State Children's Health Insurance Program Programs Research Articles

Behavioral Health Services in Separate CHIP Programs on the Eve of Parity

The Children's Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits. However, a substantial share of states imposed limits or cost sharing that might hinder access to care. The majority of states use managed care to administer behavioral health benefits. It is important to monitor how states adapt their programs to comply with parity.

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.

Discontinuity of Coverage for Medicaid and S‐CHIP Children at a Transitional Birthday

To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. The likelihood of dropping public coverage after the reference birthday is modeled for children turning age 6 compared with a control cohort of children turning age 9 controlling for demographic and geographic differences between enrollees. Over 17 percent of 6-year-olds versus only 7 percent of the control cohort dropped coverage. After controlling for other factors (e.g., race/ethnicity, prior enrollment, and geographic region) having lower historical expenditures is predictive of dropping coverage among all children, although the unadjusted effect is stronger among children enrolled in PeachCare before their sixth birthday. Only 1 percent of Medicaid children who remained covered transitioned to PeachCare. Turnover at transitional birthdays identifies a common pathway for children into the ranks of the uninsured. Facilitating continuous enrollment would retain in the programs children with lower than average expenditures. This may be one of the more cost effective ways of reducing the number of uninsured children in Georgia.

Lessons from SCHIP

Lessons from SCHIP

State Children's Health Insurance Program: A Lifesaver for Children

The problems associated with a lack or absence of health insurance continues to become more obvious every day. In 1997 the federal government recognized a critical problem among children whose parents, many of whom were working, could not afford insurance, and created the State Children's Health Insurance Program (SCHIP). Many of these children did not qualify for Medicaid and thus, children of the working poor, often went without the most basic of health care services. This article describes the history of the SCHIP programs and how the nurse practitioner needs to become proactive in the care of children who are not getting their health care needs met because of a lack of insurance.

Funding Child, Elderly Health Care Gets Widespread Support

Back to table of contents Previous article Next article Health Care EconomicsFull AccessFunding Child, Elderly Health Care Gets Widespread SupportMark MoranMark MoranSearch for more papers by this authorPublished Online:15 Oct 2004https://doi.org/10.1176/pn.39.20.0390016A majority of Americans believe that the health care needs of children and the elderly are not being met, according to a survey published in the online edition of the journal Health Affairs last month.The survey also found that many Americans assume an equal distribution of health care resources among children and the elderly, when in fact there is a significant per capita and aggregate difference favoring the elderly.There is widespread support for a strong government role in providing health care to all children and the elderly, regardless of income level, and this support cut across age groups, gender, and political party affiliation, the results of the survey indicated.According to the survey, 59 percent of adults believe that the health care needs of children are not being met, while 67 percent believe that the health care needs of the elderly are not being met. When questioned about the role government should play in financing health care for these groups, 90 percent thought that government should fund health care for all low-income children and elderly, while almost the same percentage felt that this funding should be available to both age groups, regardless of income.“People want to take care of the poor and people who have needs,” said lead study author Marc Berk, vice president and senior fellow at the National Opinion Research Center (NORC) at the University of Chicago, which conducted the survey. “In an era of likely budget deficits where there is a lot of pressure to look for ways to cut programs, this survey shows that health care is not an area that the public wants to consider cutting.”The survey was funded by the Nemours Foundation and was conducted by telephone from June 4 to 18. Using random-digit dialing, 2,013 respondents from a nationwide sample were interviewed. They were asked a series of questions concerning their views on public funding of health care programs for children and for the elderly.In addition to the survey results, the September Health Affairs offers new data on generational differences in government spending, how children are affected by downturns in the economy, and an analysis of the challenges facing the State Children's Health Insurance Program (SCHIP).At least two-thirds of those surveyed indicated that they believed that children and the elderly were already receiving the same level of health care resources. In fact, however, current per capita public spending on health care for the elderly is far higher than that for children. In 2001, for example, per capita government spending on health care for the elderly was $4,360, compared with $258 for children, the authors of the survey article noted.In an interview with Psychiatric News, Berk explained that the survey question did not specify whether people assumed equal resource allocation in per capita or aggregate terms. Rather, he said, the question was a measure of how people viewed societal priorities; that is, the responses were an indication of a general assumption that the government would not favor one group over the other, he said.“Although governmental spending on the elderly vastly exceeds that for children, most Americans, including those with a college education, do not [believe] this to be the case,” Berk and colleagues stated in their report. “When asked about the relative priority that government should place on the health care needs of children versus those of the elderly, Americans clearly do not want government to choose, with a majority indicating that government should be spending about the same on children as it does on the elderly. In light of the apparent lack of understanding about current spending, the public sentiment that supports equal funding for health care for children and the elderly should probably be interpreted not as a call for an enormous shift of resources from one group to the other but as evidence that the public considers these needs to be of equal and high priority.”A study by researchers at the University of Pennsylvania School of Medicine, also published in the same issue of Health Affairs, shows that the gap in per capita social welfare spending between children and the elderly grew 20 percent in the past two decades. The study indicates that unlike spending on the elderly, spending for children suffers during economic recessions, as evidenced by recent cutbacks in many SCHIP programs stemming from overall state budget cutbacks (see Original article: page 6).The survey report, “Americans' Views About the Adequacy of Health Care for Children and the Elderly,” is posted online at<content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.446>.▪ ISSUES NewArchived

