State Children's Health Insurance Program Research Articles

Why Do Poor Children Lose Health Insurance in the SCHIP Era? The Role of Family Health.

The broad goal of the 1997 State Children’s Health Insurance Program (SCHIP) was to ensure that all poor children have health insurance. This goal has met with mixed success. The rate of poor children in the United States who were uninsured decreased from 23 percent in 1996 to 19 percent in 2002, but over 6 million children who were uninsured in 2002 were eligible for public insurance (Kaiser Commission on Medicaid Facts 2005). Thus, while SCHIP has benefited many children, its reach should be much broader. The problem of low-income children being uninsured is perplexing because most children begin life with health insurance, owing largely to the expansions of Medicaid for pregnant women and their offspring in the 1980s and 1990s (Amy Davidoff et al. 2003), and they should be able to maintain coverage under either SCHIP or Medicaid. In particular, young children who were born after the enactment of SCHIP should have uninterrupted coverage. A number of individual characteristics and programmatic features associated with public insurance coverage among eligible poor children have been identified in past research. No study, however, has examined both the effects of the health of adult family members and the health of the child, each of which has been associated with mothers’ labor supply and public Why Do Poor Children Lose Health Insurance in the SCHIP Era? The Role of Family Health

2007 Cover the Uninsured Week update

![Figure][1] Cover the Uninsured Week 2007, set for April 23-29, is running print and television ads in select states to highlight the plight of uninsured children and encourage reauthorization of the State Children's Health Insurance Program (SCHIP). Cover the Uninsured Week 2007,

Mentally Ill Could Pay Price for Bush Budget Cuts

Mentally Ill Could Pay Price for Bush Budget Cuts

Substitution Of SCHIP For Private Coverage: Results From A 2002 Evaluation In Ten States

This paper examines the extent to which the State Children's Health Insurance Program (SCHIP) might be substituting for private health insurance coverage at the time of enrollment. Among children who were newly enrolled in SCHIP in 2002 in ten states, about 14 percent had private coverage that they could have retained as an alternative to SCHIP. Of this 14 percent, about half of parents reported that the private coverage was unaffordable compared with SCHIP. This suggests that relatively few SCHIP enrollees could have retained private coverage and that even fewer had parents who felt that the option was affordable.

SCHIP At A Crossroads: Experiences To Date And Challenges Ahead

As reauthorization of the State Children's Health Insurance Program (SCHIP) looms, we examine the program's first decade and identify changes needed so that SCHIP can better serve its target population. We conclude that by many objective standards, SCHIP has been a success, but the challenge will be to maintain and build upon that success. Critical issues include the level and structure of federal funding; the continued problem of uninsurance among low-income children; the lack of information on quality, access, and costs; and whether SCHIP can serve as the foundation for addressing broader health care needs among low-income families.

Preventive Dental Care for Children in the United States: A National Perspective

Preventive dental care is a cornerstone of optimal oral health. However, in 1996, only 38% of US children received preventive dental care. We used the National Survey of Children's Health to (1) describe the proportion of US children with > or = 1 preventive dental visit within the previous year, (2) identify factors that were associated with preventive dental care use, and (3) test the hypothesis that preventive dental care use by near-poor children is associated with State Child Health Insurance Program policies for covering dental care. The National Survey of Children's Health includes data from 102,353 children, weighted to represent 72.7 million children, nationally. Our outcome of interest was > or = 1 preventive dental visit in the past year. We conducted multivariate regression analysis to identify factors that were associated significantly with this outcome using Stata survey capabilities. In 2003, 72% of US children had a reported preventive dental care visit in the previous year. On multivariable analysis, we found that being young, black or multiracial relative to white, lower income, and lacking a personal doctor were variables with a significantly lower likelihood of a preventive dental visit. Children in states with State Child Health Insurance Program dental coverage and broadest income eligibility had a 24% higher likelihood of a preventive dental visit when compared with children in states with limited or no State Child Health Insurance Program coverage for dental services, on adjusted analysis. Although the proportion of US children with a preventive dental visit now is higher than previously reported, children who are at highest risk for dental problems still are those who are least likely to receive preventive dental care. When states cover preventive dental care at income eligibility levels > or = 200% of the federal poverty level, there is a greater likelihood that near-poor children will receive preventive dental care.

The Moral Case For Covering Children (And Everyone Else)

Before the crucial upcoming debate over reauthorization of the State Children's Health Insurance Program (SCHIP) and all of the 10,000 general health reform questions that this discussion will engender, we should consider one fundamental moral question, for our answer will reveal the kinds of policies we actually want to pursue: Who should be allowed to sit at our health care table of plenty? This essay sketches an answer to this question, drawing on the literature of various faith traditions as well as recent health services research. The short answer is: Everyone, but poor kids have a special place reserved for them.

