CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. Finding 5 (Chapter VI)


Finding 5 (Chapter VI): Most new CHIP enrollees stayed enrolled in public coverage for at least 28 months, and the vast majority exited because they were no longer eligible. Many children moved between Medicaid and CHIP; while most transitioned seamlessly, coverage gaps occurred for as many as 40 percent depending on the type of transition.

Several factors influence the length of time a child remains enrolled in Medicaid or CHIP coverage, including whether the child continues to meet program eligibility guidelines, whether the family completes the renewal process, and the degree of coordination that characterizes the transfer from one program to another if family income or other conditions of eligibility change.

Enrollment data from each of the 10 study states was used to examine how long children remained enrolled in Medicaid and CHIP and movement between Medicaid and CHIP. Survey data provided insight into why children disenrolled and their coverage status after leaving.

Across the 10 states, new spells of Medicaid enrollment tended to last about twice as long (26 months) as new spells of CHIP (13 - 14 months), and when we included seamless movement between Medicaid and CHIP, the median duration of new spells of public coverage increased to 28 months. Median duration varied considerably across states, especially for Medicaid (Figure ES.4). The length of new Medicaid enrollment spells ranged from 15 months in California and Utah and 17 months in Texas to 44 months in Louisiana. Louisiana adopted several simplifications to largely automate the renewal process and limit the steps families need to take. In contrast, Texas and Utah required redeterminations more frequently than every 12 months. The renewal process in California’s Medicaid program is not automated and relies on county social service offices to process renewals.

Figure ES.4. Median Duration of New Coverage Spells, by State and Program Type, 2007-2012

Figure ES.4. Median Duration of New Coverage Spells, by State and Program Type, 2007-2012

Source: Mathematica analysis of state-provided Medicaid/CHIP administrative data.

M-CHIP = Medicaid expansion CHIP; Public = Medicaid and CHIP combined; S-CHIP = separate CHIP; Combination CHIP = state administers both M-CHIP and S-CHIP.

Most children (90 percent) leave CHIP because they gain another type of coverage or no longer meet the program’s eligibility criteria.

For 64 percent of disenrollees, CHIP ended because the child obtained some other coverage. Another 26 percent were no longer eligible because of income (14 percent), age (11 percent) or some other eligibility-related reason (1 percent). Only 5 percent left because of missing paperwork or some other problem with the renewal process. After leaving CHIP, most children transferred to Medicaid (49 percent) or were uninsured (32 percent). Six months later, 41 percent were in Medicaid, 13 percent had returned to CHIP, 14 percent had private coverage and the rest (32 percent) were uninsured.

Churning out of and back into the same program was more common in Medicaid than in separate CHIP programs

Over a four-year period, 21 percent of children leaving Medicaid returned to Medicaid within seven months, and the churn rate for separate CHIP programs was 10 percent. Churn rates remained fairly constant over the period, but varied across the 10 study states. Anywhere from 8 to 36 percent of Medicaid disenrollees churned back into the program within seven months, with the corresponding separate CHIP rates ranging between 2 and 19 percent.

It was common for children to move between Medicaid and CHIP; transitions between Medicaid and separate CHIP programs often lead to gaps in coverage.

During a one-year period, 28 percent of children in separate CHIP programs and half of those in Medicaid expansion programs also were enrolled in Medicaid at some point during the year. Over a three-year period, the likelihood of an enrollment period in both programs increased markedly: 74 percent of Medicaid expansion CHIP enrollees and 52 percent of separate CHIP enrollees also had at least one enrollment period in Medicaid. Many children moving between Medicaid and separate CHIP programs experience a coverage gap of two to six months. In terms of the median percentage across the states, 40 percent of transitions from Medicaid to separate CHIP programs and 33 percent of those from Medicaid expansion to separate CHIP programs resulted in such a coverage gap; gaps were less common for transitions in the other direction, occurring for 16 and 11 percent of transitions from separate CHIP to Medicaid or Medicaid expansion programs, respectively. These findings point to the importance of continued program coordination and policies to streamline transitions between programs, especially transitions from Medicaid to separate CHIP programs. Premium or enrollment fee requirements and waiting periods unique to separate programs may be a factor for some transitions to separate CHIP programs.

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