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

The authors describe Title XXI of the Social Security Act as a funding scheme for children’s health insurance that represents an “experiment in federalism,” a new cooperative model under which state and federal governments interact on an equal basis. Under this scheme, the federal government provides funding and the states remain free to establish administrative details. The authors compare the advantages and disadvantages of this new approach with older approaches, such as Medicare 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.