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

08/01/2014

Most children leaving CHIP transferred to Medicaid or became uninsured; few gained private coverage.

In the month after leaving CHIP, 49 percent of children across the 10 study states transferred to Medicaid, and 32 percent became uninsured (Figure VI.3). Only 18 percent of disenrollees were reported to have some form of private insurance just after leaving CHIP; the rate fell to 14 percent during subsequent months. At six months after disenrollment, 13 percent of CHIP disenrollees had returned to CHIP.

Figure VI.3. Coverage Status of CHIP Disenrollees in 10 States at Different Times After Leaving CHIP, 2012

Figure VI.3. Coverage Status of CHIP Disenrollees in 10 States at Different Times After Leaving CHIP, 2012

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees; CHIP disenrollees, including 2,159 survey cases and 58,025 disenrollees who transferred to Medicaid. The survey and administrative data are combined, with the survey data weighted to represent all disenrollees who did not transfer. The one month measure includes CHIP disenrollees in all 10 states (N=59,903). The 3-month and 6-month measures exclude New York because state administrative data could not be used to construct the measure of coverage at 3 and 6 months after disenrollment; the total number of cases for these measures is 56,229.


In the 3-states included in the Medicaid survey (California, Florida and Texas), 51 percent of Medicaid disenrollees were initially uninsured, but only 28 percent remain uninsured 6 months later (Figure VI.4). Nearly half (45 percent) of Medicaid disenrollees had regained Medicaid 6 months after exit, and another 21 percent were covered by CHIP at this point. Although 15 percent of parents of Medicaid disenrollees reported that the child had private coverage after leaving the program, administrative records indicated that about half of these children had Medicaid or CHIP three and six months after the child disenrolled.

CHIP disenrollees in the 3 Medicaid survey states were more likely to be uninsured 6 months after leaving CHIP (39 percent for CHIP versus 28 percent for Medicaid), mainly because they were less likely to gain public coverage after leaving CHIP (data not shown). While 66 percent of Medicaid disenrollees were covered by Medicaid or CHIP 6 months after disenrollment, only 44 percent of CHIP disenrollees had some form of public coverage at this point. Only 14 percent of CHIP disenrollees had gained private coverage 6 months after leaving CHIP.

Figure VI.4. Coverage Status of Disenrollees in 3 States at Different Times After Exiting Medicaid, 2012

Figure VI.4. Coverage Status of Disenrollees in 3 States at Different Times After Exiting Medicaid, 2012

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees; Medicaid disenrollees in 3 states (California, Florida and Texas), including 355 survey cases and 38,557 disenrollees who transferred to CHIP. The survey and administrative data are combined, with the survey data weighted to represent all disenrollees who did not transfer.


In the vast majority of cases (90 percent), CHIP enrollment ended because the child obtained some other type of coverage or was no longer eligible for CHIP (because of age, income, or some other eligibility-related reason).

The main reason that CHIP ended for 64 percent of disenrollees was that the child obtained some other coverage, either Medicaid or private (Figure VI.5). For another 26 percent, eligibility-related reasons such as age or income were cited as the main reason that coverage ended. It is notable that missing paperwork and other aspects of the renewal process were cited as the main reason for the end of coverage for only 5 percent of CHIP disenrollees and that only 1 percent reported that coverage ended because the parent had decided not to renew the child’s coverage.

Figure VI.5. Reported Reason Why Child’s CHIP Coverage Ended, 2012

Figure VI.5. Reported Reason Why Child’s CHIP Coverage Ended, 2012

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees; CHIP disenrollee sample (n=1,878 survey cases). The percentage of disenrollees with other coverage includes 58,025 disenrollees who transferred to Medicaid. The survey data weighted to represent all disenrollees who did not transfer.


Among children who were uninsured six months after disenrolling from CHIP, only about one quarter (23 percent) disenrolled for reasons that suggest they may still be eligible.

More than 60 percent of children who were uninsured 6 months after disenrolling from CHIP were reported to have left CHIP because they no longer met the program’s age (31 percent) or income (30 percent) criteria and another 7 percent were reported to have disenrolled to obtain other coverage (Figure VI.6). We classified CHIP disenrollees as possibly eligible if they were uninsured and were reported to have left the program for reasons such as renewal paperwork was missing or incomplete or premiums were not paid. For the pool of uninsured children who might still be eligible, missing paperwork was the most common reason cited for disenrollment (16 percent), followed by reasons related to premiums (9 percent).

For the Medicaid population (data not shown), a larger share (37 percent) of disenrollees who were uninsured at six months were reported to have left Medicaid for reasons suggesting that they may still be eligible, most often (26 percent) because paperwork was missing or not submitted. Problems with premiums or affordability were cited as the reason for disenrollment among only 1 percent of Medicaid disenrollees uninsured six months later.

Figure VI.6. Reported Reasons Coverage Ended Among Children Uninsured Six Months After Exiting CHIP

Figure VI.6. Reported Reasons Coverage Ended Among Children Uninsured Six Months After Exiting CHIP

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees; 10-state CHIP disenrollee sample, n=762 disenrollees who were uninsured 6 months after leaving CHIP.


Most CHIP disenrollees ages 18 and 19 were uninsured after disenrollment, a higher percentage than younger disenrollees, primarily because they age out of CHIP and Medicaid for children and were less likely to gain Medicaid coverage as an adult.

The uninsured rate for young adults aging out of public coverage is more than double that of children under age 13 (Table VI.1). Rates of private coverage were comparable across the age groups, so the higher uninsured rate for the oldest children is driven largely by lower rates of public coverage. Only 25 percent of those ages 18 to 19 had public coverage six months after CHIP disenrollment, versus 64, 63, and 51 percent of the three younger age groups, respectively.

Table VI.1. Coverage of CHIP Disenrollees 6 Months After Disenrollment, by Age Group, 2012

  Percentage Reporting
Coverage 6 Months After Disenrollment from CHIP Ages 0 Through 5 Ages 6 Through 12 (Reference Group) Ages 13 Through 17 Ages 18 Through 19
Uninsured 20 24 35** 62**
Private 15 13 13 13
CHIP 12** 19 13** 1**
Medicaid 52** 44 38** 24**

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees; CHIP disenrollee sample, including include 2,159 survey cases and 54,070 CHIP disenrollees who transferred to Medicaid. Does not include disenrollees in New York because state administrative data could not be used to construct the measure of coverage at 6 months after disenrollment.

**Difference compared to the ages 0 to 5 group is statistically significant at p-value<0.01; *significant at p-value<.05.

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