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Benefit Design and Service Delivery: Current Research

• Howell EM, Buck JA, Teich JL. Mental health benefits under SCHIP. Health Affairs 2000 Nov-Dec; 19(6): 291-7.

  • States are beginning to experiment with the structure of their mental health and substance abuse benefits within SCHIP. As SCHIP enters its third year of implementation, there is a particular need for estimates of the cost of mental health services for SCHIP children and adolescents, information that is not readily available from any of the SCHIP plans. This paper was designed to fill that knowledge gap. After showing the initial coverage choices that States have made under SCHIP and briefly reviewing the literature from previous studies, the authors provide some estimates of the range of costs that States could face under alternative benefit designs.

• Fox HB, McManus MA, Limb SJ. Access to care by S-CHIP children with special needs. 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 American Academy of Pediatrics. Guidelines for child and adolescent mental health and substance abuse services. Elk Grove Village (IL): AAP; Oct 2000.

  • In October 2000, the American Academy of Pediatrics (AAP) released new guidelines on child and adolescent mental health and substance abuse services, calling for more comprehensive public and private insurance aimed at increasing access to treatment to address the needs of increasing numbers of children with psychosocial problems.

• Alcalde G. Providing reproductive health services for adolescents: State options. Washington (DC): National Conference of State Legislatures; Jul 2000.

  • This report provides an overview of States' options for addressing the issue of teenage pregnancy.

  • To obtain a copy of this report (#016768), contact the National Conference of State Legislatures at 303-830-2200.

• Schwalberg R, Mathis SA, Hill I. New opportunities, new approaches: serving children with special health care needs under SCHIP. Baltimore (MD): The National Policy Center for Children with Special Health Care Needs; Jun 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. 1999 Sept 26-27; In Pediatrics 2000 Apr; 105(4): 906-13.

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

  • The recommendations from this report are available at: http://www.aap.org/advocacy/adolescentsSCHIP.pdf

• Brindis CD, 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; and San Francisco (CA): University of California, San Francisco, Policy Information and Analysis Center for Middle Childhood and Adolescence and National Adolescent Health Information Center; Sept 1999.

  • This paper summarizes key findings and themes from interviews conducted with representatives from twelve 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 quality assurance mechanisms and evaluation plans under SCHIP 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.

  • This publication can be ordered from the National Maternal and Child Health Clearinghouse at 1-888-434-4624.

• Ullman F, Hill I, Almeida R. CHIP: a look at emerging State programs. Washington (DC): The Urban Institute; Sept 1999.

  • This report can be found at: http://newfederalism.urban.org/html/anf_a35.html.

  • This paper examines changes in States' average income eligibility thresholds for children, pre- and post-SCHIP. The report finds that states with the lowest level of coverage prior to SCHIP have the most expanded income eligibility thresholds. States with a higher proportion of low-income uninsured children have increased their income eligibility thresholds to a greater degree than States with smaller percentages of uninsured children. States with higher per capita personal income have raised eligibility thresholds more than States with lower per capita income. States that experienced the greatest increase in Federal matching rates expanded eligibility the most.

• Henderson T, Steinberg D. Implementing the State Children's Health Insurance Program: will service delivery needs be adequately met? Washington (DC): National Conference of State Legislatures; 1999.

  • This issue brief examines how States are addressing service delivery issues under SCHIP. In spring 1999, the National Conference of State Legislatures (NCSL) conducted a survey of 26 States that have separate State programs or combination plans. The study found that out of the 26 States surveyed, none currently spends administrative funding under SCHIP for direct contracting of services, 15 States model their SCHIP contracts on Medicaid and 10 States report having higher payment rates for SCHIP than for Medicaid. The authors conclude with suggested policy options to ensure the effective delivery of services to children in separate State programs.

  • To obtain a copy of this report (#016757) contact the National Conference of State Legislatures at 303-830-2200.

• Berman S, Bondy J, Lezotte D, et al. The influence of having an assigned Medicaid primary care physician on utilization of otitis media-related services. Pediatrics 1999 Nov; 104(5 Pt 2): 1192-7.

  • This study suggests that monthly recertification of Medicaid eligibility leads to frequent shifts on and off the program, which may undermine the delivery of cost-effective quality care. Researchers found that children who were continuously enrolled were more than four times as likely to have an assigned primary care physician compared to children who went on and off Medicaid. Results of the study showed that twelve months of continuous Medicaid enrollment and an assigned primary care physician significantly improved the quality of care for children with middle ear infections.

