The State Children's Health Insurance Program: Successes, shortcomings, and challenges

Health Affairs

Volumn 23, Issue 5, 2004, Pages 51-62

  Kenney, Genevieve ^a   Chang, Debbie I ^b  

^a URBAN INSTITUTE   (United States)

^b Nemours Div Hlth and Prev Serv   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BUDGET; CHILD HEALTH; FINANCE; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE ACCESS; HEALTH INSURANCE; HEALTH PROGRAM; HUMAN; MEDICAID; TIME;

BUDGETS; CHILD; CHILD HEALTH SERVICES; CHILD, PRESCHOOL; FINANCING, GOVERNMENT; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE COVERAGE; MEDICALLY UNINSURED; PROGRAM DEVELOPMENT; STATE HEALTH PLANS; UNITED STATES;

EID: 4644237273     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.5.51     Document Type: Article

References (58)

1. Congress enacted SCHIP as Title XXI of the Social Security Act.
2. The statute stipulated that SCHIP funds not be used to cover children who were already eligible for Medicaid or who had employer sponsored coverage.
3. States have three years to use a given allotment, at which point unused funds can be redistributed to states that have exhausted their allotments, with remaining funds reverting to the federal Treasury.
4. D.C. Ross and L. Cox, Preserving Recent Progress on Health Coverage for Children and Families: New Tensions Emerge - A Fifty-State Update on Eligibility, Enrollment, Renewal, and Cost-Sharing Practices in Medicaid and SCHIP (Washington: Kaiser Commission on Medicaid and the Uninsured, 2003).
5. L. Dubay, I. Hill, and G. Kenney, "Five Things Everyone Should Know about SCHIP," Assessing the New Federalism Policy Brief A-55 (Washington: Urban Institute, 2002).
6. D.C. Ross and I.T. Hill, "Enrolling Eligible Children and Keeping Them Enrolled," Future of Children 13, no. 1 (2003): 81-97; and A.W. Dick et al., "Consequences of States' Policies for SCHIP Disenrollment," Health Care Financing Review 23, no. 3 (2002): 65-88.
7. D.C. Ross and I.T. Hill, "Enrolling Eligible Children and Keeping Them Enrolled," Future of Children 13, no. 1 (2003): 81-97; and A.W. Dick et al., "Consequences of States' Policies for SCHIP Disenrollment," Health Care Financing Review 23, no. 3 (2002): 65-88.
8. A.W. Lutzky and I.T. Hill. "Premium Assistance Programs Under SCHIP: Not for the Faint of Heart?" Occasional Paper no. 65 (Washington: Urban Institute, 2002); and R.E. Curtis and E. Neuschler, "Premium Assistance," Future of Children 13, no. 1 (2003): 214-223.
9. A.W. Lutzky and I.T. Hill. "Premium Assistance Programs Under SCHIP: Not for the Faint of Heart?" Occasional Paper no. 65 (Washington: Urban Institute, 2002); and R.E. Curtis and E. Neuschler, "Premium Assistance," Future of Children 13, no. 1 (2003): 214-223.
10. This range is based on Urban Institute tabulations of the 2002 National Survey of America's Families (NSAF) and SCHIP enrollment statistics in V.K. Smith and D.M. Rousseau, SCHIP Program Enrollment: June 2003 Update (Washington: Kaiser Commission on Medicaid and the Uninsured, 2003).
11. G. Kenney, J. Haley, and A. Tebay, "Children's Insurance Coverage and Service Use Improve," Snapshots of America's Families no. 1 (Washington: Urban Institute, 2003).
12. A.T. LoSasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2004); P.J. Cunningham, J. Hadley, and J. Reschovsky The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996-97 to 2000-2001, Research Report no. 7 (Washington: Center for Studying Health System Change, 2002); Kenney et al., "Children's Insurance Coverage and Service Use Improve"; R.A. Cohen and H. Ni, "Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2003," January 2004, www.cdc.gov/nchs/data/ nhis/earlyrelease/insur200401.pdf (2 July 2004); and L. Ku and S. Nimalendran, Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP (Washington: Center on Budget and Policy Priorities, 2004).
13. A.T. LoSasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2004); P.J. Cunningham, J. Hadley, and J. Reschovsky The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996-97 to 2000-2001, Research Report no. 7 (Washington: Center for Studying Health System Change, 2002); Kenney et al., "Children's Insurance Coverage and Service Use Improve"; R.A. Cohen and H. Ni, "Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2003," January 2004, www.cdc.gov/nchs/data/ nhis/earlyrelease/insur200401.pdf (2 July 2004); and L. Ku and S. Nimalendran, Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP (Washington: Center on Budget and Policy Priorities, 2004).
