Examining Substitution: State Strategies to Limit "Crowd Out" in the Era of Children's Health Insurance Expansions

By Anna Fallieras, Mary Jo O'Brien, Susanna Ginsburg, and Amy Westpfahl of the The Lewin Group for Office of Health Policy of the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, December 9, 1997.

The Project Officers for ASPE were Cheryl Austein and Caroline Taplin

Table of Contents

EXECUTIVE SUMMARY

I. INTRODUCTION

II. METHODOLOGY

III. REVIEW OF THE RESEARCH ON SUBSTITUTION

IV. STATE MECHANISMS TO LIMIT SUBSTITUTION

V. ESTIMATING THE AMOUNT OF SUBSTITUTION

VI. IMPLICATIONS FOR FUTURE EXPANSIONS UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

VII. DISCUSSION

APPENDIX A: BIBLIOGRAPHY

APPENDIX B: PARTICIPANTS IN THE SEPTEMBER 9TH ROUNDTABLE DISCUSSION

APPENDIX C: OVERVIEWS OF STATE PROGRAMS

CALIFORNIA KIDS

COLORADO CHILDREN'S HEALTH PLAN

FLORIDA HEALTHY KIDS CORPORATION

CHILDREN'S MEDICAL SECURITY PLAN OF MASSACHUSETTS

MINNESOTA CARE

NEW YORK CHILD HEALTH PLUS

OREGON HEALTH PLAN

RITECARE

WASHINGTON BASIC HEALTH PLUS

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