Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. XVI. Coordination of Schip and Medicaid in States with Separate Programs


Highlights of Findings

  • States with separate programs still face challenges coordinating Medicaid and SCHIP, especially with regard to enrollment

A fundamental feature of Title XXI is that it gave states a choice regarding how they could expand children's health coverage. As discussed earlier in this report, roughly one-third of the states elected to expand through Medicaid, while two-thirds chose to create separate programs, either alone or in combination with smaller Medicaid expansions. 75 For those states expanding Medicaid, coordination between Title XXI and Title XIX was not an issue--the two programs, by definition, were integrated. However, states creating separate programs were required to coordinate SCHIP and Medicaid coverage and operations, and the numerous challenges involved with coordinating these two, sometimes very different, programs quickly became apparent. In many states, families may have children in both programs. In fact, SCHIP and Medicaid coordination has been difficult in the four study states that created separate programs (California, Colorado, New York, and Texas). Coordination issues have arisen mostly with regard to three program areas:

  • Enrollment and retention
  • Outreach and marketing
  • Service delivery and access

Ideally, the policies and practices of Medicaid and separate SCHIP programs should be aligned so that children receive seamless coverage and consumers should not easily be able to detect differences between the two programs. However, many states adopted separate program expansions under Title XXI specifically in order that the SCHIP programbe different from Medicaid and to test new models for enrollment, service delivery, and cost sharing, among other program areas. Dissimilar rules and policies can confuse families and affect them negatively if enrollment is not efficient or coordinated, and gaps materialize in coverage and care.

This section discusses SCHIP and Medicaid coordination, drawing on findings presented in earlier chapters of the report and highlighting both innovative strategies for improving coordination and problems that may affect beneficiaries' ability to access services.

75. This trend is seen both nationally, and in our sample of ten states.

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