Health Topics

• Data Development
• Health Care Reform
• Health Information Technology
• Medicaid and CHIP
• Medicare
• Mental Health and Substance Abuse
• Payment Policies and Costs
• Public and Population Health
• Quality and Health System Functioning
• State Health Policy

Health Insurance for Low-Income Uninsured Children: A National Evaluation of CHIP

Across the country, children without health insurance are a cause for concern. Many left the Medicaid rolls during welfare reform; some are from working poor families that lack insurance. Mathematica conducted a five-year national evaluation of the Children’s Health Insurance Program (CHIP), a wide-ranging federal/state initiative to expand health insurance for low-income uninsured children. Under CHIP, states receive federal matching funds to expand their Medicaid programs, purchase coverage through state-designed programs, or adapt some combination of the two approaches.

Mathematica’s CHIP evaluation for the Centers for Medicare & Medicaid Services (CMS) encompassed the following components:

• Synthesizing results of state CHIP evaluations for a CMS report to Congress
• Analyzing enrollment, disenrollment, and re-enrollment patterns based on the CHIP Enrollment Data System and the Medicaid Statistical Information System
• Assessing trends in the number and rate of uninsured children from 1997 through 2003 using the Current Population Survey
• Synthesizing the literature on retention, substitution (“crowdout”), and access to care
• Conducting studies on outreach and access to care based on state CHIP annual reports
• Using quantitative and qualitative methods to analyze outreach and enrollment effectiveness
• Producing a case study of implementation in eight states based on site visits and focus groups with parents
  
• Analyzing performance measures reported by states in their annual CHIP reports for federal fiscal years 2003 through 2005

Findings include:

• CHIP enrollment increased dramatically from implementation in October 1997, with 6.6 million children ever enrolled in federal fiscal year 2006.
• CHIP outreach and enrollment initiatives reversed declines in traditional Medicaid by reaching children who were eligible for Medicaid but uninsured.
• The number and rate of uninsured low-income children declined significantly, particularly during the early 2000s.
• Access to care improved significantly, although gaps remain for children with special health care needs and children of minority race/ethnicity.

Publications

"National Evaluation of the State Children's Health Insurance Program: A Decade of Expanding Coverage and Improving Access" (September 2007)
"SCHIP at 10: A Synthesis of the Evidence on Substitution of SCHIP for Other Coverage" (September 2007)
"Trends in Insurance Coverage: Increasing Children's Coverage and Access: A Decade of SCHIP Lessons" Issue Brief #4 (September 2007)
"Evolution of State Outreach Efforts Under SCHIP" Health Care Financing Review (Summer 2007)
"SCHIP at 10: A Synthesis of the Evidence on Access to Care in SCHIP" (January 2007)
"Detecting Enrollment Outbreaks in Three States: The Link Between Program Enrollment and Outreach" (December 2006)
"SCHIP at 10: A Synthesis of the Evidence on Retention" (November 2006)
"SCHIP and Medicaid: Working Together to Keep Low-Income Children Insured" (November 2006)
"Continued Progress in Performance Measurement Reporting by SCHIP" (September 2006)
"Beyond Coverage: SCHIP Makes Strides Toward Providing a Usual Source of Care to Low-Income Children" (December 2005)
"Improving Performance Measurement in the State Children's Health Insurance Program" (July 2005)
"SCHIP Takes a Bite Out of the Dental Access Gap for Low-Income Children" (November 2004)
"SCHIP in Ohio: Evolution and Outlook for the Future" (March 2004)
"Implementation of the State Children's Health Insurance Program: Synthesis of State Evaluations: Background for the Report to Congress" (March 2003)
"SCHIP's Steady Enrollment Growth Continues" (May 2003)
"Characteristics of SCHIP Eligibility and Enrollment Data Systems: Feasibility for Supporting Research on SCHIP" (June 2002)
"Implementation of the State Children's Health Insurance Program: Momentum Is Increasing After a Modest Start" (January 2001)