What Effects Will Cost-Sharing Have on Enrollment, Access, and Satisfaction with SCHIP?

Background

The Federal Medicaid program has traditionally targeted families with low or no income. Because of this, policymakers have customarily limited the amounts of cost-sharing that Medicaid programs can impose in order to minimize barriers to enrollment and utilization. As government-subsidized health insurance programs have expanded to serve the "working poor," however, cost-sharing issues have become more relevant and more States have begun instituting cost-sharing policies.

Cost-sharing options such as premium contributions have been used in family-based expansion programs like TennCare and Washington's Basic Health Plan and are being permitted in Title XXI programs as well. Under SCHIP, States choosing to implement new State-run programs are granted additional flexibility to impose cost-sharing requirements on participating families well beyond those traditionally permitted under Medicaid. Because of this additional flexibility, new concerns surrounding the level and extent to which cost-sharing will present a barrier to families' utilization of SCHIP services are emerging.

Cited articles from Families USA Foundation about cost-sharing:

• Premiums and Cost-Sharing Proposed by States Under XXI, The New Children’s Health Insurance Program. February 1998.

Give me more details

• Title XXI Cost-Sharing Regulations for Medicaid Expansion Programs

• Title XXI Cost-Sharing Regulations for Non-Medicaid Expansion Programs

• What Are the Implications of Instituting Copayments and Premium Cost-Sharing?

• What Are the Effects of Copayments and Premium Cost-Sharing on Access and Utilization in State Expansion Programs?

• What Are the Implications of Past State Experiences for Effect of Cost-Sharing on SCHIP Access and Utilization?

Who presented this material?

• Judith Arnold, Leighton Ku, Ph.D., M.P.H., and Rose M. Naff addressed the issue of cost-sharing at SCHIP seminar held in Sanibel Island, Florida, June 29-July 1, 1998.  At the SCHIP seminar held later in the year in Portland, Oregon, September 14-16, 1998, Rose Naff again addressed this issue.