Does SCHIP Provide Continuity of Coverage to Low-Income Children? Lessons from Oregon
This abstract was presented at the Third Annual Meeting of Child Health Services Researchers, June 2001, in Atlanta, GA.
By Susan Haber, Sc.D, and Janet Mitchell, Ph.D, of the Center for Health Economics Research.
The new State Children's Health Insurance Program (SCHIP) was intended to significantly expand insurance coverage for low-income children who do not qualify for Medicaid. However, concerns have emerged that SCHIP provides only episodic coverage and that many children disenroll after brief periods. This paper looks at patterns of enrollment in Oregon's Medicaid look-alike SCHIP program, which provides 6 months of guaranteed enrollment.
- How long are children covered by Oregon's SCHIP?
- Does length of enrollment vary across demographic groups?
- To what extent do children transition between SCHIP and Medicaid?
This paper draws on eligibility files for Oregon's SCHIP and Medicaid programs. We examine characteristics and enrollment patterns of children covered by SCHIP, including coverage under Medicaid.
Children enrolled in Oregon's SCHIP program between July 1998 and August 2000.
During just over 2 years of operation, Oregon's SCHIP program covered more than 45,000 unique children. There has been considerable turnover in enrollment and nearly all children have a single spell of SCHIP enrollment. Most are covered for only 6 months and do not re-enroll at the end of their initial guaranteed enrollment period. Length of SCHIP enrollment generally does not vary across demographic groups (age, gender, race, language, urban vs. rural residence). Nearly half of the children have neither SCHIP nor Medicaid coverage at the end of their initial 6 months of SCHIP enrollment. Approximately one-third moves into Medicaid (usually qualifying under OBRA poverty-related eligibility categories) when their SCHIP coverage ends. Hispanic and Spanish-speaking SCHIP children are more likely to move into Medicaid. In addition, a large proportion (54 percent) of children transition into SCHIP from Medicaid. Taking into account contiguous periods of Medicaid enrollment, SCHIP children were covered for an average of 14 months during our 2-year study period, with SCHIP accounting for somewhat less than half of this coverage. Approximately 10 percent were continuously covered during the 2-year period.
Oregon's SCHIP program has provided episodic coverage to most enrolled children. A high percentage of children transition between SCHIP and Medicaid because of fluctuations in family income. When assessing continuity of coverage provided by SCHIP, it is important also to take into account periods of Medicaid enrollment. Further research is required to learn whether the large percentage that do not move into Medicaid when their SCHIP coverage ends become uninsured or whether they transition to private insurance.
Implications for Policy, Delivery or Practice
SCHIP can serve as an important complement to Medicaid, ensuring ongoing coverage for low-income children whose family incomes fluctuate. Given the potential for frequent movement between SCHIP and Medicaid, it is important for states to make transitions between these programs as seamless as possible. The transition between SCHIP and Medicaid can be virtually transparent to beneficiaries in states that operate Medicaid look-alike SCHIP programs. For children in states that operate stand-alone programs with distinct delivery systems, however, the transition between Medicaid and SCHIP may create significant disruptions in continuity of care.