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• Broaddus, M. and L. Ku. Nearly 95 percent of low-income uninsured children now are eligible for Medicaid or SCHIP: measures need to increase enrollment among eligible but uninsured children. Washington, DC: Center on Budget and Policy Priorities; Dec 2000.

  This report can be found at: http://www.cbpp.org/12-6-00schip.htm

  A new analysis of Census data, presented in this report, finds that 94 percent of all uninsured children with family incomes below twice the Federal poverty level (FPL) qualify for Medicaid or SCHIP. These findings demonstrate that the Nation has largely solved the problem of making low-income children eligible for health insurance, with the notable exception of certain immigrant children. However, policymakers face the challenge of raising enrollment rates among children who are eligible for coverage but remain unenrolled and uninsured. The authors of this report suggest that Federal and State governments need to take additional steps to implement simpler, more effective enrollment procedures.

• Fox, H.B., McManus, M.A. and S.J. Limb. Access to care by S-CHIP children with special needs. San Francisco, CA; Washington, DC: Maternal and Child Health Policy Research Center; Oct 2000.

  This issue brief presents the findings from a five-State study of SCHIP insured children with complex physical, developmental, behavioral, and emotional conditions. The purpose of the study was to examine implementation issues and challenges during the first year of SCHIP operation in five States. The brief examines the adequacy of access to pediatric specialty and mental health networks; access to covered services, including mental health treatment and prescription drugs; and the operation of two States' wrap-around benefit programs for children with special needs. The report provides detailed tables on enrollment, benefits, and cost-sharing requirements and a description of each State's program.

• The Robert Wood Johnson Foundation. Key findings of a national public opinion survey of families with children who qualify for SCHIP and Medicaid. McLean, VA: The Robert Wood Johnson Foundation; Aug 2000.

  This study is based on a survey of 829 low-income parents. Participants included parents who either had children already enrolled in Medicaid or SCHIP, or had children who were eligible for coverage through either program but were unenrolled. According to this study, three out of five parents whose children may qualify for SCHIP or Medicaid do not know they are eligible, resulting in an estimated seven million unnecessarily uninsured children. While States have used SCHIP funding to expand coverage to families with moderate incomes, this survey shows that 71 percent of parents in two-income households and 69 percent of parents with an annual household income of more than $25,000 believe their children are ineligible for the program. The study also found that four out of five parents would enroll their children if they knew they were eligible for coverage.

• Edmunds, M., Teitelbaum, M., and C. Gleason. All over the map. A progress report on the State Children's Health Insurance Program (CHIP). Washington, DC: Children's Defense Fund. Jul 2000.

  This report on children's health found dramatic differences in the way States enroll children and varying degrees of success in reducing the numbers of uninsured children. The Children's Defense Fund (CDF) estimates that nearly 12 million children are uninsured, with 7 million of them eligible for SCHIP or Medicaid but not enrolled. According to the report, 1 in 3 Hispanic children and 1 in 5 black children remain uninsured, and 9 out of 10 uninsured children live with parents who work. CDF ranked States based on monthly rates of progress in enrolling children in SCHIP and Medicaid. The report covers the period from October 1997 through September 30, 1999.

• Byck, G.R. A comparison of the socioeconomic and health status characteristics of uninsured, State Children's Health Insurance Program-eligible children in the United States with those of other groups of insured children: implications for policy. Pediatrics. 2000 Jul; 106(1 Pt 1): 14-21.

  This article describes the sociodemographic and health status characteristics of the national uninsured SCHIP-eligible population. It compares this population with Medicaid-enrolled children, privately insured children, and privately insured children who have family income in the SCHIP eligibility range. The data demonstrate that uninsured SCHIP-eligible children are substantially different from children in these groups, particularly compared with Medicaid-enrolled children. SCHIP-eligible children are more likely to live with college-educated adults than are Medicaid-enrolled children, and they are 11 times more likely to be in excellent health. These differences need to be taken into account when setting policies and implementation programs intended to increase health insurance coverage and access to health care.

• Patterson, J. Conducting children's health insurance outreach in African American communities. Washington, DC: Center on Budget and Policy Priorities; Jun 2000.

  This report can be found at: http://www.cbpp.org/6-26-00health.htm

  In 1998, nearly 20 percent of black children in the United States were uninsured and 68 percent lived in families with income below 200 percent of the FPL. This report examines a number of Medicaid and SCHIP outreach programs tailored to be sensitive to the cultures and dynamics of the black community, and it describes specific recruitment and enrollment strategies that have been employed to reach members of this community.

