Press Release

Coverage and Access Increased Significantly: New Report from Mathematica^® Details a Decade of the State Children's Health Insurance Program

Contact: Margo Rosenbach, (617) 301-8967, or Cheryl Pedersen, (609) 275-2258

Read Mathematica's statement on the release of the report.

CAMBRIDGE, MA (September 20, 2007)—Expanding health coverage for children is at the center of policy debates as reauthorization of the 10-year-old State Children's Health Insurance Program (SCHIP) continues. New findings from a study conducted by Mathematica Policy Research, Inc., highlight states' progress in conducting outreach, averting substitution, improving access, and reducing the number of uninsured low-income children. The study found that SCHIP improved children's health coverage and reduced both the number and rate of uninsured children. From 1997 to 2003, the percentage of uninsured low-income children fell from 25 percent to 20 percent. In addition, access to care improved, although some gaps remain.

A new issue brief summarizes Mathematica's comprehensive seven-year evaluation of SCHIP for the Centers for Medicare & Medicaid Services. SCHIP was enacted in 1997 when the number and rate of uninsured children were growing rapidly, especially among those just above the poverty threshold—too poor to purchase private coverage but not poor enough to qualify for Medicaid. SCHIP gave states considerable flexibility in designing programs to expand coverage for uninsured low-income children, by broadening Medicaid (M-SCHIP), creating a separate child health program (S-SCHIP), or combining the two approaches.

Findings

During the early years, states focused on conducting outreach and enrolling children in SCHIP. Although modest numbers signed up in 1998, momentum picked up in 1999 and increased rapidly through 2001. Enrollment climbed to 6 million children in 2003 and reached 6.6 million in 2006.

Additional findings from the evaluation include:

• SCHIP 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 economic slowdown of early 2000.
• Estimates of substitution varied widely, ranging from less than 10 percent to 56 percent, depending on how substitution was defined and measured.
• Access to care improved significantly, although gaps remain for children with special health care needs and children of minority race/ethnicity.

“During its first 10 years, SCHIP succeeded in covering more uninsured children and garnering strong public support,” said Margo Rosenbach, a Mathematica vice president and author of the brief. “The flexibility states had to design and modify their programs contributed to this success. Going forward, it's important to preserve states' flexibility while also strengthening and standardizing measures of program performance and accountability.”

Considerations for Reauthorization

The evaluation identified several issues for policymakers to consider for the reauthorization of SCHIP:

• Maintain the option of M-SCHIP and S-SCHIP program models. The flexibility of the S-SCHIP model was key to gaining and maintaining state buy-in, even during budget shortfalls.
• Continue the flexibility of S-SCHIP benefit packages so that states can tailor them to their local market conditions and fiscal situations.
• Enhance coordination with traditional Medicaid, especially at renewal, to facilitate transfers between SCHIP and Medicaid.
• Provide more flexibility to states in developing premium assistance components, to strengthen coordination with employer-sponsored insurance coverage when it is available.
• Strengthen performance-monitoring capabilities through submission of detailed enrollment and utilization data.

The issue brief, “Increasing Children's Coverage and Access: A Decade of SCHIP Lessons” by Margo Rosenbach is available at http://www.mathematica-mpr.com/publications/redirect_pubsdb.asp?strSite=pdfs/SCHIPdecadeissbr.pdf. The full report on which the brief is based is available at http://www.mathematica-mpr.com/health/schippubs.asp#cms. For more information on Mathematica's two major SCHIP evaluations, go to http://www.mathematica-mpr.com/health/schipsumm.asp.

Mathematica, one of the nation's leading independent research firms, conducts policy research and surveys for federal and state governments, as well as private clients. The employee-owned firm, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted some of the most important studies of health care, education, welfare, employment, nutrition, and early childhood policies and programs in the United States. Mathematica strives to improve public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on the provision of information collection and analysis to its clients.

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