Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. C. Implementation Experiences


Case study respondents in all six study states consider the SCHIP benefit packages good or, in some cases, comprehensive; moreover, the parents participating in focus groups in nine states were, for the most part, satisfied with coverage. Furthermore, SCHIP coverage across the six case study states was consistently described as at least as good as, and often considerably better than, private insurance. While coverage in the two Medicaid expansion programs obviously is considered much broader than private insurance, this same opinion was often held of separate programs. In California and Texas, for example, case study respondents noted that dental, hearing, and vision services are better under SCHIP than in most private insurance options (and that SCHIP has less onerous cost sharing). In Texas, also, SCHIP coverage is considered better than private options for behavioral health and physical, speech, and occupational therapies. The SCHIP package in Colorado is well-regarded (especially after the state added dental coverage) because it is comparable to packages offered by local employers.

Across the six states, case study respondents, including child advocates, identified few children who needed care that was not covered; and state officials have received few complaints from families about coverage limits. The most notable complaints lodged against a state's coverage were found in Colorado, where case study respondents reported that the initial lack of coverage for preventive dental care was a problem. New York plans to address the major gap in its benefit package--emergency transportation--by adding coverage in the near future.

Parents in the focus groups concurred with the case study respondents with respect to the limitations in dental coverage in SCHIP. At the same time, complaints about dental coverage were also common among those whose children are enrolled in Medicaid or have private insurance. Although children frequently used preventive dental services, many parents lamented the number of dental care procedures that are considered cosmetic and not covered by SCHIP. SCHIP parents in the focus groups also commented on the limitations in the coverage of vision services and prescription drugs. Other parents, though not as often as SCHIP parents, also voiced complaints, about their limited choice of vision care providers and suppliers, the frequency with which they can exercise their child's vision benefit, and the poor quality and limited choice of eyeglass frames. In addition, some parents voiced frustration about limitations on drugs covered by the program.

Nevertheless, with these exceptions, parents who participated in the focus groups were happy with the benefits their children received in Medicaid and SCHIP. In contrast, privately insured parents in the focus groups commented on the lack of coverage for preventive services for their children.

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