• Schwalberg, R., Mathis, S.A. and I. Hill. New opportunities, new approaches: serving children with special health care needs under SCHIP. Volume 1: synthesis of study results. Washington, DC: The National Policy Center for Children with Special Health Care Needs; June 2000.

  This report describes case studies on five States' provisions for serving children with special health care needs (CSHCN) under SCHIP programs. These five States used different models to deliver and finance the care of CSHCN enrolled in SCHIP. However, several common themes emerged from their efforts that supported the successful design and implementation of their SCHIP models, including:

  • Recognition of the need for special provisions.
  • Establishment of screening mechanisms.
  • Provision of enhanced benefits and use of innovative delivery systems.
  • Family involvement and a focus on quality.

• Improving the implementation of SCHIP for adolescents. Report of an invitational conference sponsored by the American Academy of Pediatrics, Section on Adolescent Health, September 26-27, 1999. Pediatrics. 2000 Apr; 105(4): 906-12.

  This report identifies strategies to help States translate SCHIP into greater access to quality health care for adolescents and provides a set of AAP approved recommendations designed to assist States in structuring their SCHIP and Medicaid programs to better meet the needs of adolescents.

• Almeida, R.A. and G.M. Kenney. Gaps in insurance coverage for children: a pre-CHIP baseline. The Urban Institute; 2000. New Federalism: National Survey of America's Families, Series B, No. B-19.

  Data from the 1997 National Survey of America's Families are analyzed in this study to estimate the number and composition of the population of children who lacked health insurance prior to the implementation of SCHIP. Findings show that 9.2 million children ages 18 and under and 2 million individuals ages 19-20 lacked insurance coverage in 1997. Over three-quarters of uninsured children ages 18 and under were in families with incomes below 200 percent of the FPL. Consistent with historic Medicaid coverage policies, older children are more likely than younger children to be uninsured and almost half of all low-income individuals ages 19-20 were uninsured (47.7 percent). With SCHIP, States now have the potential to provide insurance coverage for almost all low-income uninsured children ages 18 and under. The challenge will be to translate that potential into coverage for all eligible but uninsured children.

• Morse, A. SCHIP and Access for Children in Immigrant Families. Denver, CO; Washington, DC: National Conference of State Legislatures; Feb 2000. Report No. 016682.

  This report provides an overview of immigrant children's access to SCHIP. It clarifies eligibility issues and barriers faced by citizen and noncitizen children in immigrant families and gives a concise overview of the immigrant population and how States can respond to their needs through SCHIP programs.

  To obtain a copy of this report (#016682), contact the National Conference of State Legislatures at 303-830-2200.

• English, A., Morreals, M. and A. Stinnett. Adolescents in public health insurance programs: Medicaid and CHIP. Chapel Hill, NC: Center for Adolescent Health and the Law; Dec 1999.

  This study found that teens and young adults are uninsured at higher rates than other age groups, with more than 2.3 million uninsured adolescents eligible but not currently enrolled in Medicaid or SCHIP. In addition, the report found that 1.3 million uninsured adolescents under age 19 are ineligible for the programs either because States have not elected to cover them or their family income level exceeds federally allowed limits. According to the authors, States should provide coverage for adolescents in families earning up to 200 percent of the FPL. In light of the various health problems that many teens face, the report advised States to establish a comprehensive set of benefits that includes preventive care as well as diagnostic and treatment services.

  To obtain a copy of this report, contact the Center for Adolescent Health and the Law at 919-968-8870.

• Brindis, C.D., VanLaneghem, K., Kirkpatrick, R., et al. Adolescents and the State Children's Health Insurance Program (CHIP): healthy options for meeting the needs of adolescents. Washington, DC: Association of Maternal and Child Health Programs; Sept 1999. Report No. L104.

  This paper summarizes key findings and themes from interviews conducted with representatives from 12 States. Most States are addressing access issues for all SCHIP enrollees, but few have identified provisions to reduce barriers to care, especially for adolescents. In particular, confidentiality protections are a key access issue and concern for many States. In addition, most States have not fully established SCHIP quality assurance mechanisms and evaluation plans for eligible groups, let alone efforts that specifically address adolescents. Although most States acknowledge that adolescents require a special focus, major challenges remain in addressing the unique needs of this population.

  To obtain a copy of this report (L104), contact the Association of Maternal and Child Health Programs at 703-356-1964.