Congress stipulated that the evaluation include 10 states with varied geographical and urban/rural representation, diverse approaches to program design, and a large proportion of the low-income, uninsured children in the United States. The 10 states selected for the evaluation (Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia) span the four census regions, reflect diverse program designs, and represented 53 percent of the nation’s uninsured children and 57 percent of children enrolled in CHIP when the states were selected in 2010. (Appendix Table B.1 summarizes how the selected states met the criteria for the evaluation.)
Congress also stipulated that the evaluation survey families of CHIP enrollees and disenrollees and study low-income children likely to be eligible for Medicaid or CHIP but not enrolled. In addition to surveying CHIP enrollees and disenrollees in 10 states, and Medicaid enrollees and disenrollees in the 3 largest of these states, the evaluation included case studies in the 10 survey states and a national telephone survey of CHIP administrators. Other evaluation components included analyses of data on low-income uninsured children from the National Survey of Children’s Health (NSCH) and Current Population Survey (CPS) data on coverage trends since CHIP was enacted. Data from the American Community Survey (ACS) was used to project coverage for low-income children under different assumptions about CHIP funding after major coverage provisions of the Affordable Care Act take effect.
The evaluation addressed questions about: (1) the design and evolution of CHIP programs and how they were influenced by CHIPRA policies and changes introduced through the Affordable Care Act; (2) coverage and participation rates among CHIP’s target population of low-income children; (3) prior coverage experiences of new enrollees and whether CHIP substitutes for private coverage; (4) enrollment trends, how long children remain enrolled, and coverage experiences after leaving CHIP; (5) access, service use, and family well-being; and (6) family perceptions of CHIP and their experiences applying, enrolling, and renewing coverage.