Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. A. Enabling Legislation for the SCHIP Evaluation

02/26/2003

ENABLING LEGISLATION FOR THE SCHIP EVALUATION H.R.3426

Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999

(Introduced in the House)

SEC. 703. IMPROVED DATA COLLECTION AND EVALUATIONS OF THE STATE CHILDREN’S HEALTH INSURANCE PROGRAM.

(b) FEDERAL EVALUATION, OF STATE CHILDREN'S HEALTH INSURANCE PROGRAMS-

Section 2108 (42 U.S.C. 1397hh) is amended by adding at the end the following:

(c) FEDERAL EVALUATION

(1) IN GENERAL- The Secretary, directly or through contracts or interagency agreements, shall conduct an independent evaluation of 10 States with approved child health plans.

(2) SELECTION OF STATES- In selecting States for the evaluation conducted under this subsection the Secretary shall choose 10 States that utilize diverse approaches to providing child health assistance, represent various geographic areas (including a mix of rural and urban areas) and contain a significant portion of uncovered children.

(3) MATTERS INCLUDED- In addition to the elements described in subsection (b)(1). the evaluation conducted under this subsection shall include each of the following:

  1. Surveys of the target population (enrollees, disenrollees, and individuals eligible for but not enrolled in the program under this title).
  2. Evaluation of effective and ineffective outreach and enrollment practices with respect to children (for both the program under this title and the Medicaid program under title XIX), and identification of enrollment barriers and key elements of effective outreach and enrollment practices, including practices that have successfully enrolled hard-to-reach populations such as children who are eligible for medical assistance under title XIX but have not been enrolled previously in the Medicaid program under that title.
  3. Evaluation of the extent to which State Medicaid eligibility practices and procedures under the Medicaid program under title XIX are a barrier to the enrollment of children under that program and the extent to which coordination (or lack of coordination) between that program and the program under this title affects the enrollment of children under both programs.
  4. An assessment of the effect of cost-sharing on utilization, enrollment, and coverage retention.
  5. Evaluation of disenrollment or other retention issues, such as switching to private coverage, failure to pay premiums, or barriers in the recertification process.

(4) SUBMISSION TO CONGRESS- Not later than December 31, 2001, the Secretary shall submit to Congress the results of the evaluation conducted under this subsection.

(5) FUNDING- Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $10,000,000 for fiscal year 2000 for the purpose of conducting the evaluation authorized under this subsection. Amounts appropriated under this paragraph shall remain available for expenditure through fiscal year 2002.

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