14. A.T. LoSasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2004); P.J. Cunningham, J. Hadley, and J. Reschovsky The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996-97 to 2000-2001, Research Report no. 7 (Washington: Center for Studying Health System Change, 2002); Kenney et al., "Children's Insurance Coverage and Service Use Improve"; R.A. Cohen and H. Ni, "Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2003," January 2004, www.cdc.gov/nchs/data/ nhis/earlyrelease/insur200401.pdf (2 July 2004); and L. Ku and S. Nimalendran, Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP (Washington: Center on Budget and Policy Priorities, 2004).
15. A.T. LoSasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2004); P.J. Cunningham, J. Hadley, and J. Reschovsky The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996-97 to 2000-2001, Research Report no. 7 (Washington: Center for Studying Health System Change, 2002); Kenney et al., "Children's Insurance Coverage and Service Use Improve"; R.A. Cohen and H. Ni, "Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2003," January 2004, www.cdc.gov/nchs/data/ nhis/earlyrelease/insur200401.pdf (2 July 2004); and L. Ku and S. Nimalendran, Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP (Washington: Center on Budget and Policy Priorities, 2004).
16. A.T. LoSasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2004); P.J. Cunningham, J. Hadley, and J. Reschovsky The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996-97 to 2000-2001, Research Report no. 7 (Washington: Center for Studying Health System Change, 2002); Kenney et al., "Children's Insurance Coverage and Service Use Improve"; R.A. Cohen and H. Ni, "Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2003," January 2004, www.cdc.gov/nchs/data/ nhis/earlyrelease/insur200401.pdf (2 July 2004); and L. Ku and S. Nimalendran, Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP (Washington: Center on Budget and Policy Priorities, 2004).
17. Kenney et al., "Children's Insurance Coverage and Service Use Improve."
18. L. Dubay and G. Kenney, "Addressing Coverage Gaps for Low-Income Parents," Health Affairs 23, no. 2 (2004): 225-234.
19. L.C. Dubay and G. Kenney, "Assessing SCHIP Effects Using Household Survey Data: Promises and Pitfalls," Health Services Research 35, no. 5, Part 3 (2000): 112-127.
20. Although these surveys differ in terms of their design, response rates, instruments, and approaches to estimating impacts, the overall pattern of the findings is consistent. P.C. Damiano et al., hawk-i Impact on Access and Health Status: Second Evaluation Report to the Board of Directors of the Healthy and Well Kids in Iowa Program (Iowa City: University of Iowa, Health Policy Research Program, Public Policy Center, January 2002); R.T. Slifkin et al., Assessing the Effects of the North Carolina Health Choice Program on Beneficiary Access to Care (Chapel Hill: University of North Carolina, Cecil G. Sheps Center for Health Services Research, 2001); A.W. Dick et al., "SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare?" Health Affairs 23, no. 5 (2004): 63-75; and PG. Szilagyi et al., "Improved Access and Quality of Care after Enrollment in the New York State Children's Health Insurance Program (SCHIP)," Pediatrics 113, no. 5 (2004): e395-e404.
21. Although these surveys differ in terms of their design, response rates, instruments, and approaches to estimating impacts, the overall pattern of the findings is consistent. P.C. Damiano et al., hawk-i Impact on Access and Health Status: Second Evaluation Report to the Board of Directors of the Healthy and Well Kids in Iowa Program (Iowa City: University of Iowa, Health Policy Research Program, Public Policy Center, January 2002); R.T. Slifkin et al., Assessing the Effects of the North Carolina Health Choice Program on Beneficiary Access to Care (Chapel Hill: University of North Carolina, Cecil G. Sheps Center for Health Services Research, 2001); A.W. Dick et al., "SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare?" Health Affairs 23, no. 5 (2004): 63-75; and PG. Szilagyi et al., "Improved Access and Quality of Care after Enrollment in the New York State Children's Health Insurance Program (SCHIP)," Pediatrics 113, no. 5 (2004): e395-e404.
