Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. 1. Survey of SCHIP and Medicaid Enrollees and Disenrollees

02/26/2003

A unique feature of this evaluation is a telephone survey of SCHIP enrollees and recent disenrollees in ten states, and of Medicaid enrollees and recent disenrollees in two of the ten. This survey will permit the first systematic look across states of the characteristics of the SCHIP population, as well as an assessment of the effects of particular program features on the enrollment experience, experience in the SCHIP program, and reasons for disenrollment. The survey, which will be fielded during 2002 and early 2003 and analyzed during 2003, will collect information from approximately 21,000 children across the ten study states.

The survey instrument was designed to address the detailed evaluation questions spelled out in the design report. To the extent possible, it draws heavily on valid and reliable questions from existing surveys. 13

The survey asks about:

  • Insurance status before enrollment
  • Insurance status since disenrollment
  • The enrollment process
  • Reasons for enrolling and disenrolling
  • Access to care, service use, and satisfaction
  • Demographic characteristics

The survey targets three distinct groups of children: (1) those who enrolled recently, (2)those who have been enrolled for five or more months, and (3) those who disenrolled recently. By targeting children in these distinct groups, the survey will gather data on questions that are salient for each group. 14 For example, the parents of recent enrollees--for whom the experience of enrollment is fresh--will be asked how easy it is to enroll, while the parents of disenrollees--for whom leaving is recent--will be asked why their child left the program.

The analysis of the survey of SCHIP enrollees and disenrollees will provide new descriptive information about program participation behavior and enrollment dynamics--why families enroll and disenroll from SCHIP and Medicaid; coverage transitions (that is, among SCHIP, Medicaid, private coverage and periods without insurance); SCHIP's role as a transitional versus longer-term source of insurance; whether public health insurance programs substitute for private coverage; and access to care, service use and satisfaction with SCHIP and Medicaid. The analysis will also estimate whether SCHIP leads to improvements in access to care, service use, and satisfaction.


13. Surveys from which the SCHIP survey drew are: SLAITS, the National Study of America's Families (NSAF), the Medical Expenditure Panel Study (MEPS), the National Health Insurance Study (NHIS), the Community Tracking Study (CTS), the Medicaid CAHPS, the Studies of Section 1115 Medicaid Demonstrations conducted in five states by MPR and in four states by the Urban Institute, and Kaiser Family Foundation Medicaid surveys on barriers to enrollment. In addition, we looked at the set of common questions developed by researchers participating in the Child Health Insurance Research Initiative (CHIRI) and questionnaires developed by Peter Szilagyi and his coworkers for a longitudinal study of SCHIP enrollees in four geographic regions of New York State.

14. Recent enrollees are defined as those who have been enrolled one month or less at the time the sample frame was constructed. Longer-term enrollees are those enrolled five or more months. Recent disenrollees were disenrolled at the time of sample frame construction but were enrolled in the preceding month (In all three cases, however, by the time the sample member is surveyed, additional time will have passed).

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