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

Enrolling children in public insurance: SCHIP, Medicaid, and state implementation.

The Balanced Budget Act of 1997 established federal grants to the states to create the State Children's Health Insurance Program (SCHIP). This presented the states with a number of implementation choices concerning administrative models for the new programs, as well as choices about eligibility standards, enrollment simplification, crowd-out, and cost sharing requirements. At the same time, the states were also implementing welfare reform. We describe the most important of these implementation choices, and using data from the Current Population Survey, we estimate the impacts of state policy on enrollment in this multiprogram environment. The results indicate that SCHIP programs that are administered as Medicaid expansions are more successful than either separate SCHIP plans or combination programs in enrolling children. States that remove asset tests and implement presumptive eligibility and self-declaration of income have higher enrollment levels. Continuous eligibility and adoption of mail-in applications have no effect on overall enrollment. Waiting periods and premiums reduce enrollment. Stringent welfare reform reduces children's enrollment, despite federal policy that was intended to protect children from the consequences of welfare reform. The negative impacts of a number of these policy reforms substantially reduce enrollment, potentially offsetting the more favorable impacts of other policy choices. We estimate that if all states adopted the policy options that facilitate program use, enrollment for children with family incomes less than 200 percent of the poverty line could be raised from the current rate of 42 percent to 58 percent.

Simplifying children's Medicaid and SCHIP.

The states have implemented the State Children's Health Insurance Program (SCHIP) in a variety of ways. We describe these choices and estimate the resulting enrollment impacts. Many widely adopted policies, including mail-in applications and twelve-month continuous eligibility, have had limited impacts. Other policies that increase enrollment, including presumptive eligibility and self-declaration of income, have not been widely adopted. SCHIP programs administered as Medicaid expansions have been more successful in enrolling children than either separate SCHIP plans or combination programs. Waiting periods, premiums, and welfare reform have had important negative impacts on children's program enrollment.

The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?

Elimination of racial and ethnic disparities in health has become a major national goal. The State Children's Health Insurance Program (SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. Telephone interview (mailed survey in Alabama) about the child's health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. New SCHIP enrollees (0-17.9 years old in Alabama, Kansas, and New York and 11.5-17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any race]), prior health insurance, health care access and utilization, and health status. Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single-parent and lower-income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. IMPLICATIONS FOR MONITORING AND IMPROVING SCHIP: SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program's impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.

Health of children in title XXI: should we worry?

Health of children in title XXI: should we worry?

