State Children's Health Insurance Program Program Research Articles

Improving children's healthcare through state health insurance programs: An emerging need

State Children's Health Insurance Program (SCHIP) in the USA plays a critical role in healthcare service utilization. This study assesses children's needs for healthcare services among the variations of SCHIP. This study applies the PRECEDE-PROCEED behavioral model to analyze the behavior of children with healthcare needs and unmet healthcare needs by using the National Survey of Children with Special Healthcare Needs of the USA. Children who were previously under a Medicaid program are apt to enroll in SCHIP programs. SCHIP children with healthcare needs are more likely than comparable non-SCHIP children to use hospital outpatient departments instead of using doctors' offices and health centers. Children under the SCHIP single and SCHIP combination programs are more likely to use doctors' offices and health centers than those in the Medicaid expansion program. SCHIP combination or SCHIP Medicaid expansion states are significantly less likely to have unmet healthcare needs than children in SCHIP single states. Medicaid has a significant impact on the SCHIP program. There is a substitution of healthcare service facilities between hospital outpatient departments and either the doctors' offices or health centers.

Parental eligibility for public health insurance: a study of the State Children's Health Insurance Program and child coverage rates

This article investigates whether offering parental coverage for public health insurance increases coverage rates among children. Using data from the Current Population Survey (CPS), we examine the effect of parental benefits on participation rates of children in the State Children's Health Insurance Program (SCHIP). Our findings indicate a significant difference in take-up rates for children in states offering parental coverage compared to neighbouring states that did not in the period surrounding the introduction of the SCHIP program (1997–2002). Specifically, states offering parental coverage have greater program participation (on the order of 10% points) among children even after controlling for observable demographic characteristics and the household's position in the income distribution. Thus, extending coverage to the parents of SCHIP-eligible children appears to be an effective strategy to reduce uninsurance rates among children.

How Does the SCHIP Exclusion Affect Health Insurance Coverage for Children of Low Income State Workers?

A provision of the law that created the State Children's Health Insurance Program (SCHIP) to provide low cost coverage for moderate income children whose parents do not have employment-based coverage excludes children whose families are eligible for participation in a state employee health benefit plan from enrollment in the state's SCHIP program. This exclusion applies even when a child is not covered and would otherwise be eligible for SCHIP based on his or her family's income. This article presents an analysis of the implication of this policy on coverage among state employee dependents and the potential effect on these children. We found no evidence that low income children of state workers were disproportionately lacking coverage from 2002 to 2004, but rapidly increasing premiums in state benefit plans may portend problems for these children.

The State Children's Health Insurance Program and Job Mobility: Identifying Job Lock among Working Parents in Near-Poor Households

To assess whether near-poor parents' job mobility is reduced due to the non-portability of employer-provided health insurance—an effect termed job lock—the authors examine data from the Survey of Income and Program Participation for 1996 and 2001, years bracketing the introduction of the State Children's Health Insurance Program (SCHIP). Among the working fathers whose children met the SCHIP eligibility criteria, those whose wives did not have their own employer-provided insurance were 5–6% more likely to separate from their current employer in the year of the later survey than in the year of the earlier survey, whereas those whose wives were insured exhibited no comparable change in mobility. These results confirm the presence of job lock: for men whose wives were uninsured, but not for those whose wives were insured, the authors argue, the SCHIP program presented a new opportunity to switch jobs without losing health insurance.

Lessons from SCHIP

Lessons from SCHIP

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.

Prior Health Care Experiences of Adolescents who Enroll in SCHIP

The State Children's Health Insurance Program (SCHIP) was designed to provide health insurance to low-income children and adolescents. Little is known about prior access to care and health care experiences of new SCHIP enrollees. We surveyed Florida and New York new adolescent SCHIP enrollees about their health status, prior health care utilization, access, and unmet needs. Most enrollees were younger (ages 12-16 years), Black or Hispanic, lived in poverty, and were without health insurance the year before SCHIP. Most had a usual source of care (USC) prior to enrollment; Blacks and Hispanics were less likely than Whites to have had a USC. Although 69% of Florida and 80% of New York adolescents reported seeing a physician the year before enrollment, 24% and 40%, respectively, reported unmet health care needs. Only 32% of Florida and 40% of the New York adolescents who were surveyed reported ever having met privately with their clinicians. Many new SCHIP enrollees report unmet needs, disparities in access, and sub-optimal care prior to enrollment. Adolescents' needs should be considered in SCHIP program and quality assurance efforts.

Wisconsinʼs Recent BadgerCare Enrollment Decline

The State Children's Health Insurance Program (SCHIP) has been intended to provide healthcare coverage to that group of children previously caught between Medicaid eligibility and adequate access to employer insurance. However, SCHIP can be implemented quite differently across the states, potentially affecting actual enrollment. We review prior studies that have attempted to dissect how the administration of SCHIP impacts enrollment, including a multivariate study by the authors that indicates presumptive eligibility, expanded parent coverage, and 12-month continuous eligibility all contribute to a reduced likelihood of being uninsured. We then detail an administrative policy change in one state, Wisconsin, that yielded unanticipated and dramatic enrollment fluctuations in its SCHIP program, BadgerCare.

