Performance Improvement 2003. Office of Health Policy

01/01/2003

Getting In, Not Getting In, and Why? Understanding SCHIP Enrollment

This study focused on the findings related to enrollment in the State Children’s Health Insurance Program (SCHIP); findings from the study of retention are examined in a companion report. The Balanced Budget Act of 1997 established Title XXI in the Social Security Act, creating SCHIP. Title XXI provided states the authority and funding to increase health insurance coverage to low-income children by either expanding Medicaid or developing new “separate” child health programs. During the first three years of SCHIP, considerable policy attention was directed at state efforts to enroll eligible children. Yet the program was often criticized for getting off to a slow start and enrolling a small percentage of the target population. States have designed and implemented numerous strategies to streamline the application process with the goal of achieving higher enrollment. This study found that: (1) states have implemented many similar strategies for simplifying the SCHIP enrollment process, but simplifications to Medicaid policies and procedures are less extensive, (2) inconsistencies between SCHIP and Medicaid eligibility rules and requirements make the enrollment process more difficult and confusing for families, (3) in most states, less than 50 percent of applicants were approved for SCHIP eligibility, however, a large proportion of applicants appeared to be Medicaid eligible and were referred to that program, (4) large portions of SCHIP applications are denied for “procedural” reasons, yet this may be the unexpected “down side” of a simplified application process, (5) SCHIP programs are asking families about existing health insurance coverage as part of the application process, and are denying coverage to those who possess it, however, it appears that only a small proportion of applicants already have insurance, and (6) state SCHIP and Medicaid data systems are highly variable in their capacity to report eligibility outcome data.

FEDERAL CONTACT: Caroline Taplin, 202-690-7906 PIC ID: 7895.2

PERFORMER: Urban Institute, Washington, DC

 

Data Needs for the State Children’s Health Insurance Program

This report summarizes discussions at a workshop which brought together state SCHIP officials and researchers to share findings and methods that would inform the design, implementation, and evaluation of SCHIP at the state and national levels. The State Children’s Health Insurance Program (SCHIP) was established by Congress to provide health insurance to uninsured children whose family income was too high for Medicaid coverage but too low to allow the family to obtain private health insurance coverage. There are SCHIP programs in all of the states and the District of Columbia. The National Research Council, through the Committee on National Statistics, was asked to explore some of the ways in which data analysis could be used to promote achievement of the SCHIP goal of expanding health insurance coverage for uninsured children from low-income families. The panel concluded that data are insufficient in the individual states to provide a clear picture of the impact of SCHIP on the number of children who are eligible for the program, and the rate at which they are retained in the program once enrolled. This situation is due, in part, to the fact that sample sizes in national surveys are too small to provide detailed data for individual states. Some practices which could improve functioning of SCHIP include: (1) developing more uniform ways of estimating eligibility and health insurance coverage among the states, (2) sharing among the states effective methods for outreach, and (3) implementing longitudinal studies to track the movement of children among the various insurance statutes.

FEDERAL CONTACT: Caroline Taplin, 202-690-7906 PIC ID: 7893

PERFORMER: National Science Foundation Washington, D.C. and, Abt Associates Inc. Cambridge, MA

 

Is There a Hole in the Bucket? Understanding SCHIP Retention

The Balanced Budget Act of 1997 established Title XXI in the Social Security Act, creating the State Children’s Health Insurance Program (SCHIP). Title XXI provided states the authority and funding to expand health insurance coverage to low-income children by expanding Medicaid, developing new “separate” child health programs, or a combination of both approaches. During the first three years of SCHIP, considerable policy attention was directed at state efforts to enroll eligible children and states implemented numerous strategies to streamline the application process with the goal of achieving higher enrollment. This study focused on state efforts to enroll and retain children in SCHIP. As state SCHIP programs have matured, national enrollment has steadily increased. The Urban Institute analyzed information about states’ application and eligibility redetermination processes under SCHIP, as well as data on the outcomes of these processes, collected data. The major findings of this study and their implications fro future policy include: (1) states’ procedures for conducting SCHIP eligibility redetermination are similar to one another, however, these processes have not undergone the same level of reform in the interest of simplification, as have initial enrollment processes, (2) less than 50 percent of children appeared to be retaining SCHIP eligibility at redetermination, but further research is needed to understand what is reasonable to expect for this program, (3) high rates of parents who do not respond to renewal notices nor submit renewal applications for their children may be cause for concern, (4) denial of eligibility for “failure to pay premiums” may or may not address whether SCHIP cost sharing is affordable, and (5) state SCHIP and Medicaid data systems are highly variable in their capacity to report eligibility and redetermination outcome data.

FEDERAL CONTACT: Caroline Taplin, 202-690-7906 PIC ID: 7895.1

PERFORMER: Urban Institute, Washington, DC

 

The Cost of Medigap Prescription Drug Coverage

This study examined the price of standard Medigap policies that offer coverage for prescription drugs. Three of the ten standard Medigap policy forms (H, I, and J) cover prescription drugs. In most states, new Medicare beneficiaries who are either buying Medigap coverage for the first time, or looking to change their policy or insurer, have access to at least one of these plans. In every state, combined enrollment in Medigap plan that covers prescription drugs was very low. Such low enrollment may be related to non-price problems of access and also to the much higher price of Medigap policies that cover prescription drugs. This study considered the average cost of Medigap policies that covered prescription drugs in 1999 and also their marginal cost relative to other standard Medigap policies. This study focused on individual, not group, Medigap plans and found that premiums for Medigap policies covering prescription drugs are expensive by most measures. The cost of Medigap policies that cover prescription drugs is also high relative to other standard Medigap policies. Therefore, the Medigap market is neither a simple nor inexpensive place for Medicare beneficiaries to obtain prescription drug coverage.

FEDERAL CONTACT: Stephen Finan, 202-690-7387 PIC ID: 7348

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

 

Premium Assistance Programs Under SCHIP: Not for the Faint of Heart?

For this study, three states--Massachusetts, Mississippi, and Wisconsin--were selected for in-depth examination because, until recently, they were the only states with federally approved State Children’s Health Insurance Program (SCHIP) premium assistance programs. Under The State Children’s Health Insurance Program (SCHIP), states have the option to subsidize employer premiums for low income children, and in some cases, their parents. Providing families with premium assistance may be a viable means of covering more uninsured children because this country’s health insurance system is dominated by employer-based coverage. This study included a literature review, a study of relevant SCHIP regulations, and a review and analysis of relevant information collected from the Urban Institute’s SCHIP evaluation--conducted as part of the “Assessing the New Federalism” project. The majority of information for this study was collected during telephone interviews and the protocol primarily focused on the impact of SCHIP regulations, state implementation experiences and lessons learned. The premium assistance programs examined in this study suggested several different findings that may be useful to other states considering such programs. They included the following: (1) outreach -- although states have recently gained considerable experience in targeting public program outreach efforts to families and community- based organizations, premium assistance programs pose a new outreach challenge to states as they directly involve and require the cooperation of employers, (2) enrollment -- Wisconsin and Massachusetts have learned they must engage in complex, time-consuming, and challenging processes for enrolling children (and often their parents) into premium assistance programs, and (3) cautious optimism -- Massachusetts and Wisconsin believe their premium assistance programs are worthwhile endeavors, but caution other states considering such programs from being overly optimistic about initial enrollment.

FEDERAL CONTACT: Caroline Taplin, 202-690-7906 PIC ID: 7895

PERFORMER: Urban Institute, Washington, DC

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