaid Services

U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, Maryland 21244

Dear Acting Administrator Weems:

Attached please find a letter sent to Acting Administrator Kuhn from members of the New York Congressional delegation urging CMS to rescind immediately the burdensome and unfair requirements imposed on states wishing to extend health insurance to moderate-income families outlined in the Centers' August 17th letter to state departments of health.

Herb Kuhn
Acting Administrator
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services 7500 Security Boulevard
Baltimore, Maryland 21244

Dear Acting Administrator Kuhn:

We are writing to urge you to rescind immediately the burdensome and unfair requirements imposed on states wishing to extend health insurance to moderate-income families outlined in the Centers' August 1ih letter to state departments of health. We also urge you to approve promptly New York State's pending Children's Health Insurance Program (SCHIP) expansion waiver.

State flexibility is at the heart of the SCHIP program. When Congress enacted the law 10 years ago it widely recognized that states should be allowed to structure their own programs based on the needs and economic realities of their own citizens. That is why the law allows states to set their own income and family contribution requirements as long as cost-sharing does not exceed 5 percent of family income and states maintain reasonable policies to prevent families from giving up private insurance for SCHIP. This flexibility and the partnership it created between the states and the federal government have contributed to the popularity and success of SCHIP today.

As you know, the cost of living differs significantly throughout the country. New York has some of the highest costs of living of any state. The same goods and services purchased in Milwaukee, Wisconsin for $4 1,500 would cost a family in New York City $87,000.Data from the Economic Policy Institute shows that families at 350% of the federal poverty level living in New York City and Long Island have no available income after paying for basic necessities such as housing, taxes, child care, and transportation to and from work.

New York's SCHIP program, also known as Child Health Plus, is a great example of the overall program's success. As the second largest SCHIP program in the country, New York has reduced its number of uninsured children by more than 40% and improved both access to health care and health outcomes among its children enrolled in the program. Furthermore, New York has imposed reasonable protections to deter privately insured individuals from dropping coverage in favor of SCHIP. It currently requires a six month waiting period with exceptions for the involuntary loss of coverage. It also requires a family contribution of approximately 2% of total income.

The August Iih requirements place unreasonable conditions on all states seeking to cover uninsured children in conditions that can not be met currently by any state. It is difficult to conclude anything other than that the real intent of the new requirements is to prevent states from expanding coverage to uninsured children in families with incomes above 250% of the federal poverty level and to roll back the expansions already approved in 19 states. This will result in hundreds of thousands of children losing health insurance.

Administrator Kuhn, earlier this week the Census Bureau released new data showing that the number of uninsured children has increased for the second year in a row and has hit a new high of 8.7 million. CMS and this Administration should be doing everything in their power to reverse this disturbing trend. Unfortunately the requirements imposed by your agency will only exacerbate the problem.

We urge you in the strongest possible way to rescind immediately your August 17th policy regarding SCHIP and to approve New York's expansion waiver. Thank you for your prompt consideration of this matter.