This chapter describes the characteristics of children enrolled in CHIP and Medicaid, based on data from the survey of enrollees conducted in the 10 study states.47 The findings focus on the samples of established CHIP enrollees (N=5,498) and established Medicaid enrollees (N=1,630). We used findings from the 2011/2012 National Survey of Children’s Health (NSCH) as national benchmarks for comparisons.48 We made comparisons with the sample whose parents reported that the child was covered by public insurance (the survey does not report Medicaid and CHIP separately) and the overall sample of children in the NSCH. Additionally, we made comparisons to survey findings from 2002–2003 in the prior 10-state evaluation of CHIP (see Kenny and Trenholm et al. 2005 for the findings from the prior evaluation).
In 2012, CHIP continued to serve a population of children with diverse demographic and family backgrounds and health needs (Table VII.1). The majority of CHIP enrollees were of school age, with 86 percent ages 6 to 18 years. The low proportion of children younger than age 6 is partly reflective of this younger group being eligible for Medicaid at higher income levels during the survey period.
Table VII.1. Characteristics of Established CHIP Enrollees, Their Caregivers, and Their Households in 10 States, 2012
|Age in Years|
|Child Health Status|
|Child Mental Health Status|
|Child Dental Health Status|
|Any Special Health Care Needa||26|
|Emotional, Developmental, or Behavioral Problems||7|
|Parent & Household|
|At Least One Parent Employed||87|
|Highest Education Level of Parent/Guardian|
|Less Than High School||23|
|High School or Equivalent||30|
|Some College, Trade School, or Other Higher Education||48|
|Household Income by FPL|
|One Parent and Stepparent/Other Guardian||8|
|Number of Children in Household|
Source: 2012 Congressionally Mandated Survey of CHIP and Medicaid Enrollees and Disenrollees.
Note: CHIP enrollees include those in separate CHIP as well as Medicaid expansion CHIP programs. The 10 states included in the study were: Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia. More than half of CHIP enrollees in this study were Hispanic, a larger share than among CHIP enrollees nationally. Percentages may not sum to 100 due to rounding. Abbreviations: CHIP – Children’s Health Insurance Program; FPL – federal poverty level.
a A child was identified as having a special health care need if his or her parent reported an ongoing health condition for which the child experienced one or more of the following: (1) need or use of prescription medications, (2) more than routine use of services, (3) need or use of specialized therapies or services, (4) need or use of mental health counseling, or (5) a functional limitation.
b Based on respondents’ language of choice for survey; English and Spanish were the only languages offered.
A majority of CHIP enrollees in the 10 study states were Hispanic (54 percent). This was higher than the proportion of Hispanic children estimated nationally from the 2011/2012 National Survey of Children’s Health (NSCH) (publicly insured, 35 percent; overall, 23 percent). The large Hispanic population in our sample was driven mainly by the demographic characteristics of the four largest states (California, Florida, New York, and Texas) included in the study, based on the criteria required by Congress for the selection of study states. The next most populous group in CHIP was non-Hispanic white children (28 percent) followed by non-Hispanic black and children of other races/ethnicities (10 and 9 percent, respectively).
Like most populations of children, the majority of CHIP enrollees were characterized by their parents as healthy. When asked to rate their child’s overall health status, parents of 71 percent of established CHIP enrollees rated their child’s health as excellent or very good and only 7 percent rated it as fair or poor (on a 5-point scale: excellent, very good, good, fair, poor). Similarly, 80 percent of children were reported to have excellent or very good mental health and only 5 percent had fair or poor mental health per their parent’s report. A lower percentage of established CHIP enrollees had excellent or very good, dental health (52 percent), and 18 percent were reported to have fair or poor dental health.
A sizable minority of CHIP enrollees had substantial health impairments and health care needs. Similar to national estimates for all children from the NSCH, more than one-third of CHIP enrollees were overweight or obese (37 percent). About one in 4 enrollees had at least one special health care need (26 percent), and more than one in 10 had two or more special health care needs (12 percent).49 Seven percent of established CHIP enrollees had an emotional, developmental, or behavioral problem for which treatment or counseling was needed. Asthma was the most common specific health condition reported for CHIP-enrolled children in our sample (10 percent).
As expected, the CHIP enrollees surveyed were predominantly in families with at least one parent who works and has some amount of post-high school education. Over 90 percent of CHIP enrollees surveyed were in families with incomes below 200 percent of the FPL, and most (69 percent) had incomes under 150 percent of the FPL. Most CHIP enrollees lived in two-parent households (70 percent with two parents or with one parent and a stepparent), and most lived in households with more than one child (79 percent). About one-third of enrollees lived with a parent or guardian who was primarily Spanish speaking (32 percent).
CHIP enrollees in the 10 study states in 2012 had similar demographic and health characteristics when compared to children enrolled in CHIP during the prior 10-state evaluation in 2002/2003. Key differences included higher proportions of enrollees in 2012 living in a household with no parent employed (2012 survey, 17 percent; 2002/2003 survey, 8 percent) and living in urban areas (2012 survey, 93 percent; 2002/2003 survey, 86 percent).
The characteristics of CHIP enrollees differed considerably across the 10 study states. For example, the proportion of Hispanic enrollees ranged from 5 percent in Alabama to 76 percent in California and the proportion of enrollees with primarily Spanish-speaking parents ranged from 2 percent in Alabama and Michigan to 46 percent in California. The rate of CHIP-enrolled children with special health care needs ranged from highs of 42 percent in Ohio and 41 percent in Michigan to a low of 19 percent in California. There was also large variation in dental health status, with more than 20 percent of children in California having fair or poor parent-reported dental health, compared to 8 percent in Alabama. There were differences across states in the percentage of enrollees with certain risk factors for poor health, including unhealthy weight and exposure to smoke in the household. Of the 10 states in this study, Alabama and Virginia had the highest rates of children who were overweight or obese (43 percent), whereas Utah had the lowest (26 percent). More than one in 10 CHIP enrollees were exposed to smoking in the household in Louisiana and Ohio (11 percent and 16 percent, respectively), compared to 1 percent in California and Utah.
47 Further details are presented in Zickafoose et al. (2103), contained in Harrington and Kenney et al. (2014).
48 The NSCH is a nationally representative telephone survey of households with children ages 0–17 years. National estimates from the 2011/2012 NSCH reported here are based on publicly available data provided on the NSCH website and estimates generated from a publicly available data file provided by the Child and Adolescent Health Measurement Initiative: Data Resource Center for Child and Adolescent Health. “The National Survey of Children’s Health.” Available at [http://www.childhealthdata.org/learn/NSCH]. Accessed September 5, 2013.
49 A child was identified as having a special health care need if his or her parent reported an ongoing health condition for which the child experienced one or more of the following: (1) need or use of prescription medications, (2) more than routine use of services, (3) need or use of specialized therapies or services, (4) need or use of mental health counseling, or (5) a functional limitation.