Are We Meeting our Children's Health Care Needs? An Evaluation of SCHIP

A report to Congress examined the design and implementation of State Children's Health Insurance Programs and how they have enrolled, served, and retained eligible children. The evaluation focused on 10 states with a large proportion of eligible and enrolled children nationwide, developing findings from surveys of enrolled and recently disenrolled children in those states. The study incorporated a national perspective, drawing on a national survey of state program administrators, and from a national survey of low-income uninsured children. View other publications, including the public use data files, from the evaluation.

The study found that states were quick to adopt generous programs, undertake outreach, and simplify processes to enroll and retain enrollees. They enrolled children the program was intended to serve. Families enrolling their children found it fairly easy to do so, although families with eligible uninsured children were often unaware that their child was eligible. The programs provided children with needed services, leaving enrollees with fewer unmet needs than they would have had in the absence of SCHIP. Most children who left SCHIP had other coverage within six months (one-third were still uninsured, but about half of these children may no longer be eligible). Many children leaving SCHIP were enrolled in Medicaid, and in states with Medicaid expansion programs, the rate of Medicaid coverage after SCHIP was even higher.

Key questions addressed were:

• How did states design their programs, and what were their experiences implementing them?
• What are the characteristics of the children who enrolled in SCHIP?
• Did families substitute SCHIP for employer coverage?
• How did families find out about SCHIP, and how easy was it to enroll?
• What do the parents of low-income uninsured children know about SCHIP? Would they enroll their children if they were told they were eligible?
• How long do children stay on the program?
• What is children's access to services under SCHIP, and is it better than it would have been if SCHIP did not exist?
• What happens to children's coverage when they leave SCHIP?
  

Overview 

The evaluation focused on 10 states (California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas) that represent a wide range of program designs and geographic regions, and that capture a high proportion of the target population—low-income children who were uninsured at the time SCHIP was established. The evaluation included both quantitative and qualitative research components. 

The cornerstone of the quantitative component was a cross-sectional survey in all 10 states of new SCHIP enrollees, established enrollees, and recent disenrollees. This component involved analysis of a survey of the eligible but unenrolled population (conducted by the National Center for Health Statistics). The 10-state survey permitted a rigorous examination of the linkages between key analytic elements, including child and family demographics, program design features, and SCHIP-related outcomes and experiences (such as reported barriers to enrollment, access to care, and enrollee satisfaction).

The qualitative component comprised in-depth case studies to improve knowledge of issues related to the goals and objectives of SCHIP and the processes states followed in implementing their initiatives. The qualitative component included (1) an extensive review of documents, reports, and summary materials produced by states and other organizations involved in studying SCHIP program features and outcomes; (2) a national survey of SCHIP program administrators; and (3) an analysis of findings from focus groups in nine states.

The Urban Institute and the MayaTech Corporation were subcontractors for the evaluation, which was conducted for the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

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