New Congressionally Mandated Report Details SCHIP's First Five Years

PRINCETON, N.J. (March 5, 2003)—Although current state budget shortfalls threaten funding, the evidence to date suggests that the State Children's Health Insurance Program (SCHIP) is a successful program popular among legislators, families, advocates, and providers alike, according to a new report to Congress prepared by Mathematica Policy Research, Inc., and its subcontractor the Urban Institute. Furthermore, knowledge of the program among eligible families is widespread and growing, and families appear to have good access to primary care, although there are some concerns about access to specialists and dentists.

The report, the first from the congressionally mandated evaluation, found that states acted quickly and made great use of the flexibility afforded by the SCHIP statute to design their programs, although they did face many implementation challenges.

The report draws on case studies in six of the ten states included in the national evaluation: California, Colorado, Louisiana, Missouri, New York, and Texas. These states include the three largest SCHIP programs in the nation. Researchers interviewed state officials, advocates, plan staff, and providers. Other data sources include findings from focus groups (conducted by Health Systems Research, Inc.) with parents from families whose children SCHIP targets, preliminary data from a survey of low-income uninsured families nationwide, and enrollment records from three states.

The report details findings in the following areas:

• Outreach. Early on, states emphasized mass media campaigns to establish awareness of SCHIP but most added community-based efforts. Outreach was not uniformly effective across states or subgroups of the population, and more work is needed to increase awareness and understanding of program rules. In particular, Hispanic families interviewed in Spanish and families below 50 percent of the poverty level were the least aware of SCHIP.
• Enrollment. Enrollment grew steadily after the programs were implemented. In fiscal year 2002, 5.3 million children were covered at some point during the year, an increase of 15 percent over the number enrolled in fiscal year 2001. State officials also reported that Medicaid enrollment had increased as a result of SCHIP outreach.
• Program Entry and Exit. Nearly all states succeeded in developing simple SCHIP application and enrollment procedures. Typically, procedures include short joint applications for SCHIP and Medicaid, mail-in application options, and telephone or in-person help with filling out an application. Few states use an asset test for SCHIP (a common feature of Medicaid applications in the past), and many have 12-month continuous eligibility periods and require minimal documentation to establish eligibility. However, many low-income parents with uninsured children, particularly less-educated ones and those interviewed in Spanish, perceived the application process as difficult.
• Enrollee Satisfaction. Researchers found high enrollee satisfaction with the SCHIP program—families liked the low price, the range of benefits, and access to providers offered. Parents of low-income uninsured children generally also had positive attitudes toward SCHIP and Medicaid—82 percent of those who had heard of one or both programs said they would enroll their children if told they were eligible.
• Benefits. Although Medicaid benefits are usually more comprehensive than SCHIP ones, SCHIP programs offer benefits that are broader than those provided under private health insurance. SCHIP benefits meet the needs of most children, according to study participants.
• Cost-Sharing. Many states require modest cost-sharing. Study participants generally reported this cost-sharing to be reasonable and not overly burdensome financially.
• Access to Care. Overall, access appeared to be good, especially in urban areas. In large part, this was attributed to states' use of managed care, which increased the supply of providers and the number of children with a "medical home." However, some families still reported difficulty obtaining covered services, and access in rural areas was more limited than in urban areas.
• Coordination. Researchers noted that more coordination is needed between SCHIP and Medicaid in states with separate child health programs to create seamless coverage, so that children whose family income changes can move between the two programs without disruption.

A final report to Congress, which is due in 2004, will draw on multiple data sources, including case studies in all 10 evaluation states and a household survey in each of these states, to provide more detailed information about reasons for enrollment and disenrollment, access to care, evidence of crowdout, and the impacts of the program on enrollment.

The interim report, "Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children's Health Insurance Program," by Judith Wooldridge, Ian Hill, Mary Harrington, Genevieve Kenney, Corinna Hawkes, and Jennifer Haley, with assistance from Hilary Bellamy and Renee Schwalberg, is available on the Mathematica® web site [in PDF] or on the Urban Institute web site.

For printed copies, contact Mathematica Publications, 609-275-2350. The study was funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (http://aspe.hhs.gov).

Mathematica®, one of the nation's leading independent research firms, conducts policy research and surveys for federal and state governments, as well as private clients. The employee-owned firm, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted some of the most important studies of health care, education, welfare, employment, nutrition, and early childhood policies and programs in the United States. Mathematica strives to improve public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on the provision of information collection and analysis to its clients.

The Urban Institute, located in Washington, D.C. is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance challenges facing the nation. Its health policy center examines how the dynamics of the health care market and government policy affect cost and access to care and who pays for it, with an emphasis on insurance issues facing low income families and how Medicaid and SCHIP are meeting those needs. For more information on the Urban Institute visit www.urban.org.

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