Because they are growing and developing, children have a distinct set of health care needs that evolve over time and differ from those of adults. Moreover, while as a group children are relatively healthy, one in seven has special health care needs. Given that under reform, many children will be covered through private plans and some children who are currently covered through public programs may be shifted to private plans, it is particularly important to consider how well private plans might meet children’s health care needs.

Problems obtaining oral health and dental care disproportionately affect low-income and minority children. Medicaid, and CHIP, are major sources of oral health and dental coverage for millions of low-income children. In fact, CHIPRA guarantees dental benefits under CHIP beginning Oct. 1, 2009. But barriers that leave many children without adequate oral health and dental care remain.

The stated goal of West Virginia’s Medicaid Redesign was to improve the health of beneficiaries by promoting healthy behaviors such as smoking cessation, regular doctor visits, and weight loss. Parents of children who receive health care coverage under Medicaid, even if they aren’t eligible themselves, must sign an agreement or their children will automatically be assigned to the basic plan with reduced benefits. Because so few families have successfully executed the agreement, West Virginia’s changes have resulted in limiting benefits, primarily for children, with no real impact on improving health or promoting healthy behavior.

A key feature of Florida's Medicaid Reform pilot is the Enhanced Benefits Rewards Program which provides each Medicaid beneficiary up to $125 a year in credits for certain healthy behaviors, such as keeping a doctor’s appointment. The credits may be applied to the purchase of health and personal care products at participating pharmacies. This policy brief analyzes the program reporting that it has has been expensive to launch and slow to catch on, raising questions about its effectiveness and efficiency. It reports that though beneficiaries have earned $12.5 million in credits, only about 10 percent of those credits have been spent.

This report examines the continuing role of Medicaid's EPSDT benefit in a changing health care system. Part I provides an overview of EPSDT, including information about the flexibility provided by the DRA, and also details state practices in implementing EPSDT benefits within managed care arrangements. Part II synthesizes the findings of an expert workgroup convened by the Center for Health Care Strategies to identify promising approaches for modernizing EPSDT to better meet the needs of children and families in today's health care system. The report concludes with opportunities and challenges that lie ahead in modernizing EPSDT, both in states that use managed care purchasing arrangements and in states that move toward greater use of DRA flexibility.

This paper puts forward state and federal approaches to help manage prescription drugs efficiently and ensure that Medicaid gets the best possible price on prescription drugs while maintaining access to needed drugs for Medicaid beneficiaries.

This report provides information on The Deficit Reduction Act of 2005, which allows states to vary the benefit packages they offer to some groups of Medicaid beneficiaries. It reports that states can require most children and parents to enroll in new “benchmark” benefit packages that do not provide all the benefits covered by regular Medicaid.

The Deficit Reduction Act of 2005 gives states new options to scale back health-care benefits for children and parents enrolled in Medicaid. This report reviews West Virginia's federal approval to provide a scaled-back basic benefit package for most children and parents in its Medicaid program, while giving them access to an “enhanced” benefit package if they sign and conform to an agreement with the state.

This issue brief analyzes the differences between Medicaid and SCHIP’s benefit standards. It reviews the health care guarantees that children would lose if the Medicaid standard were replaced by SCHIP-like rules.This issue brief analyzes the differences between Medicaid and SCHIP’s benefit standards. It reviews the health care guarantees that children would lose if the Medicaid standard were replaced by SCHIP-like rules.

Effective and efficient management of the Medicaid program is essential. Managing the Medicaid program well ensures that beneficiaries get the health and long-term care services they need, providers offer high quality care in a system that operates efficiently, and public resources are spent effectively. This paper proposes four discrete strategies to improve and streamline management of different elements of the Medicaid program to help achieve key program goals.

This brief reports on new research that indicates that increasing the continuity of children’s Medicaid coverage reduces subsequent hospitalizations for chronic health conditions like asthma or diabetes.  The research—a new study conducted by Dr. Andrew Bindman and his associates at the University of California at San Francisco—indicates that improving the continuity of Medicaid coverage through 12-month continuous eligibility can improve children’s health and avert unnecessary hospitalization costs.

