Expanding Coverage for Low-Income Children

SCHIP and Medicaid | California Initiatives

Across the country, the large number of children without health insurance are a cause for concern. Some have left Medicaid but are eligible for SCHIP; others are from working poor families that lack employer insurance coverage.

SCHIP- and Medicaid-Related Studies

Mathematica is addressing how the complementary Medicaid and SCHIP programs cover low-income families and promote access to care. Moreover, we are assessing how states decide to modify these programs when budgets are tight.

Our work includes two national evaluations of SCHIP. The first study, for the Centers for Medicare & Medicaid Services, involved a comprehensive review of research examining the effectiveness of specific SCHIP program features in meeting a broad range of goals. These goals included increasing program enrollment and retention, broadening coverage, expanding access, improving satisfaction, and enhancing quality of care. The second study, conducted for the U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, described SCHIP program implementation, ease of enrollment, access to services, and coverage after leaving SCHIP. It also addressed a key policy question—does SCHIP substitute for employer coverage? View all the publications from our SCHIP-related studies.

We are conducting several other related projects. For example, we are evaluating Covering Kids & Families, a program that helps state and local coalitions nationwide expand enrollment in SCHIP and Medicaid. This evaluation, for the Robert Wood Johnson Foundation, is providing formative feedback on grantees' effectiveness.

California Initiatives

To study efforts to expand health insurance coverage for children in California, we are evaluating the Santa Clara Children's Health Initiative, a partnership of community organizations that has launched an ambitious effort to provide health insurance to all children below 300 percent of the federal poverty line in the county. The evaluation has examined the impact of the initiative on enrollment in the two major state health insurance programs, Medi-Cal and Healthy Families. In addition, the evaluation is analyzing the impact of a new insurance program, Healthy Kids, which serves low-income children who are ineligible for the two state programs. We are studying access, utilization, and unmet needs of children who participate, a large fraction of whom are undocumented Hispanic residents. We are also conducting a survey of participants in a similar Healthy Kids Program in San Mateo County, as part of a larger evaluation of the San Mateo Children’s Health Initiative. We have interviewed approximately 1,500 families, many of whom are also undocumented Hispanic residents. The study is funded by the David and Lucile Packard Foundation.

Another study compares use of and access to health care for the Healthy Kids and CaliforniaKids programs—local, county-based insurance programs in California for low-income children. The report from this study provides an overview of the features of both programs, the use of basic health care services by the children who are enrolled, and typical experiences accessing inpatient and other high-cost care. The report concludes with several recommendations on how future research can more rigorously and more precisely examine children's access to and use of the two programs. The California HealthCare Foundation funded the study.