CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. Evaluation Design


Congress specified that states selected for the evaluation should represent varied geographic areas and urban/rural populations, diverse approaches to program design, and a large proportion of the low-income, uninsured children in the United States (CHIPRA Section 603 and BBRA 1999 Sec. 703 (c)(2)). Together, the 10 states selected (Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia) cover the four census regions, reflect diverse program designs, and represented 53 percent of the nation’s uninsured children and 57 percent of children enrolled in CHIP when selected in 2010. (Appendix Table B.1 summarizes how the selected states met the criteria for the evaluation).

The evaluation had five major components:

  1. A large survey of CHIP enrollees and disenrollees conducted during 2012 in the 10 states selected for the evaluation. Administered to the parents or guardians of children with current or recent CHIP coverage, the survey provided information not otherwise available on the characteristics of CHIP children and their families; perceptions of and experiences with application and renewal processes; coverage experiences prior to and after enrollment; the health status and health care needs of CHIP enrollees; enrollee experiences with accessing health care; and program impacts on access, use, and family wellbeing. A complementary survey of Medicaid enrollees, administered in 3 of the 10 CHIP survey states (California, Florida, and Texas), contributed similar types of findings on children and families enrolled in Medicaid.
  2. A second major component involved qualitative data from CHIP case studies conducted in 2012 in the same 10 states selected for the survey. Featuring site visits to various state and local stakeholders (such as program administrators, providers, and child advocates) and focus groups with families of CHIP-enrolled children, the case studies examined the design of CHIP programs and how this evolved over time, and how programs were affected by CHIPRA and the Affordable Care Act.
  3. The third component was a nationwide survey of CHIP program administrators, conducted in early 2013. This telephone survey provided information about the implementation and influence of key CHIPRA provisions and how the Affordable Care Act had affected CHIP programs to date and how it was expected to influence programs in the future.
  4. The fourth component made use of state program data—CHIP annual reports and related data submitted by states, as well as administrative data from state eligibility and enrollment systems—to analyze enrollment and retention trends and dynamics and identify program features and other factors influencing these outcomes. We explored enrollment and retention trends, including transitions between CHIP and Medicaid, and churning out of and back into the program.
  5. The final component drew on data from several national surveys (the NSCH module of the State and Local Area Integrated Telephone Survey [SLAITS], CPS, and ACS), to explore how low-income families with uninsured children perceive CHIP and Medicaid, study coverage trends since CHIP was enacted, examine Medicaid and CHIP program participation rates, and simulate future coverage under different assumptions about future funding and eligibility for Medicaid and CHIP.

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