Case studies of the ten selected states were designed and conducted in 2001 to develop an understanding of why states designed their children's health insurance programs as they did, the challenges and issues states faced during implementation, the perceived and measurable effects of states' efforts, and the continuing evolution of SCHIP programs. These case studies provide critical background for interpreting findings from other analyses conducted under this evaluation.
The first step was to collect and review information about the case study states. Protocols for semi-structured interviews with policymakers, advocates, providers and other key state and local staff were developed, and visits to each state were arranged. Between June 2001 and October 2001, the evaluation team visited six of the ten study states: California, Colorado, Louisiana, Missouri, New York, and Texas. The team spent a full week in each state. Team members conducted interviews with between 40 and 50 state and local officials, including SCHIP and Medicaid administrators and their staff, state legislators and their staff, officials from the governor's office, state public health officials, provider associations, health plan associations, and private sector vendors under contract with the states to perform various administrative functions. In selected localities in each state, the team interviewed providers, child and family advocates, health plan officials, local Medicaid eligibility workers, outreach workers, and community-based application assisters. These 40 to 50 individuals in each state are described throughout the report as "case study respondents." Based on the information gathered during the site visits, detailed state-specific, case study reports were developed.
The site visit protocols included questions on the following topics:
- Outreach and program awareness
- Eligibility standards and policies designed to foster enrollment and retention
- Policies intended to avoid the substitution of SCHIP for private insurance coverage
- The benefits packages offered to SCHIP enrollees
- The service delivery system, service use, and access
- Family coverage and premium assistance programs
- Financing and the fiscal outlook
- Coordination between Medicaid and SCHIP
Each case study report synthesized the information collected. The case study reports from the first six states were the primary source for an interim cross-cutting report (Hill, Harrington and Hawkes 2002), from which Part 2 of this report (study findings) draws heavily.