22. Although these surveys differ in terms of their design, response rates, instruments, and approaches to estimating impacts, the overall pattern of the findings is consistent. P.C. Damiano et al., hawk-i Impact on Access and Health Status: Second Evaluation Report to the Board of Directors of the Healthy and Well Kids in Iowa Program (Iowa City: University of Iowa, Health Policy Research Program, Public Policy Center, January 2002); R.T. Slifkin et al., Assessing the Effects of the North Carolina Health Choice Program on Beneficiary Access to Care (Chapel Hill: University of North Carolina, Cecil G. Sheps Center for Health Services Research, 2001); A.W. Dick et al., "SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare?" Health Affairs 23, no. 5 (2004): 63-75; and PG. Szilagyi et al., "Improved Access and Quality of Care after Enrollment in the New York State Children's Health Insurance Program (SCHIP)," Pediatrics 113, no. 5 (2004): e395-e404.
23. Although these surveys differ in terms of their design, response rates, instruments, and approaches to estimating impacts, the overall pattern of the findings is consistent. P.C. Damiano et al., hawk-i Impact on Access and Health Status: Second Evaluation Report to the Board of Directors of the Healthy and Well Kids in Iowa Program (Iowa City: University of Iowa, Health Policy Research Program, Public Policy Center, January 2002); R.T. Slifkin et al., Assessing the Effects of the North Carolina Health Choice Program on Beneficiary Access to Care (Chapel Hill: University of North Carolina, Cecil G. Sheps Center for Health Services Research, 2001); A.W. Dick et al., "SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare?" Health Affairs 23, no. 5 (2004): 63-75; and PG. Szilagyi et al., "Improved Access and Quality of Care after Enrollment in the New York State Children's Health Insurance Program (SCHIP)," Pediatrics 113, no. 5 (2004): e395-e404.
24. G. Kenney et al., "The Experiences of SCHIP Enrollees and Disenrollees in Ten States: Findings from the Congressionally-Mandated SCHIP Evaluation," report prepared for the Assistant Secretary of Planning and Evaluation, U.S. Department of Health and Human Services (Princeton, N.J.: Mathematica Policy Research, forthcoming).
25. T.M. Selden, J.L. Hudson, and J.S. Banthin, "Tracking Changes in Eligibility and Coverage among Children, 1996-2002," Health Affairs 23, no. 5 (2004): 39-50.
26. M. Rosenbach et al., Implementation of the State Children's Health Insurance Program: Synthesis of State Evaluations (Baltimore: Centers for Medicare and Medicaid Services, 2003).
27. D.C. Ross and L. Cox, Making It Simple: Medicaid for Children and CHIP Income Eligibility Guidelines and Enrollment Procedures (Washington: Kaiser Commission on Medicaid and the Uninsured, 2000).
28. L.J. Blumberg, "Balancing Efficiency and Equity in the Design of Coverage Expansions for Children," Future of Children 13, no. 1 (2003): 203-211.
29. A.W. Lutzky and I. Hill, "Has the Jury Reached a Verdict? States' Early Experiences with Crowd-Out under SCHIP," Occasional Paper no. 47 (Washington: Urban Institute, 2001).
30. G. Kenney and J. Holahan, "Public Insurance Expansion and Crowd-Out of Private Coverage," Medical Care 41, no. 3 (2003): 337-340.
31. L. Bilheimer, "Expanding Health Insurance Coverage for Children under Title XXI of the Social Security Act" (Washington: Congressional Budget Office, February 1998).
32. See LoSasso and Buchmueller, "The Effect of the State Children's Health Insurance Program"; and Cunningham et al., The Effects of SCHIP.
33. See LoSasso and Buchmueller, "The Effect of the State Children's Health Insurance Program"; and Cunningham et al., The Effects of SCHIP.
34. D. Hughes, J. Angeles, and E. Stilling, Crowd-Out in the Healthy Families Program: Does It Exist? (San Francisco: University of California, San Francisco, Institute for Health Policy Studies, 2002); E. Shenkman, H. Steingraber, and C. Bono, Florida KidCare Program Evaluation Report, January 2002, www.ichp.edu/FloridaKidCare/2001-2002Reports/2001-2002FinalKC3rdYear.pdf (2 July 2004); and R.A. Allison et al., "Do Children Enrolling in Public Health Insurance Have Other Options?" Kansas Health Institute Research Brief (Topeka: KHI, September 2003).
35. D. Hughes, J. Angeles, and E. Stilling, Crowd-Out in the Healthy Families Program: Does It Exist? (San Francisco: University of California, San Francisco, Institute for Health Policy Studies, 2002); E. Shenkman, H. Steingraber, and C. Bono, Florida KidCare Program Evaluation Report, January 2002, www.ichp.edu/FloridaKidCare/2001-2002Reports/2001-2002FinalKC3rdYear.pdf (2 July 2004); and R.A. Allison et al., "Do Children Enrolling in Public Health Insurance Have Other Options?" Kansas Health Institute Research Brief (Topeka: KHI, September 2003).
