d

May 19, 2008

The Honorable George W. Bush
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

The Honorable Michael O. Leavitt
Secretary, U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear President Bush and Secretary Leavitt:

As representatives of non-partisan organizations committed to improving health care for all children, we are writing to share our deep concern regarding the impact of the directive to states that was issued by the HHS Centers for Medicare and Medicaid Services (CMS) on August 17, 2007. In particular, we are concerned that scores of children who are currently enrolled in the State Children's Health Insurance Program (SCHIP) will lose coverage as a result of this policy change. Unfortunately, the letter sent to states by CMS on May 7, 2008, which seeks to clarify the directive's requirements, does not change the policy outlined in the August 17 directive and, sadly, does nothing to mitigate its impact. States still must overcome serious hurdles before they can provide SCHIP coverage to uninsured children in working families and children – even those who lose a parent or whose parents become unemployed – will be subject to a one-year waiting period before they will be eligible for coverage under SCHIP.

As organizations committed to ensuring that all of our nation's children have access to affordable health care coverage, we strongly believe that no child in America who is currently covered under SCHIP or Medicaid should lose their health coverage or access to care as a result of this administrative directive. We share your commitment to ensuring that federal health coverage programs make our nation's lowest income children the foremost priority, however, the CMS directive runs directly contrary to our common goal of covering America's poorest children first. The August 17 directive already is jeopardizing access to health care for low-income children in at least 23 states. Moreover, recent reports by the Government Accountability Office (GAO) and the Congressional Research Service (CRS) affirm that the directive goes beyond what is permissible under current law. Unfortunately, the May 8, 2008 letter to states which seeks to clarify the previous directive did not address these serious concerns. In light of the directive's impact on state efforts to provide coverage for their uninsured children and the findings of the GAO and CRS reports, we respectfully request that you withdraw the August 17 directive and restore states' ability to determine how best to cover their state's children.

With more than nine million American children lacking any form of health insurance and nearly two-thirds of that number already eligible for Medicaid or SCHIP, we must do all we can to reduce coverage barriers, not add additional ones. We appreciate your recognition of the importance of improving SCHIP enrollment, including the campaign pledge you made at the Republican National Convention in 2004: "America's children must also have a healthy start in life. In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs." Most recently, we thank you for including in your fiscal year 2009 budget request to Congress funding for grants to states and other community-based organizations to improve outreach and increase the enrollment of eligible children into SCHIP or Medicaid. Indeed, all of these efforts are critical if we are to tackle the coverage crisis facing our nation's most vulnerable children. However, rescinding the August 17 directive is essential if we are to make serious progress on this front.

Instead of spending precious federal resources on litigation to restrict coverage of low-income children, we should focus our efforts on improving coverage for these kids. No child in America should lose their health coverage as a result of philosophical differences in Washington, D.C. Our nation must do better for our children.

We know you agree that our children are our nation's most precious resource and that investments in health care for kids reap benefits that last a lifetime. We welcome the opportunity to discuss these issues with you and to work with you to be sure that all of our nation's children have access to the health care services and coverage they need.

