Children's Health Insurance Program Research Articles

The Great Recession of 2007-2009 and Public Insurance Coverage for Children in Alabama: Enrollment and Claims Data from 1999-2011.

This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. We analyzed enrollment and claims data from Medicaid and the Children's Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. A one-percentage-point increase in a county's unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state's unemployment rate during the Great Recession, combined enrollment of children in Alabama's public health insurance programs increased by 24% and total expenditures rose by 40%. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

Policy Campaign: One State's Journey to Influence the Reauthorization of the Children's Health Insurance Program

Policy Campaign: One State's Journey to Influence the Reauthorization of the Children's Health Insurance Program

Improving Data, Enhancing Enrollment: Florida Covering Kids & Families CHIPRA Data System.

According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children under 19 years of age are uninsured, giving Florida the second largest number of uninsured children in the United States. Florida Covering Kids & Families (FL-CKF) is dedicated to developing innovative outreach methods for enrolling and retaining eligible children in Florida KidCare, the state's Children's Health Insurance Program. FL-CKF has developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. The data system was created using the Checkbox survey systems. Community and school outreach partners enter data each month on all completed Florida KidCare applications via a secure interface. The system requires data be entered in a uniform format and forces vital data points to be completed. These data are then transmitted to the state to obtain timely application determination information on enrollments. The data system helps FL-CKF to determine which outreach strategies are successful and where changes need to be made to increase effectiveness. The system also provides feedback to community outreach partners in order to enable follow up with families when needed. Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan.

Tobacco smoke exposure increases breathing problems of children. Texas Children's Health Plan is a Managed Medicaid and Children's Health Insurance Program (CHIP) managed care provider. The aim of this study is to determine associations among tobacco smoke exposure, asthma prevalence, and asthma health-care utilization. Texas Children's Health Plan conducts an annual survey of members who have a physician visit. Questions were added to the survey in March 2010 about asthma and tobacco smoke exposure. Survey results for children < 18 years of age were matched to health plan claims data for the 12 months following the date of the physician visit. A total of 22,470 parents of unique members/patients from birth to < 18 years of age participated in the survey. More whites than African Americans or Hispanics report that the child's mother is a smoker (19.5% vs 9.1% and vs 2.3%, respectively; P < .001). Compared with children whose mother does not smoke, parent report of asthma diagnosis and claims for dispensing of short-acting beta agonist medication are greater if the mother is a smoker (adjusted OR, 1.20 [95% CI, 1.03-1.40] and 1.24 [95% CI, 1.08-1.42], respectively). In contrast to Medicaid, in which there are no out-of-pocket costs, the CHIP line of business requires copays for ED visits. ED visits are influenced by maternal smoking only in the CHIP line of business (adjusted OR, 4.40; 95% CI, 1.69-11.44). Maternal smoking increases risk for asthma diagnosis and prescription of asthma quick relief medication. Maternal smoking predicted asthma-related ED visits only for the CHIP line of business.

Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

(1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

Professionalism in interventional cardiology and the new value-based payment system.

Professionalism in interventional cardiology and the new value-based payment system.

CHIP-ing Away at Health Disparities: Has State-Provided Health Insurance Reduced Race- and Nativity-Based Differences in Health Care Utilization among US Children?

Although recent legal permanent residents and undocumented immigrants are generally barred from accessing public health insurance, some US states cover immigrant children through the Children’s Health Insurance Program (CHIP). In this study, we examine the contextual effect of US state health insurance eligibility policy, particularly with respect to immigrant children, on race/ethnic and nativity-based disparities in children’s routine health care. Utilizing our original data on state CHIP eligibility policies and child-level data from the Survey of Income and Program Participation, we find that a significant portion of between-state variation in children’s routine health care results from diversity in CHIP eligibility rules for poor and foreign-born children. Immigrant-specific disparities are reduced when states do not require five years of residency for CHIP participation.