Medicaid At The Ten-Year Anniversary Of SCHIP: Looking Back And Moving Forward

The adoption of the State Children's Health Insurance Program (SCHIP) in 1997 spurred widespread efforts to simplify and revitalize Medicaid coverage for children. To an extent often not recognized, these Medicaid improvements were a key factor behind much of the progress that has been made in covering low-income children: These children's uninsurance rate dropped from 22.3 percent in 1997 to 14.9 percent in 2005, and more than 70 percent of those gains can be attributed to Medicaid. The program, however, faces a number of issues that will need to be addressed if the country is to continue to make progress.

The Impacts of the State Children's Health Insurance Program on Children Who Enroll: Findings from Ten States

Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees. Surveys of 16,700 SCHIP enrollees were conducted in 2002 as part of a congressionally mandated study. Three domains of SCHIP enrollees were included: (1) children who were recently enrolled in SCHIP, (2) those who had been enrolled in SCHIP for 5 months or more, and (3) those who had recently disenrolled from SCHIP. Response rates varied across states and domains but were clustered between 75 and 80 percent. Five different types of indicators were examined: (1) service use; (2) unmet need; (3) parental perceptions about being able to meet their child's health care needs; (4) presence and type of a usual source of care; and (5) provider communication and accessibility. The experiences SCHIP enrollees have while on the program are compared with those a separate sample of children had before enrolling using a separate sample pretest and posttest design, controlling for observable characteristics of the children and their families. The sample was drawn based on a list frame of SCHIP enrollees. The survey was administered in English and Spanish, by Computer-Assisted Telephone Interviewing (CATI). Field follow-up was used to locate families who could not be reached by telephone and these interviews were conducted by cellular telephone. SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups. Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.

Effects of the State Children's Health Insurance Program on Access to Dental Care and Use of Dental Services

To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. The 1997-2002 National Health Interview Survey. The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics. When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects. Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.

109th Congress wraps up

The 109th Congress ended in the early morning hours of Dec. 9, 2006. Many last-minute legislative actions had an impact on children's health. Following are several highlights. The State Children's Health Insurance Program (SCHIP) was expected to face between $800 million and $950 million in federal

The Impact of Program Design on Enrollment in State Children's Health Insurance Programs

The success of State Children's Health Insurance Programs (SCHIP) in expanding insurance coverage among low‐income children varies considerably across states. Scholars have looked to different program characteristics to explain this variation, but have arrived at disparate conclusions regarding the impact of one of the most significant design choices—the decision to create a new program or to pursue increased child health insurance rates through an expansion of the existing Medicaid program. This study suggests that understanding the impact of programmatic choices requires a more careful consideration of the mechanisms through which these different program designs might influence enrollment than has been offered in previous research. Employing a multilevel governance framework, it suggests that there is a hitherto unexplored indirect impact, where design choices influence administrative behavior, which in turn influences enrollment success in SCHIP programs. It is important to understand the effect of administrative design choices because this is one of the key areas in which states exercise discretion in the implementation of many federal programs.

Multiple Obstacles Keep Millions From Insurance

Multiple Obstacles Keep Millions From Insurance

Parent proxy-report of their children's health-related quality of life: an analysis of 13,878 parents' reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales.

BackgroundHealth-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. While pediatric patient self-report should be considered the standard for measuring perceived HRQOL, there are circumstances when children are too young, too cognitively impaired, too ill or fatigued to complete a HRQOL instrument, and reliable and valid parent proxy-report instruments are needed in such cases. Further, it is typically parents' perceptions of their children's HRQOL that influences healthcare utilization. Data from the PedsQL™ DatabaseSM were utilized to test the reliability and validity of parent proxy-report at the individual age subgroup level for ages 2–16 years as recommended by recent FDA guidelines.MethodsThe sample analyzed represents parent proxy-report age data on 13,878 children ages 2 to 16 years from the PedsQL™ 4.0 Generic Core Scales DatabaseSM. Parents were recruited from general pediatric clinics, subspecialty clinics, and hospitals in which their children were being seen for well-child checks, mild acute illness, or chronic illness care (n = 3,718, 26.8%), and from a State Children's Health Insurance Program (SCHIP) in California (n = 10,160, 73.2%).ResultsThe percentage of missing item responses for the parent proxy-report sample as a whole was 2.1%, supporting feasibility. The majority of the parent proxy-report scales across the age subgroups exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the Total Scale Scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analyzing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL™ scale and summary score, across age subgroups, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium to large effect size range.ConclusionThe results demonstrate the feasibility, reliability, and validity of parent proxy-report at the individual age subgroup for ages 2–16 years. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which reliable and valid responses across age categories are achievable. Even as pediatric patient self-report is advocated, there remains a fundamental role for parent proxy-report in pediatric clinical trials and health services research.

How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8,591 children across age subgroups with the PedsQL 4.0 Generic Core Scales.

