This report provides state-level data on annual and quarterly enrollment in SCHIP and Medicaid, from fiscal years 1998 through 2001. It augments the Centers for Medicare & Medicaid Services annual reports on SCHIP enrollment trends by (1) using information on program characteristics to analyze differences in state enrollment patterns through 2001, (2) reviewing annual and quarterly data to describe growth patterns and program turnover, and (3) estimating the extent to which SCHIP has expanded coverage of low-income uninsured children beyond those covered by Medicaid.

This congressionally mandated analysis of state evaluations provides the first comprehensive picture of the early years of the SCHIP program, using a standardized framework developed to facilitate cross-state comparisons. For all 50 states, the report describes program implementation and progress in reaching and enrolling eligible children and reducing the number of low-income uninsured children. The report also summarizes states' evidence of the effect of SCHIP outreach and enrollment simplification on Medicaid enrollment. The following areas are also explored: context under which programs developed, eligibility criteria, benefits and cost sharing, delivery systems, coordination with other programs, outreach efforts, and strategies to avoid crowd-out.

Suggests that the program is picking up speed after some initial implementation challenges, although states vary in the extent to which they have expanded coverage for low-income children.

Reviews projects in TN, HI, RI, OK, and MD, where there were large expansions of Medicaid managed care implemented through Section 1115 demonstration waivers. Notes that the projects were controversial and chaotic in the beginning but have matured with time and that Tennessee's expansion reduced uninsurance rates among low-income persons.

Looks at expansion of Medicaid managed care in Tennessee, Hawaii, Rhode Island, Oklahoma, and Maryland, noting that projects were controversial and chaotic in the beginning but matured with time. Tennessee reduced uninsurance rates for low-income groups. In addition, quality assurance systems developed gradually but still need improvement, and capitation rates need to be assessed periodically to make sure they remain adequate.

Discusses challenges in severing welfare and Medicaid, the complexity of Medicaid rules, and pressing administrative issues for Medicaid. Also recommends potential solutions, including new roles for welfare workers, an easier eligibility process, and rethinking the mission of Medicaid programs.

Adds more weight to the body of evidence showing that declines in the welfare caseload are likely to have a noticeable effect on state Medicaid programs, in terms of overall enrollment, caseload mix, and per capita expenditures. Also points to continuity problems in enrollment, which may be contributing to lack of insurance for low-income parents and children.

Looks behind the Medicaid enrollment declines that began in the wake of welfare reform, noting that they are due in part to program complexity and ongoing operational problems in state Medicaid programs. Call the Henry J. Kaiser Family Foundation at (800) 656-4533 for printed copies.

Uses Medicaid administrative data to see how 1995 declines in welfare enrollment in California and Florida affected Medicaid. Available from Urban Institute. Contact Bonnie Nowak at (202) 261-5850.

Available free from the Food and Nutrition Service at (703) 305-2340.

Available from The Urban Institute at (202) 833-7200.

A review of the effectiveness of six federally funded in-kind programs designed to mitigate the effects of poverty on low-income children, including food stamps, Medicaid, and Head Start. Printed copies available by faxing (650) 948-6498, or by writing Circulation, Center for the Future of Children, The David and Lucile Packard Foundation, 300 Second St., Ste. 102, Los Altos, CA 94022.

Available from Urban Institute as "Counting the Uninsured: A Review of the Literature" part of the Assessing the New Federalism project. (202) 857-8687.

Looks at first-year experiences in HI, RI, and TN, finding quick design, limited opportunities for stakeholder input, and implementation problems, especially with enrollment. All three states were able to attract and retain managed care organizations in the first year.

Available free of charge from The Henry J. Kaiser Family Foundation (800) 656-4533.