Location of Usual Source of Care among Children and Adolescents in the United States, 1997-2013

To examine national trends in the percentage of children whose usual source of care is at a clinic, health center, or hospital outpatient department (hereafter "clinics") and whether trends differ by sociodemographic subpopulations. Analysis of serial, cross-sectional, nationally representative in-person household surveys, the 1997-2013 National Health Interview Surveys, was conducted to identify children with a usual source of care (n = 190,571), and the percentage receiving that care in a clinic. We used joinpoint regression to identify changes in linear trends, and logistic regression with predictive margins to obtain per-year changes in percentages, both unadjusted and adjusted for sociodemographic factors. Interaction terms in logistic regressions were used to assess whether trends varied by sociodemographic subgroups. Of all children with a usual source of care, the percentage receiving that care in a clinic declined 0.44 percentage points per year (P < .001) from 22.97% in 1997 to 19.31% in 2002. Thereafter, it increased approximately 0.57 percentage points per year (P < .001), reaching 26.1% in 2013. Trends for some sociodemographic subgroups varied from these overall trends. No changes were observed between 2003 and 2013 for non-Hispanic black and Medicaid/State Children's Health Insurance Program insured children. This study shows that, although the percentage of children with a usual source of care in a clinic declined between 1997 and 2002, it has steadily increased since that time.

The Affordable Care Act and Access to Care for People Changing Coverage Sources.

We investigated how access to and continuity of care might be affected by transitions between health insurance coverage sources, including the Marketplace (also called the Exchange), Medicaid, and the Children's Health Insurance Program (CHIP). From January to February 2014 and from August to September 2014, we searched provider directories for networks of primary care physicians and selected pediatric specialists participating in Marketplace, Medicaid, and CHIP in 6 market areas of the United States and calculated the degree to which networks overlapped. Networks of physicians in Medicaid and CHIP were nearly identical, meaning transitions between those programs may not result in much physician disruption. This was not the case for Marketplace and Medicaid and CHIP networks. Transitions from the Marketplace to Medicaid or CHIP may result in different degrees of physician disruption for consumers depending on where they live and what type of Marketplace product they purchase.

Confessions of a Square Peg

Confessions of a Square Peg

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries

Evidence, Politics, and the Future of the Children's Health Insurance Program.

The major expansion of health insurance coverage through the creation of the Children’s Health Insurance Program (CHIP) in 1997 was driven by the recognition that millions of children—those whose family incomes were too high to qualify for Medicaid but for whom other insurance was unobtainable—were falling through the cracks of the US health insurance system. At the time, CHIP appeared a bipartisan victory, representing an expansion of public insurance coverage that gave states wide latitude to contract with private plans or place limits on enrollment. 1 By 1999, all states had implemented CHIP. Since the creation of the program, states have implemented a diverse array of policy options under CHIP to serve children and have dramatically improved access to and continuity of insurance coverage for children in low-income families. In the short term, funding for CHIP is likely to be temporarily extended by Congress. In the long term, the future of CHIP should be part of a serious and bipartisan discussion among policy makers about how to best ensure access to health insurance for children in low-income families and develop a comprehensive health policy approach for children and families.

Medicaid Proposal Updates Managed Care Rules

You have accessThe ASHA LeaderPolicy Analysis1 Aug 2015Medicaid Proposal Updates Managed Care RulesIn comments, ASHA raises issues of quality measures, continuity of care, provider enrollment and other topics. Laurie Alban HavensMA, CCC-SLP Laurie Alban Havens Google Scholar More articles by this author , MA, CCC-SLP https://doi.org/10.1044/leader.PA.20082015.26 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Proposed regulations for managed care programs under Medicaid and the Children’s Health Insurance Program (CHIP) would create more uniformity among state programs while improving beneficiary choices and quality. Issued in late May by the Centers for Medicare and Medicaid Services (CMS), the proposal updates 2002 regulations for managed care organizations. Estimates indicate that managed care enrollment in Medicaid—the largest payer of health care services in the United States—has jumped 48 percent to 46 million beneficiaries, and that almost three-quarters of Medicaid beneficiaries will be enrolled in managed care organizations by the end of 2015. Almost three-quarters of Medicaid beneficiaries will be enrolled in managed care organizations by the end of 2015. As a result of this growth, audiologists and speech-language pathologists are providing services to greater numbers of patients covered by Medicaid and CHIP managed care organizations. ASHA’s comments to CMS on the proposal address several issues that affect audiologists and SLPs who participate—or are interested in participating—as providers in Medicaid managed care plans. Alignment of plans. Because people often move among insurers, ASHA is requesting that eligibility standards for managed care programs be the same as those for other payers, such as traditional Medicaid and Medicaid expansion plans and the plans that are part of the health insurance exchanges. With standardized enrollment qualifications, a patient leaving one plan would likely qualify for another. Network adequacy. Managed care organizations should be required to update their network or providers regularly, to ensure sufficient providers to meet enrollees’ needs and to allow audiologists and SLPs who want to participate to enroll as spaces become available. Quality improvement. CMS should institute methods that adequately measure the quality of speech-language and hearing services, rather than using measures developed for other disciplines. Continuity of care. When beneficiaries qualify for both Medicare and Medicaid, managed care plans should ease the change from or among multiple payers by minimizing the wait for treatment approval from the new providers. Appeals. CMS should streamline the process for beneficiaries who want to appeal plan decisions to deny services. Historically, the timeframe to appeal denied claims has been limited, although payers have been allowed more time to provide a response. ASHA will provide more information on the effects of the regulations when the final rule is issued sometime later this year. Author Notes Laurie Alban Havens, MA, CCC-SLP, is director of ASHA private health plans and Medicaid advocacy. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 20Issue 8August 2015 Get Permissions Add to your Mendeley library History Published in print: Aug 1, 2015 Metrics Current downloads: 134 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2015 American Speech-Language-Hearing AssociationLoading ...