Promoting Public Health Insurance for Children

Until the State Children's Health Insurance Program (SCHIP) was adopted in 1997, states were not expected to actively promote their public health programs for children or to encourage enrollment. But the availability of new administrative funds under SCHIP for outreach and marketing spurred states to create marketing campaigns to raise awareness about and increase involvement in SCHIP and Medicaid. At the same time, many of these activities were new, and states had little experience in developing marketing materials and advertising campaigns. Over time, however, states gained skill and expertise in promoting their children's health programs. As states began marketing SCHIP, they also started to focus on enrolling children in Medicaid. Historically, states did not promote Medicaid enrollment because most families were automatically enrolled when they signed up for welfare, or Aid to Families with Dependent Children (AFDC). In 1996, however, welfare reform eliminated the link between eligibility for Medicaid and AFDC, giving Medicaid the opportunity to redefine itself as a health insurance program for low-income families. (See the article by Mann, Rowland, and Garfield in this journal issue.) State advertisements and outreach strategies used to encourage enrollment in SCHIP were also used to encourage enrollment in Medicaid. This article examines how states marketed their SCHIP and Medicaid programs and identifies lessons learned from these efforts. The article focuses primarily on state advertising and marketing campaigns--since these were such new activities for public health programs that serve children--and less on outreach efforts that occurred at the community level. To describe state marketing and message strategies, this article draws on a 2000 study conducted for the Kaiser Commission on Medicaid and the Uninsured. The study included in-depth interviews with 55 officials responsible for SCHIP outreach in 48 states (including Washington, D.C.). (1,2) In addition, the study reviewed and analyzed 37 print ads, 24 television ads, and 15 radio ads from 38 states. The purpose of these efforts was to create a baseline of information about states' marketing efforts for SCHIP and Medicaid and to identify common as well as innovative approaches and messages states used. Insights from these interviews and an analysis of state marketing materials for SCHIP and Medicaid form the basis for this article. (3) The article first discusses the various strategies states used to market their children's health coverage programs. It then reviews the most common messages used to encourage parents to enroll their eligible children in a coverage program, and it briefly discusses efforts to evaluate the effectiveness of state marketing campaigns. Finally, the article concludes with a review of the lessons learned through these efforts and offers suggestions on how these lessons can be incorporated into future children's health coverage campaigns. Marketing Child Health Coverage Programs Depending on the type of public health program states implemented, and whether they promoted their public health insurance programs separately or jointly, state officials used a variety of marketing strategies to promote their programs. Strategies included the use of appealing program names, multimedia campaigns, targeted outreach campaigns, and partnerships with community-based organizations (CBOs). (See Appendix 1 at the end of the article.) New Program Names Forty-one states gave their SCHIP programs new names (see Appendix 1). Program officials surveyed in the Kaiser study reported creating names that would sound appealing to potentially eligible families and would alleviate some of the stigma attached to government-sponsored programs for low-income families. For example, states gave their programs names that sounded like commercial health plans, such as Healthy Families in California, Partners for Healthy Children in South Carolina, and PeachCare for Kids in Georgia. …

Enrolling Eligible Children and Keeping Them Enrolled

Coverage under Medicaid and the State Children's Health Insurance Program (SCHIP) provides low-income children with a vital link to needed health care, yet a significant proportion of children eligible for these programs remain uninsured. States have found that expanding eligibility and marketing new programs are not enough to increase enrollment of eligible uninsured children in public health programs. States also need to simplify enrollment and renewal procedures to make them more family-friendly. According to survey data, a key reason for underenrollment is that families find enrollment and renewal procedures too complex. This article details the efforts that states have made to increase enrollment in Medicaid and SCHIP, and it offers recommendations for strengthening these efforts. Although barriers to enrollment and renewal still exist, states are making progress in several ways, such as: Simplifying eligibility procedures. Using community-based application assistance. Eliminating procedural differences between Medicaid and separate SCHIP programs. The authors recommend that states continue to simplify program requirements and procedures, making it easier for children to enroll in Medicaid and SCHIP, retain coverage for as long as they qualify, and transfer between programs when necessary. In addition, outreach and community-based application assistance will continue to be essential activities, along with developing efforts to enroll children through other public programs, such as the food stamp program.

Improving the Implementation of State Children's Health Insurance Programs for Adolescents Report of an Invitational Conference Sponsored by the American Academy of Pediatrics, Section on Adolescent Health*, September 26–27, 1999

* Abbreviations: SCHIP = : State Children's Health Insurance Program • AAP = : American Academy of Pediatrics • AIDS = : acquired immunodeficiency syndrome • FPL = : federal poverty level • EPSDT = : Early and Periodic Screening, Diagnosis, and Treatment The enactment of the State Children's Health Insurance Program (SCHIP)‡ in 1997 and Medicaid eligibility expansions over the past decade have enormous implications for all children, and particularly for adolescents. While adolescents continue to lack insurance at a higher rate than most other age groups in the United States, large numbers of adolescents are eligible for, but not enrolled in, Medicaid and SCHIP. Even for those who are enrolled, additional barriers impede them from fully benefiting from the coverage they have. American Academy of Pediatrics (AAP) projections for the year 2000 suggest that 1 in 6 adolescents 13 through 18 years old will be without insurance, despite SCHIP and Medicaid expansions. Since 1991, adolescent uninsurance rates have averaged 16.5%. Many more adolescents are underinsured, with health insurance that does not include preventive care, mental health and substance abuse treatment, medications, or dental care. The importance of public programs such as Medicaid has grown in recent years, as the decline in the percentage of 10- through 18-year-old adolescents with private health insurance coverage has been offset by the increase in the proportion covered by public programs.1 Uninsurance rates among adolescents are higher than those of most age groups in the United States. Yet recent year 2000 projections from the AAP suggest that nearly 2.4 million adolescents 13 through 18 years old are eligible for, but not enrolled in, Medicaid and SCHIP programs. If states were to raise their eligibility limits for SCHIP to the limits allowed by federal law, an additional 65 000 adolescents would be eligible. Together these programs could cover almost two thirds of the adolescents who lack insurance.2 Insurance coverage through Medicaid and SCHIP is of critical importance because it can provide the majority of uninsured adolescents access to health care they urgently need. This can be …