• Rothman, MB, Wheatley BP. Ensuring seamless coverage for low-income families: model State strategies. Washington (DC): Alpha Center; Jun 1998.

  • This monograph is designed to assist State policymakers in developing and implementing policies to promote seamless insurance coverage for low-income populations. It describes the types of coverage breaks that enrollees face when they transition between public programs or move from public to private coverage (or vice versa), and details the policies States have implemented to manage these breaks in coverage.

• Wheatley BP, Sherman MJ. State children's coverage programs: existing structures and proposed expansions. Washington (DC): Alpha Center; Mar 1998.

  • This paper provides comparisons of children's healthcare coverage programs in six States (Colorado, Florida, Massachusetts, Minnesota, New Mexico, and New York). The programs are compared with regard to eligibility, premiums, benefits and limitations, and co-payments. The paper highlights the program changes that Title XXI has allowed or required these states to make.

• Fox HB, McManus MA, Graham RR, et al. Plan and benefit options under the State Children's Health Insurance Program. Issue Brief (2). Washington (DC): Maternal and Child Health Policy Research Center; Jan 1998.

  • This issue brief examines each of the five SCHIP benefit options: Medicaid, benchmark coverage, benchmark-equivalent coverage, secretary-approved coverage, and direct services under a waiver. Also included are tables on benefits in the standard Federal employees benefit plan, State employees' benefit plans in 5 selected States, and the largest commercial HMO benefit plans in 5 selected States.

    • George Washington University Center for Health Services Research and Policy. Optional purchasing specifications: Medicaid managed care for pediatric services. Washington (DC): The Center; Sept 1999.
    • George Washington University Center for Health Services Research and Policy. Optional purchasing specifications: SCHIP. Washington (DC): The Center; Mar 2000.
    • George Washington University Center for Health Services Research and Policy. Optional purchasing specifications: Medicaid managed care for children with special health care needs. Washington (DC): The Center; Aug 2000.

  • These reports can be found in the Sample Purchasing Specifications Section at: http://www.gwumc.edu/sphhs/healthpolicy/.

  • These three documents have been produced under a Health Resources and Services Administration (HRSA) contract in consultation with officials from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Care Financing Administration (HCFA), (now the Centers for Medicare and Medicaid Services (CMS)), the Assistant Secretary for Planning and Evaluation (ASPE) and the Department of Education (DOE). These technical assistance documents are tools to assist State officials in purchasing services from managed care organizations on behalf of children who are eligible for Medicaid or SCHIP.

• Pernice C, Robinson GK, Bush S, et al. A summary of planned mental health and substance abuse services and activities in the State Children's Health Insurance Programs. Bethesda (MD): Substance Abuse and Mental Health Services Administration.; Jan 1999.

  • This report contains information obtained from the Title XXI applications submitted by each State to the Health Care Financing Administration (HCFA), (now the Centers for Medicare and Medicaid Services (CMS)), regarding: 1) what type of SCHIP program the State would implement; 2) what population would be eligible for expanded coverage; 3) which benefits would be offered; 4) how the State would conduct outreach and enroll individuals; 5) how effectiveness would be measured; and 6) how States would involve the public in determining the SCHIP plan, design, implementation, and, as required, modification. The information is provided for each State in a series of charts and tables that describe the impact of SCHIP on children with mental health and substance abuse treatment needs.

• Heffron J, Davis D. An analysis of the mental health/substance abuse benefits and cost-sharing policies of approved State Children's Health Insurance Program plans. Alexandria (VA): National Mental Health Association; Apr 2000.

  • This report is a companion guide to the National Mental Health Association's publication Strategies for Advocacy and Public Education Related to the State Children's Health Insurance Program. It tracks mental health and substance abuse benefits in each State.

• Hill I. Charting new courses for children's health insurance. Policy & Practice: American Public Human Services Association 2000 Dec; 58(4).

  • This report can be found at: http://newfederalism.urban.org/pdf/child-health-insurance.pdf.

  • This 18-State study of Title XXI/SCHIP implementation strategies found that distinct trade-offs surround the adoption of either Medicaid or separate program expansions. Medicaid expansions, while simpler to administer, appear burdened by historical links to public welfare. In addition, political, family, and provider resistance remain. States that created separate programs, while burdened by start-up and coordination challenges, have demonstrated greater innovation in the areas of outreach, enrollment, and service delivery. These programs appear to be more attractive to working poor families who want coverage that feels like private insurance, as well as to providers and policymakers. Regardless of the approach selected, SCHIP has stimulated restructuring of public insurance programs and movement away from traditional welfare-linked models.