Who and where are the children yet to enroll in medicaid and the children's health insurance program?

Health Affairs

Volumn 29, Issue 10, 2010, Pages 1920-1929

  Kenney, Genevieve M ^a   Lynch, Victoria ^a   Cook, Allison ^b   Phong, Samantha ^c  

^a URBAN INSTITUTE   (United States)

^b TUFTS UNIVERSITY   (United States)

^c STANFORD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD; CHILD WELFARE; HEALTH INSURANCE; HUMAN; INSURANCE; MEDICAID; METHODOLOGY; ORGANIZATION AND MANAGEMENT; PRESCHOOL CHILD; UNITED STATES; UTILIZATION REVIEW;

CHILD; CHILD WELFARE; CHILD, PRESCHOOL; ELIGIBILITY DETERMINATION; HUMANS; INSURANCE COVERAGE; INSURANCE, HEALTH; MEDICAID; UNITED STATES;

EID: 79952115436     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0747     Document Type: Article

References (32)

1. U.S. Department of Health and Human Services. Children's Health Insurance Program Reauthorization Act: one year later; connecting kids to coverage [Internet]. Washington (DC): HHS; 2010 Feb 4 [cited 2010 Aug 16]. Available from: http://www.insurekidsnow.gov/chip/chipra_anniversary_report.pdf
2. Sebelius K The moral obligation to seize available tools to enroll eligible children in health coverage. Health Aff (Millwood). 2010;29(10).
3. Kenney G, Yee J. SCHIP at a crossroads: experiences to date and challenges ahead. Health Aff (Millwood). 2007;26(2):356-69.
4. Dubay L, Kenney G. The impact of CHIP on children's health insurance coverage: an analysis using the National Survey of America's Families. Health Serv Res. 2009;44(6): 2040-59.
5. Hudson J, Selden T. Children's eligibility and coverage: recent trends and a look ahead. Health Aff (Millwood). 2007;26(5):w618-29.
6. Davidoff A, Kenney G, Dubay L. Effects of the State Children's Health Insurance Program expansions on children with chronic health conditions. Pediatrics. 2005;116(1): e34-42.
7. Kaye N, Pernice C, Cullen A. Charting SCHIP III: an analysis of the third comprehensive survey of State Children's Health Insurance Programs [Internet]. Portland (ME): National Academy for State Health Policy; 2006 [cited 2010 Aug 16]. Available from: http://www.allhealth.org/briefingmaterials/ChartingSCHIPIIIAnAnalysisoftheThirdComprehensive-539.pdf
8. Kenney G, Cook A, Dubay L. Progress enrolling children in Medicaid/CHIP: who is left and what are the prospects for covering more children? [Internet]. Washington (DC): Urban Institute; 2009 [cited 2010 Aug 17]. Available from: http://www.urban.org/uploadedpdf/411981_Progress_Enrolling_Children_11_10.pdf
9. Ross DC, Marks C. Challenges of providing health coverage for children and parents in a recession: a 50 state update on eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and SCHIP in 2009 [Internet]. Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2009 Jan [cited 2010 Aug 16]. Available from: http://www.kff.org/medicaid/upload/7855.pdf
10. Georgetown University Health Policy Institute, Center for Children and Families. The Children's Health Insurance Program Reauthorization Act of 2009: overview and summary [Internet]. Washington (DC): Georgetown University; 2009 Mar [cited 2010 Aug 16]. Available from: http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf%20publications/federal%20schip%20policy/chip%20summary%2003-09.pdf
11. Davern M, Quinn B, Kenney G, Blewett LA. The American Community Survey and health insurance coverage estimates: possibilities and challenges for health policy researchers. Health Serv Res. 2009; 44(2):593-605.
12. U.S. Census Bureau. American Community Survey [home page on the Internet]. Suitland (MD): Census Bureau; [cited 2010 Aug 16]. Available from: http://www.census.gov/ acs/www/
13. Ruggles S, Alexander TJ, Genadek K, Goeken R, Schroeder M, Sobek M. Integrated public use microdata series: version 5.0 [machine-readable database]. Minneapolis (MN): University of Minnesota, 2010.
14. U.S. Census Bureau. American Community Survey: how to use the data: quality measures [Internet]. Suitland (MD): Census Bureau; 2009 [cited 2010 Aug 16]. Available from: http://www.census.gov/acs/www/UseData/sse/
15. Griffin D, Hughes T. Mixed mode data collection in the American Community Survey. Paper presented at: American Association of Public Opinion Research Conference. 2010 May 13-16; Chicago, IL.
16. Turner J, Boudreaux M, Lynch V. A preliminary evaluation of health insurance coverage in the 2008 American Community Survey [Internet]. Suitland (MD): U.S. Census Bureau; 2009 Sep 22 [cited 2010 Aug 16]. Available from: http://www.census.gov/hhes/www/hlthins/data/acs/2008/2008ACS_healthins.pdf
17. The Indian Health Service (IHS) is not typically counted as health insurance coverage because of limitations in the scope of available services and geographic reach of IHS facilities. In 2008, approximately 140,000 children were estimated to have only IHS coverage.
18. Lynch V, Boudreaux M, Davern M. Applying and evaluating logical coverage edits to health insurance coverage in the American Community Survey [Internet]. Suitland (MD): U.S. Census Bureau; 2010 Jul [cited 2010 Aug 16]. Available from: http://www.census.gov/hhes/www/hlthins/publications/coverage_edits_final.pdf
