The State Children’s Health Insurance Program: An Administrative Experiment in Federalism

The authors describe Title XXI of the Social Security Act as a fund-ing scheme for children’s health insurance that represents an “experi-ment in federalism,” a new cooperative model under which state and fed-eral governments interact on an equal basis. Under this scheme, the federal government provides funding and the states remain free to estab-lish administrative details. The authors compare the advantages and dis-advantages of this new approach with older approaches, such as Medi-care and Medicaid. The authors argue that Title XXI has proven successful in allowing state governments without fiscal or administrative capacity the flexibility to aid children in need of medical care. Finally, the authors urge continued study of Title XXI to determine the extent to which cooperative federalism can serve as a model for national health care.

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