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Are We Meeting Our Children's Health Care Needs? An Evaluation of CHIP

Our national evaluation of the Children's Health Insurance Program (CHIP) looked at the program in 10 states. A report to Congress examined the design and implementation of CHIP and how programs enrolled, served, and retained eligible children. Mathematica's evaluation focused on states with a large proportion of eligible and enrolled children nationwide and developed findings from surveys of enrolled and recently disenrolled children in these states. The study incorporated a broad perspective, drawing on national surveys of state program administrators and low-income uninsured children.

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 found it fairly easy to enroll their children, 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 CHIP. Most children who left CHIP 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 CHIP were enrolled in Medicaid, and in states with Medicaid expansion programs, the rate of Medicaid coverage after CHIP was even higher.

Key questions addressed were:

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

Overview 

The evaluation focused on California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas—states that represented a wide range of program designs and geographic regions. These states also captured a high proportion of the target population—low-income children who were uninsured at the time CHIP 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 CHIP 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 CHIP-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 CHIP 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 CHIP program features and outcomes; (2) a national survey of CHIP 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.

Publications

"Congressionally Mandated Evaluation of the State Children's Health Insurance Program" (October 2005) Full Report, Executive Summary
"The Experiences of SCHIP Enrollees and Disenrollees in 10 States: Findings from the Congressionally Mandated SCHIP Evaluation" (October 2005) Full Report, Appendixes
"Final Cross-Cutting Report on the Findings from Ten State Site Visits" (June 2004)
"Congressionally Mandated Evaluation of the State Children's Health Insurance Program" (June 2003) Executive Summary (February 2003)

Site Visit Reports
"The State of California's Healthy Families Program" (November 2002)
"The State of Colorado's Child Health Plan Plus (CHP+)" (March 2002)
"The State of Illinois KidCare Program" (November 2003)
"The State of Florida's KidCare Program" (May 2003)
"The State of Texas TexCare Partnership" (December 2002)
"The State of New York's Child Health Plus Program" (December 2002)
"The State of North Carolina's Health Choice for Children Program" (November 2002)
"The State of New Jersey's FamilyCare Program" (November 2002)
"The State of Louisiana's LaCHIP Program" (February 2002)
"The State of Missouri's MC+ for Kids Program" (January 2002)

Public Use Files
Variable Codebook
Survey Instruments (June 2006)
Documentation