On August 17, 2007, the Centers for Medicare and Medicaid Services (CMS) issued a directive setting forth stringent criteria that would restrict children’s health coverage under the State Children’s Health Insurance Program (SCHIP) in as many as 23 states and the District of Columbia.

CMS promulgated this guidance to states already covering or implementing coverage plans for children with a family income at or above 250 percent of the federal poverty level (FPL). In order to obtain federal funds to cover children at this income level, states must indicate that they are meeting a number of requirements, one of which is that at least 95 percent of all children living in families that earn below 200 percent of FPL ($34,340 for a family of three) have health coverage.

On May 20, 2008 – just 90 days away from the implementation of the directive – First Focus sent a letter signed by 179 organizations from across the nation to President Bush and and Department of Health and Human Services Secretary Mike Leavitt urging them to repeal the CMS directive.