Congress mandated in the Balanced Budget Refinement Act of 1999 that the Secretary of the Department of Health and Human Services (DHHS) conduct an independent study of the State Children's Health Insurance Program. The legislation articulates the range of issues that the evaluation is to investigate, as well as some of the methods to be used. Congress specifically directed that the evaluation:
- Identify enrollment barriers and the key elements of effective and ineffective outreach and enrollment practices in both SCHIP and Medicaid (under Title XIX), including practices that successfully enroll hard-to-reach populations.
- Assess the extent to which state Medicaid eligibility procedures are a barrier to enrollment of children in Medicaid.
- Assess the extent to which coordination between Medicaid and SCHIP (or lack thereof) affects enrollment of children in both programs.
- Determine the effect of cost-sharing on use of services, enrollment and retention in the program.
- Identify and assess causes of disenrollment, such as switching to private coverage, failure to pay premiums, and barriers in the redetermination process.
The mandate also stipulated the following study parameters:
- Include ten states.
- Select states that reflect geographic and urban/rural representation, diverse approaches to program design, and large proportion of all low-income uninsured children in the United States.
- Survey enrollees and disenrollees and collect information about why many eligible children are not enrolled.
- Report to Congress due December 31, 2001. 3
3. As described in the section on evaluation design (see page 15), ASPE required substantial additional time to carry out the required study, and renegotiated the due date for the report with Congressional staff. After all the research components have been completed, a final report will be submitted to Congress in 2004.