CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. Finding 3 (Chapter IV)

08/01/2014

Finding 3 (Chapter IV): Relatively few low-income children in CHIP have access to private insurance coverage, and direct substitution of private for public coverage at the time of CHIP enrollment was estimated to be as low as 4 percent. Even when dependent coverage is available to families with children enrolled in CHIP, affordability is likely an important barrier many parents face in accessing employer sponsored insurance coverage for their children.

More than 80 percent of new CHIP enrollees had a period of public insurance coverage in the 12 months before enrolling in CHIP (Figure ES.3). Just over half (52 percent) were covered continuously and another 30 percent had public coverage earlier in the year but were uninsured just prior to enrolling. A much smaller share of new CHIP enrollees (13 percent) had private coverage in the 12 months before enrolling in CHIP, including 2 percent that had a gap in coverage before enrolling and 10 percent that enrolled directly after private coverage.5

Figure ES.3. Coverage of New CHIP Enrollees in 12 Months Prior to Enrollment

Figure ES.3. Coverage of New CHIP Enrollees in 12 Months Prior to Enrollment

Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees.
Note: New enrollees are those enrolled in CHIP for three months following at least two months without CHIP coverage.


Survey information on the reason private coverage ended was used to differentiate between private coverage dropped voluntarily and coverage lost due to circumstances beyond the family’s control; 28 percent of the reasons private coverage ended were classified as voluntary. With 13 percent of new enrollees reporting any prior private coverage during the 12 months prior to enrolling in CHIP, and 28 percent ending this coverage for voluntary reasons, the estimate of direct substitution at the time of enrollment was 4 percent.

A broader measure of access to private coverage finds that roughly 43 percent of CHIP enrollees had a parent with access to employer-sponsored insurance (ESI), but only 20 percent were reported to have access to dependent coverage. An even smaller portion of CHIP enrollees (12 percent) were reported to have access to dependent coverage where the employer contributes something toward the premium, suggesting that even when dependent coverage is available, affordability is likely an important barrier many parents face in accessing ESI coverage for their children. Access to ESI for low-income uninsured children and Medicaid enrollees was also very limited. And uninsured rates among parents of Medicaid and CHIP enrollees were also high. In California, Florida and Texas, 62 percent of CHIP enrollees and 54 percent of Medicaid enrollees had at least one uninsured parent.6


5 The estimates in Figure ES.1 of children with prior private coverage with and without a gap in coverage do not sum to the total estimate of children with prior private coverage due to rounding.

6 Among CHIP enrollees across the 10 survey states, 57 percent had at least one uninsured parent.

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