Performance Improvement 2003. The Impact of the State Children’s Health Insurance Program (SCHIP) on Community Health Centers

The State Children’s Health Insurance Program (SCHIP) was enacted in 1997 to expand health insurance coverage for children. This evaluation focused on the impact of the enhanced insurance status of children served by two HRSA sponsored programs: the community health centers (CHCs) and Title V maternal and child health programs, and the impact on HRSA grantee organizations. The study included site visits; interviews with former CHC users; and an analysis of CHCs transactional encounter data.

Three groups of children were evaluated 1) children who continue using HRSA sites after enrolling in SCHIP; 2) children who are new to the HRSA sites; and 3) children who discontinued use of the HRSA sites.

CHC strategies that increased SCHIP enrollment included the involvement of all site staff, especially clinicians, in encouraging SCHIP enrollment; establishing a protocol for uninsured patients; cultivating a relationship with the local SCHIP administrative staff; and follow-up on submitted applications. The recommendations for CHCs included dedicating staff to outreach and enrollment activities, instituting formal processes for referring uninsured patients to outreach staff; and conducting follow-up on SCHIP/Medicaid applications. State-based recommendations included investment in CHC-based outreach and education activities; implementation of presumptive eligibility for enrollment into SCHIP; passive re- determination after 12 months in the SCHIP program; and requiring SCHIP health plans to contract with safety-net providers.

AGENCY SPONSOR: Health Resources Services Administration FEDERAL CONTACT: Jerilynn Regan, 301-594-4283

PIC ID: 7125

PERFORMER: Center for Health Service Research and Policy, George Washington University

The study addressed two primary goals: 1) document health insurance volatility experienced by users of the health centers covered by SCHIP vs. Medicaid; and 2) determine whether and how SCHIP has affected safety net providers such as community health centers (CHCs) and Title V maternal and child health (MCH) programs. The analytic framework examined the effect of the SCHIP in areas such as parents’ ability/willingness to seek health services for their children at a CHC site or from other providers; children’s health insurance volatility; and SCHIP’s effect on CHC sites.

Over 12 million children lack health insurance coverage, and therefore may lack access to health care. This report evaluated the State Children’s Health Insurance Program (SCHIP), which was enacted in 1997 to expand the scope of state-provided services as an adjunct for children not eligible for Medicaid. The study focused on the experience of CHCs and examined three groups of children: those who continued using the Health Resources Services Administration (HRSA) program sites after enrolling in SCHIP; those who were new to the HRSA sites; and those who were previous users but were no longer visiting the HRSA site.

The analysis included quantitative and qualitative components. Site visits to CHC programs were conducted, former CHC users were interviewed, and CHC encounter data were analyzed. In addition, state and county officials, representatives of safety net providers, community-based organizations, and other stakeholders were interviewed to provide contextual information. Fourteen health centers and sixteen individual health care delivery sites in six states were evaluated. Patient encounter data was extracted from an insurance transaction database.