One in 4 US children has health insurance through public, government-sponsored programs—Medicaid or the State Children's Health Insurance Program (SCHIP). These public programs are important not only because of the vast number of children they cover but also because children who lack health insurance have worse access to care than those with either public or private health insurance. Public programs also disproportionately serve children with special health care needs. Furthermore, children's health care facilities depend heavily on Medicaid and SCHIP patients and the accompanying reimbursements to maintain programs and services, including programs that also benefit privately insured children. Therefore, Medicaid and SCHIP policies have a tremendous impact on health care delivery to US children, shaping the scope and quality of health care as well as the nature of pediatric practice. This article reviews key aspects of SCHIP, a program whose future is at a crossroads, focusing on issues that are important to pediatricians and others who deliver care to children.
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