19. The Appendix can be accessed by clicking the Appendix link in the box to the right of the article online.
20. Davern M, Klerman JA, Ziegenfuss J, Lynch V, Baugh D, Greenberg G. A partially corrected estimate of Medicaid enrollment and uninsurance: results from an imputational model developed off linked survey and administrative data. J Econ Soc Meas. 2009;34(4):219-40.
21. According to Urban Institute tabulations of data from the 2008 National Health Interview Survey.
22. The American Community Survey includes 1.4 million children with employer-sponsored or other coverage who were also reported to have Medicaid/CHIP at the time of the survey. See the Appendix (as in Note 19) for information on how the Medicaid and CHIP administrative totals were derived for June 2008. The difference between our adjusted state Medicaid/CHIP total and the respective administrative total varies across states; for more than half of the states, the difference is less than 10 percent.
23. Dubay L, Cook A. How will the uninsured be affected by health reform? Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2009 Aug.
24. See the Appendix, as in Note 19, for more information on the ACS eligibility simulation.
25. Estimates of eligible unenrolled children were similar for the Current Population Survey, which found that an estimated 4.9 million (68 percent) uninsured children were eligible for Medicaid or CHIP in 2009. Urban Institute tabulations using the Health Policy Center's CPS Medicaid/CHIP Eligibility Model, based on data from the 2009 CPS.
26. We also produced additional sets of participation estimates to show the impact of excluding children who appear to have Medicaid as well as other coverage (so-called wraparound coverage) and of excluding children not found to be eligible. The pattern of findings reported here is consistent with these additional estimates in terms of variation across states and subgroups. For example, participation rates for eligible children that included children with other coverage were higher than participation rates that excluded these children (82.6 percent compared to 81.8 percent). However, state-level patterns remained consistent: Nevada and Utah were the lowest (57.5 percent and 67.9 percent) and Massachusetts and the District of Columbia were the highest (95.6 percent and 95.5 percent). Participation rates that included children reported to have Medicaid/ CHIP but not found to be eligible in the model were higher than those that excluded them, at around 84.0 percent; however, again, the state-level patterns of participation were similar to those among eligible children with no dual report of Medicaid/CHIP and employer-sponsored insurance; Nevada and Utah were again the lowest (62.7 percent and 73.4 percent) and Massachusetts and the District of Columbia, the highest (95.9 percent and 95.6 percent).
27. We used Census Bureau guidelines to define poverty levels for descriptive statistics.
28. The national participation estimate for the 2009 Current Population Survey when including children reported to have both Medicaid and other coverage was 81.7 percent, compared to 82.6 percent for the American Community Survey. Urban Institute tabulations using the Health Policy Center's CPS Medicaid/ CHIP Eligibility Model, based on data from the 2009 CPS.
29. Making valid comparisons of participation rates between Medicaid/ CHIP and other programs is difficult because of differences in how the target population is defined across programs, particularly as it relates to excluding from the denominator those Medicaid/CHIP-eligible children who had private coverage. U.S. Government Accountability Office. Means tested programs: information on program access can be an important management tool [Internet]. Washington (DC): GAO; 2005 Mar [cited 2010 Aug 16]. Available from: http://www.gao.gov/new.items/d05221.pdf
30. Dorn S, Kenney GM. Automatically enrolling eligible children and families into Medicaid and SCHIP: opportunities, obstacles, and options for federal policymakers [Internet]. New York (NY): Commonwealth Fund; 2006 Jun [cited 2010 Aug 16]. Available from: http://mobile.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2006/Jun/Automatically%20Enrolling%20Eligible%20Children%20and%20Families%20Into%20Medicaid%20and%20SCHIP%20%20Opportunities%20%20Obsta/Dorn_auto%20enrollingchildren_931%20pdf.pdf
31. Dorn S, Garrett B, Perry C, Clemans- Cope L, Lucas A. Nine in ten: using the tax system to enroll eligible, uninsured children into Medicaid and SCHIP [Internet]. Washington (DC): Urban Institute; 2009 Jan [cited 2010 Aug 16]. Available from: http://www.urban.org/UploadedPDF/411844_tax_system.pdf
32. The following item includes a discussion of enhancements to federal surveys that could strengthen their ability to produce reliable data for monitoring coverage changes under both CHIPRA and the Affordable Care Act. Kenney G, Lynch V. Monitoring children's health insurance coverage under CHIPRA using federal surveys. Washington (DC): National Academies Press; 2010 Jul.