CMS Should Improve Efforts to Assess Whether SCHIP is Substituting for Private Insurance

February, 2009 In this report, relevant SCHIP annual reports were examined and reviewed to determine the crowd-out. CMS provided guidance to states regarding activities to minimize crowd-out in SCHIP, and the information it collected was of limited use in assessing whether crowd-out should be a concern. In issuing guidance to states, CMS instituted specific requirements for program designs that the agency identified as being at greater risk of crowd-out, including programs with higher income eligibility thresholds . . .