Sincerely,

First Focus
American Association of School Administrators
LEAnet
National Association of Community Health Centers
PICO National Network
The 2010 Cover All Kids Initiative
AARP
Action for Children North Carolina
Alliance for Excellent Education
American Academy of HIV Medicine
American Academy of Nursing
American Academy of Pediatrics
American Academy of Pediatrics, Pennsylvania Chapter
American Academy of Pediatrics Utah
American Association of People with Disabilities
American College of Obstetricians and Gynecologists
American Dental Education Association
American Humane Association
American Medical Women's Association
American Music Therapy Association
American Network of Community Options and Resources (ANCOR)
American Nurses Association
American Psychiatric Association
American Psychological Association
American Public Health Association
Anchorage School District (AK)
Anchorage's Promise (AK)
Association for Community Affiliated Plans
Association of Clinicians for the Underserved (ACU)
Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN)
Autism Society of America
Bayonne Jewish Community Center
Bayonne YMCA
Bazelon Center for Mental Health Law
Bedford Youth & Family Services (MA)
The Black Children's Institute of Tennessee
California State Association of Counties
Catholic Charities of the Archdiocese of Newark
Catholic Charities USA
Catholic Health Association of the United States
Catholic Healthcare West
Center for Public Policy Priorities (TX)
Center for Medicare Advocacy, Inc.
Child and Adolescent Health Measurement Initiative
Child and Family Policy Center, Des Moines, IA
Children and Adults with Attention Deficit/Hyper Activity Disorder
Child Welfare League of America
Children First for Oregon
Children Now (Sacramento/Oakland, CA)
Children's Aid Society
Children's Dental Health Project
The Children's Health Fund
The Children's Partnership
Clinch Valley Community Action, Inc. (North Tazewell, VA)
Clinical Social Work Association
Colorado Children's Campaign, Denver, CO
Colorado Community Health Network
Colorado Organization on Adolescent Pregnancy, Parenting, and Prevention
Community Action Partnership
Community Health Care Association of New York State
Connecticut Association for Human Services
Connecticut Legal Services, Inc.
Consumer Health Coalition
Corona-Norco United Way (CA)
County Commissioners' Association of Ohio
County Commissioners Association of Pennsylvania
County Welfare Directors Association of California
Cystic Fibrosis Foundation
DePelchin Children's Center (Houston, TX)
Disability Rights Education and Defense Fund
Easter Seals
Educational Arts Team
The Epilepsy Foundation
Families USA
Family Voices
Family Voices-NJ
FAMIS Outreach Project (Radford, VA)
FRESC: Good Jobs Strong Communities
Greater Hartford Legal Aid, Inc. (CT)
Healthy York Network (York, PA)
Health Care For All Massachusetts
HIV Medicine Association
Hudson Perinatal Consortium, Inc. (Jersey City, NJ)
Immunization Action Coalition
Indiana Primary Health Care Association
Intermountain Pediatric Society
Iowa/Nebraska Primary Care Association
Jersey City Library Literacy Program
Legal Assistance Resource Center of CT
Legislative Coalition for People with Disabilities (Utah)
Lutheran Services in America
Maine Children's Alliance
Maryland Women's Coalition for Health Care Reform
Maternal and Child Health Access (Los Angeles, CA)
Maternity Care Coalition (Philadelphia, PA)
Mental Health America
Medicaid Health Plans of America
Mental Health/Mental Retardation Program Administrators of Pennsylvania
Methodist Healthcare Ministries (San Antonio, TX)
Miami-Dade County
Michigan County Social Services Association
Michigan's Children
Montview Boulevard Presbyterian Church Health Care Task Force (Denver, CO)
Mountain Youth Resources
National Association for Children's Behavioral Health
National Association for the Education of Young Children
National Association of Anorexia Nervosa and Associated Disorders
National Association of Children's Hospitals
National Association of Counties
National Association of County Behavioral Health and Developmental Disability Directors
National Association of County Human Services Administrators
National Association of Pediatric Nurse Practitioners
National Association of School Psychologists
National Association of Social Workers
National Association of State Directors of Special Education
National Council for Community Behavioral Healthcare
National Council of Jewish Women
National Council of Urban Indian Health
National Down Syndrome Congress
National Federation of Families for Children's Mental Health
National Health Law Program (NHeLP)
National Hispanic Health Foundation
National Hispanic Medical Association
National Partnership for Women & Families
National Women's Law Center
New Haven Legal Assistance Association
New Mexico Alliance for School-Based Health Care
New Mexico Voices for Children
NH Healthy Kids Corp
Organization of Chinese Americans (OCA)
Ohio Child Support Enforcement Agency Directors' Association
Ohio Job and Family Services Directors' Association
Oklahoma Institute for Child Advocacy
OPTIONS for Independence
Oregon Action
Pennsylvania Association of County Human Services Administrators
Pennsylvania Partnerships for Children
Prevent Blindness America
Public Children Services Association of Ohio
Public Health-Seattle & King County (WA)
Rhode Island KIDS COUNT
Rural Health Association of Tennessee
Salt Lake County Mayor
Salt Lake Community Action Program
Sargent Shriver National Center on Poverty Law
SC Appleseed Legal Justice Center, Columbia, SC
Service Employees International Union
Southeastern Network of Youth and Family Services, Bonita Springs, FL
Statewide Parent Advocacy Network of New Jersey
Tennessee Commission on Children and Youth
Tennessee Health Care Campaign
Tennessee Justice Center
Tennessee Primary Care Association
Texas Association of Public and Nonprofit Hospitals
Texas Coalition for Nurses in Advanced Practice
Texas Network of Youth Services
The Arc of the United States
The Arc of Utah
TII CANN - Title II Community AIDS National Network
United Cerebral Palsy
United Neighborhood Health Services, Inc.
United Spinal Association
United Way of America
United Ways of California
United Way of Greater High Point
United Way of Hudson County
United Ways of Louisiana
United Ways of New Jersey
United Way of Pennsylvania
United Ways of Texas
Utah Covering Kids & Families Coalition
Visiting Homemaker Services of Hudson County
Voices for America's Children
Voices for Children, Nebraska
Voices for Ohio's Children
Voices for Utah Children
Washington Health Foundation
Washington Physicians for Social Responsibility
YWCA of Metropolitan Dallas