Coverage and care consequences for families in which children have mixed eligibility for public insurance.

Public health insurance for low-income children in the United States is primarily available through Medicaid and the Children's Health Insurance Program (CHIP). Mixed eligibility occurs when there is a mix of either "Medicaid- and CHIP-eligible" children or a mix of "eligible (for public insurance) and ineligible (for public insurance)" children in the family. We used data from the Medical Expenditure Panel Survey (MEPS) Household Component for 2001-12 to examine insurance coverage, access to care, and health care use for eligible children in families with mixed-eligible siblings compared to those in families where all siblings were eligible for one program. We found that mixed eligibility has a significant dampening effect for eligible children in families with a mix of eligible and ineligible siblings. These children were more likely to be uninsured and less likely to have a usual source of care, less likely to have any preventive dental or well-child visits during the year, and less likely to fully adhere to recommended preventive dental and well-child visits than eligible children with all-Medicaid- or all-CHIP-eligible siblings. We found no significant impact for eligible children living in Medicaid-CHIP-mixed families.

Goodbye, Sustainable Growth Rate-Hello, Merit-Based Incentive Payment System.

On 16 April 2015, President Obama signed the Medicare Access and Children's Health Insurance Program Reauthorization Act, or MACRA. In addition to repealing the sustainable growth rate formula, thi...

Block Granting Medicaid: A Model for Twenty-First Century Health Reform?

Block Granting Medicaid: A Model for Twenty-First Century Health Reform?

Health Reform Redux: Where Might a Republican Congress Be Heading?

Health Reform Redux: Where Might a Republican Congress Be Heading?

If Rollbacks Go Forward, Up To 14 Million Children Could Become Ineligible For Public Or Subsidized Coverage By 2019

In spring 2015 Congress passed legislation to extend funding for the Children's Health Insurance Program (CHIP) through the end of fiscal year 2017. This two-year extension pushes to 2017 the question of whether CHIP funding will end, allowing states to end their separate state CHIP programs. Also, when the Affordable Care Act's maintenance-of-effort requirements expire after 2019, states will be allowed to roll back Medicaid- and CHIP-eligibility thresholds to minimum levels allowed by federal law. This study investigated the potential health insurance options available to low-income children if these events happen. If all states roll back coverage to federal statutory minimums, then, among children in families with incomes up to 400percent of the federal poverty guidelines, the share ineligible for public coverage or subsidized Marketplace coverage would increase from 22percent in 2014 (12.5million children) to 46percent after 2019 (26.5million children). While not all states are likely to reduce eligibility to federal statutory minimums, these estimates highlight the fact that many children who do lose public eligibility will not become eligible for subsidized Marketplace coverage.

Health Care Reform

The Affordable Care Act of 2010 (ACA) was grafted onto a complex structure employment-based health benefit plans supplemented by a number of federal and state health care programs including Medicare, Medicaid and the Child Health Insurance Program (CHIP). This article examines the development of health care benefits in the United States before 2010. A following article will appraise the ACA.