Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program

Judith Wooldridge, Mathematica Policy Research, Inc.
Ian Hill, The Urban Institute ,
Mary Harrington, Mathematica Policy Research, Inc. ,
Genevieve Kenney, The Urban Institute ,
Corinna Hawkes, The Urban Institute ,
Jennifer Haley, The Urban Institute

with assistance from
Hilary Bellamy, Health Systems Research, Inc. ,
Renee Schwalberg, Health Systems Research, Inc.

February26, 2003

Submitted to:

Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
200 Independence Avenue S.W.
Washington, DC 20201

 Submitted by:

Mathematica Policy Research, Inc.
P.O. Box 2393
Princeton, NJ 08543-2393
(609) 799-3535 and
The Urban Institute
2100 M Street, NW
Washington, DC 20037

Project Director: Judith Wooldridge

CONTENTS

A PDF version is also available2, 905 Kb

EXECUTIVE SUMMARY

PART 1: BACKGROUND

I A Brief History of SCHIP

  1. Introduction
  2. Statutory Framework
  3. Program Implementation
  4. Enrollment Trends
  5. Delivery Systems
  6. What Is Known?

II The Congressionally Mandated Evaluation

  1. The Congressional Mandate
  2. Development of the Evaluation Plan
  3. Evaluation Topics and Research Questions

III Evaluation Design

  1. Overview of Design Activities
  2. Selecting States and Gaining Their Cooperation
  3. Designing and Implementing the Case Studies
  4. Focus Group Study Design
  5. State and Local Area Integrated Telephone Survey (SLAITS) Analysis
  6. Special Studies
  7. Enrollment Data
  8. Survey Design and Analysis
    1. Survey of SCHIP and Medicaid Enrollees and Disenrollees
    2. Survey of State Program Administrators

PART 2: FINDINGS

IV Introduction to Findings

V Overview of SCHIP Programs in Six of the Ten Study States

VI Outreach

  1. Background and Policy Development
  2. Outreach Strategies
    1. Statewide Marketing Efforts
    2. Community-Based Outreach
  3. Implementation Experiences

VII Awareness of SCHIP and Medicaid among Low-Income Families

  1. Perceptions of the Value of SCHIP and Medicaid
  2. Awareness and Perceptions of Medicaid and SCHIP Among Low-income Families with Uninsured Children
    1. Background and Policy Issues
    2. The National Picture
    3. Subgroup Differences

VIII Eligibility and Enrollment

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences
    1. Eligibility Policies and Enrollment Procedures
    2. Enrollment

IX Eligibility Redetermination and Retention

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences

X. Benefits

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences

XI Service Delivery Systems, Access and Utilization

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences

XII Cost Sharing

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences

XIII Crowd-Out

  1. Background and Policy Development
  2. Program and Policy Characteristics
  3. Implementation Experiences

XIV Family Coverage and Premium Assistance Programs

  1. Background and Policy Development
  2. Family Coverage
    1. Experiences with Family Coverage in the Study States
    2. Experiences with Family Coverage in New Jersey, Rhode Island, and Wisconsin
  3. Premium Assistance Programs

XV Financing and Fiscal Outlook

  1. Policy Development and Program Characteristics
  2. Implementation Experiences

XVI Coordination of SCHIP and Medicaid in States with Separate Programs

  1. Enrollment and Retention
  2. Outreach and Marketing
  3. Service Delivery and Access

XVII Conclusions

  1. Successes
  2. Challenges
  3. Emerging Issues

References

Appendices

  1. Enabling Legislation for the SCHIP Evaluation
  2. Focus Group Summary Tables
  3. Final Report to Congress

TABLES

  1. Major Evaluation Topics and Contributing Data Sources
  2. Crosswalk of Findings and Data Sources
  3. Crosswalk of States and Data Sources
  4. SCHIP State Plans: Dates of Submission, Approval and Implementation
  5. SCHIP Eligibility Expansion as a Percentage of the Federal Poverty Level
  6. State SCHIP Outreach Strategies
  7. Potential Barriers to Medicaid/SCHIP Enrollment for Low-income Uninsured Children, Early 2001
  8. SCHIP and Medicaid Simplification Strategies
  9. Verification Required from Applicants to SCHIP and Medicaid
  10. Avenues for Submitting SCHIP and Medicaid Applications
  11. SCHIP and Medicaid Enrollment
  12. Redetermination Forms, Requirements, and Procedures for SCHIP and Medicaid
  13. Benefit Packages for Separate State Programs: Enhancements Made to the Benchmark Plan
  14. Benefit Packages for Separate State Programs: Services Not Covered by SCHIP
  15. Benefit Packages for Separate State Programs: Services Limited under SCHIP
  16. SCHIP Delivery System Features
  17. Cost Sharing Provisions
  18. State SCHIP Policies to Deter Crowd-out
  19. SCHIP Allotments and Expenditures, in Millions, 1998-2001
  20. Federal Matching Rate and Sources of State Shares

FIGURES

  1. Awareness of Medicaid and Separate SCHIP Programs
  2. Perceptions of Eligibility for and Attitudes Toward Enrolling in Medicaid/SCHIP Programs
  3. Perceptions of Eligibility for and Attitudes Toward Enrolling in Medicaid/SCHIP Programs, by Household Income
  4. SCHIP Enrollment Trends for the Study States
  5. SCHIP Enrollment Trends as a Percentage of the Target Figure for Each State