One component of ASPE’s evaluation of the State Children’s Health Insurance Program (SCHIP) examined the experiences and perceptions of the population targeted for Medicaid and SCHIP coverage. A focus group study was conducted to learn what families whose children are eligible for Medicaid or SCHIP know about these programs, how they feel about them, whether they encountered barriers to enrolling their children, and whether participation in Medicaid and SCHIP has improved their access to needed health care. ASPE contracted with Health Systems Research, Inc. (HSR), and its subcontractor, Lake Snell Perry and Associates, to conduct the study.
Focus Group Study Design
The contractor conducted 51 focus groups in all, from four target populations in nine states. The selected states are: California, Colorado, Florida, Georgia, Maryland, Missouri, New York, Ohio, and Texas. The target populations are:
- families with children enrolled in SCHIP or Medicaid;
- families with children disenrolled from SCHIP or Medicaid;
- families with children who are eligible for SCHIP or Medicaid but not enrolled; and,
- families with children who would be eligible for SCHIP except that they have employer- sponsored insurance.
Within these four populations, HSR recruited a wide variety of focus groups, defined based on income, race/ethnicity, language, and location (rural, urban, or suburban). In addition, the contractor conducted focus groups with several special populations, including adolescents, families of children with special health care needs, families with income over 200% of the federal poverty level, and welfare “leavers.” HSR worked with state and local officials to identify and recruit focus group participants.
Focus Group Topics
The study explored the following important issues with focus group participants:
- Perceptions. What are families’ perceptions about health insurance in general and Medicaid/SCHIP in particular? What experiences with private or public insurance do families have, and how do these experiences affect their perception of Medicaid/SCHIP?
- Participation and barriers to participation. What influences bear on participants’ decision-making and actions regarding enrollment, renewal, and disenrollment? What do participants think of application and enrollment requirements and how do these requirements facilitate or hinder enrollment?
- Outreach. How do different outreach strategies affect families’ knowledge of public programs and motivation to enroll? Does the effectiveness of different outreach efforts vary depending on race/ethnicity, income, location, etc.? If so, what works for whom?
- Premiums and cost-sharing. How do families view premiums and cost-sharing in SCHIP? What is the burden on families of different cost-sharing schedules?
- Access, utilization, and satisfaction. How has participation in SCHIP affected participants’ utilization of health services? How satisfied are participants with the quality and accessibility of the health care they receive?
Information gathered through the focus group study will be analyzed and incorporated into ASPE’s SCHIP evaluation report to Congress due in early 2003.