The effect of two publicly funded insurance programs on use of dental services for young children.

The purpose of this study is to compare the use of dental services for preschool aged children enrolled in North Carolina Medicaid, a traditional program based on a fee-for-service schedule, and North Carolina Health Choice (NCHC), an State Children's Health Insurance Program (S-CHIP) dental insurance program structured similarly to private insurance. All children (165,858) 1-5 years of age enrolled in Medicaid and S-CHIP (NCHC) at some time during one study year (October 1, 1999-September 30, 2000). DATA SOURCES/EXTRACTION METHODS: Medicaid and NCHC enrollment and dental claims files were obtained for individual children. An observational study with a retrospective cohort design. Use of dental services for each child was measured as having at least one dental claim during the outcome period (October 1, 1999-September 30, 2000). Multivariable logistic regression models were developed to compare the effect of two differently administered insurance programs on the use of dental services, controlling for demographic, enrollment, and county characteristics. Children enrolled solely in S-CHIP (NCHC) were 1.6 times more likely (95 percent confidence intervals (CI)=1.50-1.79) to have a dental visit than those enrolled solely in Medicaid. Prediction models for children enrolled for 12 months indicated that those enrolled in S-CHIP (NCHC) had a significantly higher probability of having a dental visit (50 percent) than those enrolled in both plans (44 percent) or Medicaid only (39 percent), a trend found in all age groups. The S-CHIP (NCHC) program appears to provide children with increased access to dental care compared to children in the Medicaid program.

Enrolling children in the State Children's Health Insurance Program (S-CHIP): Can we do more?

Enrolling children in the State Children's Health Insurance Program (S-CHIP): Can we do more?

States Have Second Thoughts About Health Benefit Cuts

Back to table of contents Previous article Next article Government NewsFull AccessStates Have Second Thoughts About Health Benefit CutsKate MulliganKate MulliganSearch for more papers by this authorPublished Online:1 Oct 2004https://doi.org/10.1176/pn.39.19.0390006Texas Gov. Rick Perry (R) gave children in the State Children's Health Insurance Program (SCHIP) a temporary reprieve in mid-August when he announced a delay in implementation of regulations that would have eliminated coverage for beneficiaries whose parents have overdue premiums.The new rules, which were scheduled to take effect on August 15, could have affected as many as 20,000 children, according to an August 13 report at<www.kaisernetwork.org>.Texas's Fiscal 2004 budget, which was implemented July 1, 2003, reduced funds for the SCHIP program by $299 million and increased participating families' copayments and premiums.Texas children accounted for more than half of this first-ever national decline in SCHIP enrollment. In that state, SCHIP enrollment has declined by more than 149,000 children (29 percent) since the beginning of Fiscal 2004. Most of the reduction in enrollment occurred among children in families with incomes below 150 percent of the federal poverty level (Psychiatric News, September 3).The Web site<www.startelegram.com> reported on September 2 that the SCHIP cuts had become a campaign issue in Texas's 17th congressional district. Rep. Chet Edwards (D) organized a press conference at which physicians spoke against the budget cuts that began July 1, 2003. Edwards lambasted his opponent, state Rep. Arlene Wohlgemuth (R), who“ was the author of the state's overhaul of the health system.. .that resulted in changes to SCHIP.”Cuts in Medicaid also have become a campaign issue in Mississippi. The new chair of the state Democratic Party, Wayne Dowdy, said, “The Democratic Party is going to concentrate on the issues that affect the real people of Mississippi like health care for the elderly [and] this Medicaid issue.”He asked for a special legislative session to rescind changes to and cuts in Medicaid.At the urging of Mississippi Gov. Haley Barbour (R), the state's legislature enacted budget cuts that could result in dropping 65,000 Medicaid beneficiaries from the rolls.Implementation of the cuts was delayed from July 1 to September 15. The Mississippi legislature passed a resolution in May requesting the governor's permission to “revisit” the legislation (Psychiatric News, August 6).Policy analyst Barbara Yondorf told attendees at the National Academy for State Health Policy's annual conference in August that a literature review found that the SCHIP and Medicaid programs had been the most effective strategies to address the problem of how those without health insurance can receive needed medical care (see Original article: page 5).A report released August 31 by the Center for Studying Health System Change (HSC) came to a similar conclusion.According to “Trends in Americans' Access to Needed Medical Care, 2001-2003,” the “most notable improvements in access to medical care occurred for low-income children, likely reflecting growth in public insurance coverage.”That report is posted online at<www.hschange.org/CONTENT/701>.▪ ISSUES NewArchived

Context or composition: what explains variation in SCHIP disenrollment?