Evaluation of New York State's Child Health Plus: Access, Utilization, Quality of Health Care, and Health Status

The recently enacted State Children's Health Insurance Program (SCHIP) is modeled after New York State's Child Health Plus (CHPlus) program. Since 1991, CHPlus has provided health insurance to children 0 to 13 years old whose annual family income was below 222% of the federal poverty level and who were ineligible for Medicaid or did not have equivalent health insurance coverage. CHPlus covered the costs for ambulatory, emergency, and specialty care, and prescriptions, but not inpatient services. To assess the change associated with CHPlus regarding 1) access to health care; 2) utilization of ambulatory, inpatient, and emergency services; 3) quality of health care; and 4) health status. Six western New York State counties (including the city of Rochester). Children (0-6.99 years old) enrolled for at least 9 consecutive months in CHPlus. The design was a before-and-after study, comparing individual-level outcomes for the 12 months immediately before CHPlus enrollment and the 12 months immediately after enrollment in CHPlus. Parent telephone interviews and medical chart reviews conducted 12 months after enrollment to gather information. Subjects' primary care charts were located by using interview information; emergency department (ED) charts were identified by searching patient records at all 12 EDs serving children in the study; and health department charts were identified by searching patient records at the 6 county health department clinics. 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. Complete data were obtained for 1730 children. Coverage by CHPlus was associated with a significant improvement in access to care as measured by the proportion of children reported as having a usual source of care (preventive care: +1.9% improvement during CHPlus and sick care: +2. 7%). CHPlus was associated, among children 1 to 5 years old, with a significant increase in utilization of preventive care (+.23 visits/child/year) and sick care (+.91 visits/child/year) but no measurable change in utilization of specialty, emergency, or inpatient care. CHPlus was also associated, among children 1 to 5 years old, with significantly higher immunization rates (up-to-date for immunizations: 76% vs 71%), and screening rates for anemia (+11% increased proportion screened/year), lead (+9%), vision (+11%), and hearing (+7%). For 25% of the children, a parent reported that their child's health was improved as a result of having CHPlus. After enrollment in CHPlus, access to and utilization of primary care increased, continuity of care improved, and many quality of care measures were improved while utilization of emergency and specialty care did not change. Many parents reported improved health status of their child as a result of enrollment in CHPlus. Implication. This evaluation suggests that SCHIP programs are likely to improve access to, quality of, and participation in primary care significantly and may not be associated with significant changes in specialty or emergency care.

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)

A Profile of the Population Enrolled in New York State's Child Health Plus

The recently enacted State Children's Health Insurance Program (SCHIP), designed to provide affordable health insurance for uninsured children, was modeled in part on New York State's Child Health Plus (CHPlus), which was implemented in 1991. All SCHIP programs involve voluntary enrollment of eligible children. Little is known about characteristics of children who enroll in these programs. To provide a profile of children enrolled in CHPlus between 1993 and 1994 in the 6-county upstate New York study area, and to estimate the participation rate in CHPlus. Methods. A parent interview was conducted to obtain information about children, 0 to 6.9 years old, who enrolled in CHPlus in the study area. Two school-based surveys and the Current Population Survey were used to estimate health insurance coverage. Enrollment data from New York State's Department of Health, together with estimates of the uninsured, were used to estimate participation rates in CHPlus. Most children enrolled in CHPlus in the study area were white. Although 17% of all children in the study area who were <13 years old and living in families with incomes below 160% of the federal poverty level were black, only 9% of CHPlus-enrolled children were black. Twenty-one percent of enrolled children were uninsured during the entire year before enrollment and 61% of children had a gap in coverage lasting >1 month. Children were generally healthy; only 4% had fair or poor health. Eighty-eight percent of parents of enrolled children had completed high school or a higher level of education. Parents reported that loss of a job was the main reason for loss of prior health insurance for their child. Most families learned about CHPlus from a friend (30%) or from their doctor (26%). The uninsured rate among children in the study area was approximately 4.1%. By 1993, the participation rate in CHPlus was about 36%. Blacks were underrepresented in CHPlus. Because the underlying uninsured rate was relatively low and parental education and family income were relatively high, the effects of CHPlus observed in this evaluation may be conservative in comparison to the potential effects of CHPlus for other populations of children. Participation rates during the early years of the program were modest.