BackgroundThe last decade has evidenced a dramatic increase in the development and utilization of pediatric health-related quality of life (HRQOL) measures in an effort to improve pediatric patient health and well-being and determine the value of healthcare services. The emerging paradigm shift toward patient-reported outcomes (PROs) in clinical trials has provided the opportunity to further emphasize the value and essential need for pediatric patient self-reported outcomes measurement. Data from the PedsQL™ DatabaseSM were utilized to test the hypothesis that children as young as 5 years of age can reliably and validly report their HRQOL.MethodsThe sample analyzed represented child self-report age data on 8,591 children ages 5 to 16 years from the PedsQL™ 4.0 Generic Core Scales DatabaseSM. Participants were recruited from general pediatric clinics, subspecialty clinics, and hospitals in which children were being seen for well-child checks, mild acute illness, or chronic illness care (n = 2,603, 30.3%), and from a State Children's Health Insurance Program (SCHIP) in California (n = 5,988, 69.7%).ResultsItems on the PedsQL™ 4.0 Generic Core Scales had minimal missing responses for children as young as 5 years old, supporting feasibility. The majority of the child self-report scales across the age subgroups, including for children as young as 5 years, exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the Total Scale Scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analyzing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL™ scale and summary score, across age subgroups, including children as young as 5 years, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium to large effect size range.ConclusionThe results demonstrate that children as young as the 5 year old age subgroup can reliably and validly self-report their HRQOL when given the opportunity to do so with an age-appropriate instrument. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which children can provide reliable and valid responses across age categories.

Improved Health Care Among Children With Special Health Care Needs After Enrollment Into the State Children’s Health Insurance Program

To assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with special health care needs (CSHCN). Little is known about the impact of health insurance on CSHCN. Parents of a stratified random sample of new enrollees onto New York's SCHIP were interviewed by telephone at enrollment (n = 2644) and 1 year later (n = 2290, 87% response). At baseline, the cohort of CSHCN was defined by means of the standardized CSHCN screener instrument. The impact of SCHIP was assessed for CSHCN and for subgroups of CSHCN stratified by prior insurance (uninsured or insured) or type of chronic condition (physical or mental/behavioral). Access (having a usual source of care [USC], unmet medical needs); and quality (continuity of care at the USC, parent rating of quality of care or worry about child) were measured. Bivariate and multivariate analyses compared measures 1 year before SCHIP versus the year during SCHIP. A total of 398 (17%) of 2290 children had special health care needs identified at baseline. Enrollment onto SCHIP was generally associated with improved access: unmet needs for prescription medications declined 3-fold for all subgroups (eg, 36% to 9% among the previously uninsured) and unmet needs for specialty care declined >4-fold among CSHCN who were previously insured (48% to 10%) or had mental/behavioral conditions (32% to 2%; all P < .05). Enrollment was associated with improved continuity with the USC, parent-reported quality of care, and worry, irrespective of prior insurance or type of chronic condition (P < .05). Enrollment onto New York's SCHIP improved medical care for CSHCN.

Dynamics In Medicaid And SCHIP Eligibility Among Children In SCHIP's Early Years: Implications For Reauthorization

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

Can Private Companies Contribute To Public Programs’ Outreach Efforts? Evidence From California

We studied an innovative outreach effort in California, which trains and certifies community organizations to help complete Medicaid and State Children's Health Insurance Program (SCHIP) applications. In this paper we provide a detailed description of participating organizations, the populations they serve, and their success at turning submitted applications into enrollments. We found that insurance brokers and income tax preparers-for-profit groups that are not typically associated with outreach-make important contributions to Medicaid and SCHIP in California. Brokers, in particular, help serve a hard-to-reach population: those on the higher end of the income eligibility thresholds.

U.S. Health Spending By Age, Selected Years Through 2004

This paper examines variations in health spending by children, working-age adults, and seniors for selected years between 1987 and 2004. Seniors spent far more per person than children or working-age adults, but the relative gap between the age groups has not changed much since 1987 except for those age eighty-five and older. Since the inception of the State Children's Health Insurance Program (SCHIP) in 1997, the proportion of children's health spending financed by public sources has increased, while the share paid for out of pocket has decreased. The future age-mix is expected to have a major impact on nursing home spending growth while minimally affecting overall Medicare spending growth.

Why Millions Of Children Eligible For Medicaid And SCHIP Are Uninsured: Poor Retention Versus Poor Take-Up

More than two-thirds of uninsured U.S. children are eligible for public coverage, and most current policy debate assumes that this is largely attributable to poor take-up. This paper explores the contribution of poor retention in Medicaid and the State Children's Health Insurance Program (SCHIP) to this phenomenon. The results indicate that one-third of all uninsured children in 2006 had been enrolled in Medicaid or SCHIP the previous year. Among those uninsured but eligible for public coverage in 2006, at least 42 percent had been enrolled in Medicaid or SCHIP the previous year. Both of these measures of disenrollment have increased since 2000.