To investigate (1) the relative contributions of family and contextual characteristics to observed variation in disenrollment rates from the State Children's Health Insurance Program (SCHIP), and (2) whether context explains observed family-level patterns. We use secondary data on 24,628 families enrolled in New Jersey's SCHIP program (NJ KidCare), and county-level data from the Area Resource File, the Census, and the NJ FamilyCare provider roster. Information on family characteristics, SCHIP plan, and dates of enrollment and disenrollment are taken from NJ KidCare administrative records, which provided surveillance data from January 1998 through April 2000. We estimate a multilevel discrete-time-hazards model of SCHIP disenrollment. Families enrolled in plans involving cost-sharing, blacks, and those with only one enrolled child have higher than average rates of disenrollment. Disenrollment rates for blacks are lower in counties with a high share of black physicians. These characteristics account for part of the intercounty variation in disenrollment rates; remaining intercounty variation is largely explained by physician density or population density. It may be worthwhile to pay special attention to black families and counties with high disenrollment rates to address the reasons for their lower retention. Addressing cultural differences between physician and client and the geographic distribution of medical providers might reduce disenrollment.

Health of children in title XXI: should we worry?

Health of children in title XXI: should we worry?

OMB estimates indicate that 900,000 children will lose health insurance due to reductions in federal SCHIP funding.

Despite the success of the State Children's Health Insurance Program (SCHIP) in reducing the ranks of uninsured children, the program now faces significant financing challenges. Analysis based on a model developed by the Centers for Medicare and Medicaid Services indicates that by 2007, 20 states will have insufficient federal funding to sustain their current programs, with the first states affected in 2004. As a result, the Office of Management and Budget projected last year that SCHIP enrollment will fall by 900,000 children between 2003 and 2007. The funding shortfalls are the result of several factors. Federal SCHIP funding fell by 26 percent--by more than dollar 1 billion-in each of fiscal years 2002, 2003, and 2004; dollar 1.2 billion in SCHIP funds has already expired and reverted to the Treasury at the end of fiscal year 2002, and another dollar 1.5 billion will expire at the end of 2003. The SCHIP program also has a redistribution system with targeting and timing problems. However, proposed Congressional legislation restoring federal funding, extending the dollar 2.7 billion in expiring funds, and targeting the funds to the states that most need them could avert most, if not all, of the projected enrollment decline. On the other hand, the Bush administration proposed to extend the expiring funds but does not target them to needy states; the proposal will do little to reduce the magnitude of the decline.

Evaluation of Children's Health Insurance: From New York State's Child Health Plus to SCHIP

The legislation and funding of the State Children's Health Insurance Program (SCHIP) in 1997 resulted in the largest public investment in child health care in 30 years. The program was designed to provide health insurance for the estimated 11 million uninsured children in the United States. In 1991 New York State implemented a state-funded program-Child Health Plus (CHPlus)-intended to provide health insurance for uninsured children who were ineligible for Medicaid. The program became one of the prototypes for SCHIP: This study was designed to measure the association between CHPlus and access to care, utilization of care, quality of care, and health care costs to understand the potential impact of one type of prototype SCHIP program. The study took place in the 6-county region of upstate New York around and including the city of Rochester. A before-and-during design was used to compare children's health care for the year before they enrolled in CHPlus versus the first year during enrollment in CHPlus. The study included 1828 children (ages 0-6.99 years at enrollment) who enrolled between November 1, 1991 and August 1, 1993. A substudy involved 187 children 2 to 12.99 years old who had asthma. Data collection involved: 1) interviews of parents to obtain information about demographics, sources of health care, experience and satisfaction with CHPlus, and perceived impact of CHPlus; 2) medical chart reviews at all primary care offices, emergency departments, and health department clinics in the 6-county region to measure utilization of health services; 3) claims analysis to assess costs of care during CHPlus and to impute costs before CHPlus; and 4) analyses of existing datasets including the Current Population Survey, National Health Interview Survey, and statewide hospitalization datasets to anchor the study in relation to the statewide CHPlus population and to assess secular trends in child health care. Logistic regression and Poisson regression were used to compare the means of dependent measures with and without CHPlus coverage, while controlling for age, prior insurance type, and gap in insurance coverage before CHPlus. Only one third of CHPlus-eligible children throughout New York State had enrolled in the program by 1993. Lower enrollment rates occurred among Hispanic and black children than among white children, and among children from lowest income levels. PROFILE OF CHPlus ENROLLEES: Most enrollees were either previously uninsured, had Medicaid but were no longer eligible, or had parents who either lost a job and related private insurance coverage or could no longer afford commercial or private insurance. Most families heard about CHPlus from a friend, physician, or insurer. Television, radio, and newspaper advertisements were not major sources of information. Nearly all families had at least 1 employed parent. Two thirds of the children resided in 2-parent households. Parents reported that most children were in excellent or good health and only a few were in poor health. The enrolled population was thus a relatively low-risk, generally healthy group of children in low-income, working families. ACCESS AND UTILIZATION OF HEALTH CARE: Utilization of primary care increased dramatically after enrollment in CHPlus, compared with before CHPlus. Visits to primary care medical homes for preventive, acute, and chronic care increased markedly. Visits to medical homes also increased for children with asthma. There was, however, no significant association between enrollment in CHPlus and changes in utilization of emergency departments, specialty services, or inpatient care. QUALITY OF CARE: CHPlus was associated with improvements in many measures involving quality of primary care, including preventive visits, immunization rates, use of the medical home for health care, compliance with preventive guidelines, and parent-reported health status of the child. (ABSTRACT TRUNCATED)