36. D. Hughes, J. Angeles, and E. Stilling, Crowd-Out in the Healthy Families Program: Does It Exist? (San Francisco: University of California, San Francisco, Institute for Health Policy Studies, 2002); E. Shenkman, H. Steingraber, and C. Bono, Florida KidCare Program Evaluation Report, January 2002, www.ichp.edu/FloridaKidCare/2001-2002Reports/2001-2002FinalKC3rdYear.pdf (2 July 2004); and R.A. Allison et al., "Do Children Enrolling in Public Health Insurance Have Other Options?" Kansas Health Institute Research Brief (Topeka: KHI, September 2003).
37. Urban Institute tabulations of the 2003 Current Population Survey.
38. Selden et al., "Tracking Changes in Eligibility and Coverage among Children."
39. I. Hill, H. Stockdale, and B. Courtot, "Squeezing SCHIP: States Use Flexibility to Respond to the Ongoing Budget Crisis," Assessing the New Federalism Policy Brief B (Washington: Urban Institute, 2004).
40. Rosenbach et al., "Implementation of the State Children's Health Insurance Program."
41. See Ross and Cox, "Making It Simple"; and Hill et al., "Squeezing SCHIP."
42. See Ross and Cox, "Making It Simple"; and Hill et al., "Squeezing SCHIP."
43. See Hill et al., "Squeezing SCHIP"; and J. Holahan et al., State Responses to 2004 Budget Crises: A Look at Ten States, Research Report (Washington: Urban Institute, 2004).
44. See Hill et al., "Squeezing SCHIP"; and J. Holahan et al., State Responses to 2004 Budget Crises: A Look at Ten States, Research Report (Washington: Urban Institute, 2004).
45. Urban Institute tabulations of CMS expenditure data on SCHIP.
46. E. Park, L. Ku, and M. Broaddus, "OMB Estimates Indicate That 900,000 Children Will Lose Health Insurance Due to Reductions in Federal SCHIP Funding" (Washington: Center on Budget and Policy Priorities, 2002); and Ku and Nimalendran, Improving Children's Health.
47. E. Park, L. Ku, and M. Broaddus, "OMB Estimates Indicate That 900,000 Children Will Lose Health Insurance Due to Reductions in Federal SCHIP Funding" (Washington: Center on Budget and Policy Priorities, 2002); and Ku and Nimalendran, Improving Children's Health.
48. Urban Institute tabulations of CMS expenditure data on SCHIP. With a block grant, the total pool of resources available to states is independent of changes in the demand for coverage, which can make it difficult to address changing program needs. Historically, federal funds available through block grants tend to erode in real terms over time. K. Finegold, L. Wherry, and S. Schardin, "Block Grants: Historical Overview and Lessons Learned," Assessing the New Federalism Policy Brief A-63 (Washington: Urban Institute, April 2004).
49. This is less of an issue now because of the increases made to the CPS sample, beginning in 2001, which have increased the precision of the estimates of the proportion of low-income children in a state who are uninsured based on three years of data, but estimates for many states remain imprecise.
50. Urban Institute tabulations of CMS expenditure data on SCHIP.
51. Smith and Rousseau, SCHIP Program Enrollment.
52. U.S. General Accounting Office, SCHIP and Medicaid: Recent HHS Approvals of Demonstration Waiver Projects Raise Concerns (Washington: GAO, 2002); and GAO, SCHIP: HHS Continues to Approve Waivers That Are Inconsistent with Program Goals (Washington: GAO, 2004).
53. U.S. General Accounting Office, SCHIP and Medicaid: Recent HHS Approvals of Demonstration Waiver Projects Raise Concerns (Washington: GAO, 2002); and GAO, SCHIP: HHS Continues to Approve Waivers That Are Inconsistent with Program Goals (Washington: GAO, 2004).
54. L. Dubay and G. Kenney, "Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid," Health Services Research 38, no. 5 (2003): 1283-1302; and A. Davidoff et al., "The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children," Inquiry 40, no. 3 (2003): 254-268.
55. L. Dubay and G. Kenney, "Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid," Health Services Research 38, no. 5 (2003): 1283-1302; and A. Davidoff et al., "The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children," Inquiry 40, no. 3 (2003): 254-268.
56. A. Weil and I. Hill, "The State Children's Health Insurance Program: A New Approach to Federalism," in Federalism and Health Policy, ed. J. Holahan et al. (Washington: Urban Institute, 2003), 293-323.
57. L. Dubay and G. Kenney, "Gains in Children's Health Insurance Coverage, but Further Progress Needed," Pediatrics (forthcoming).
58. S. Rosenbaum and B. Smith, "State SCHIP Design and the Right to Coverage," Issue Brief no. 1 (Washington: George Washington University, Center for Health Services Research and Policy, March 2001).