CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. VI. Length of Medicaid and CHIP Enrollment Spells and Coverage Experiences After Disenrollment



  • Children newly enrolling in public coverage remain enrolled on average for at least 28 months. Duration of coverage varied across states, particularly among state Medicaid programs.
  • Among children who left CHIP and remained uninsured six months later, most (76 percent of the uninsured, and 24 percent of all CHIP disenrollees) left CHIP because they were no longer eligible.
  • Churning is more common in Medicaid than in CHIP; approximately 18 percent of Medicaid disenrollees and 10 percent of separate CHIP disenrollees in the 10 study states returned to the same program within seven months.
  • Most children enrolled in CHIP during a three-year period were also enrolled in Medicaid at some point in the same period.
  • Transitions between separate CHIP and Medicaid programs often lead to gaps in public coverage, suggesting that coordination between these programs remains a concern.

Several factors influence the length of time a child remains enrolled in public (Medicaid or CHIP) coverage, including whether the child continues to meet program eligibility guidelines, whether the child 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. For most children, continued eligibility is primarily a function of the relevant income thresholds, which vary by state for various age groups, and the availability of employment-based coverage. Children’s duration of enrollment, however, is also related to program rules (for example, the frequency and burdensomeness of the renewal process).

In this chapter, we draw on state CHIP and Medicaid enrollment data and information from the 2012 congressionally mandated survey of CHIP and Medicaid enrollees and disenrollees to examine how long children remain enrolled in CHIP and Medicaid and to investigate children’s coverage experiences after disenrollment.42 Most of the analysis presented in this chapter focuses on the population of children ever enrolled in Medicaid or CHIP in the 10 study states during a 5-year period (November 2007 through October 2012). We use Medicaid and CHIP enrollment data on this larger population to analyze outcomes such as the duration of new coverage spells, the extent to which children return to the same program a short time after disenrollment, and transitions between Medicaid and CHIP. Movements from one program to another may be associated with disruptions in coverage, so we also document how many people move between programs and which types of transitions are more likely to be associated with coverage gaps, something that is especially important given the Affordable Care Act’s emphasis on ensuring that enrollees transition seamlessly between different coverage programs. We use the survey data to analyze the reasons children disenroll, their coverage status after leaving, and the reasons why children become uninsured.

42 This chapter draws on data presented in two more detailed memoranda: Harrington et al. (2013) contained in Harrington and Kenney et al. (2014), and Orzol et al. (2013).

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