This report reviews the impact of program structure on children’s disenrollment from Medicaid and SCHIP.  It finds that states with combined Medicaid/SCHIP programs experience an annual dropout rate of 9.6 percent, compared with 13.9 percent in states with separate programs. Having separate programs increases the risk of drop out by 45 percent. The attached file is an abstract of the article. Order the publication on the publisher's Web site.

This report reviews whether SCHIP programs that are separate from the state Medicaid program is associated have lower take-up rates. The authors found that separate programs were associated with take-up rates 8 to 10 percentage points lower than those for combined programs. The attached file is an abstract of the article. Order the publication on the publisher's Web site.

This report reviews whether a state using SCHIP funds for a Medicaid expansion has an enrollment advantage over a state that has a combination Medicaid/SCHIP program or a separate SCHIP program. The authors find that states using Medicaid expansions have higher enrollment levels—an increase of 2.7 percentage points compared with combination programs and 2 percentage points compared with separate SCHIP programs. These results may be due to the advantages Medicaid affords as an administrative model including the potential for better continuity and more seamless integration of enrollment for agency staff, who are required to screen SCHIP applicants for Medicaid eligibility, as well as for recipients who potentially shift between programs when family income changes. Finally, outreach efforts oriented around SCHIP will automatically apply to Medicaid under a Medicaid expansion.

This report finds that states utilizing Medicaid expansions have higher enrollment levels—an increase of 2.7 percentage points compared to combination programs and an increase of 3.3 percentage points compared to separate SCHIP programs. The advantage for the Medicaid expansion is found at all levels of income and is a little larger for those with relatively higher incomes (i.e., between 50 and 250 percent of the federal poverty level), which is the opposite of the fear that higher income recipients would feel more anti-Medicaid stigma.
The attached file is an abstract of the article. Order the publication on the publisher's Web site.

This guide by the Centers for Medicare and Medicaid Services (CMS) provides information on federal rules to enroll and retain low-income families and children in health care coverage.

Many states have expanded SCHIP coverage for children through a separate child health program, either exclusively or in combination with a Medicaid expansion. Each of these states, as well as those that create separate child health programs, needs to devise strategies for coordinating the new coverage program with Medicaid. This report discusses some administrative strategies, including one program name and enrollment simplifications, which could promote coordination.

Of the 9 states GAO interviewed, 5 states measured the occurrence of crowd-out, but they all used different methodologies to develop their estimates; the remaining states did not measure crowd-out. None of the officials viewed crowd-out as a concern, with most basing this assessment on a variety of factors, including the lack of available and affordable private health insurance for the SCHIP population in their state.

This research brief highlights findings from a seven-state study examining retention of children in SCHIP and coverage of kids after they leave the program. The report finds that once children enrolled in SCHIP leave public insurance, they are far more likely to become uninsured—and remain uninsured for some time—than they are to obtain private coverage. The findings suggest that the extent to which SCHIP has substituted for private insurance may be well below the rates estimated in some studies.

This update to an earlier report discusses crowd-out and its implications, highlighting findings from recent studies. Crowd-out estimates range from near zero to 60%, depending on the population studied and the methodology used, and are higher-income children. Recent efforts to reduce crowd-out, such as waiting periods and higher premiums, have been shown to discourage enrollment in public programs by both the privately-insured and the uninsured. The brief also discusses the role of the availability and affordability of employer-sponsored insurance in maintaining private coverage.

Prepared for the Centers for Medicare and Medicaid Services (CMS) as part of the Congressionally mandated evaluation of SCHIP, this report reviews the research on crowd out after 10 years of experience with SCHIP and presents new data collected as part of the larger evaluation.

As Congress debated SCHIP reauthorization in 2007, there was much discussion on the crowd-out effects of SCHIP. This briefing in August 2007, provided an overview of the issue in the context of the current debate. A transcript of the briefing is provided; for additional resources, see the Alliance for Health Reform.

This report outlines the design and financing structure of SCHIP and synthesizes findings on the effect of the program on children’s health coverage. The findings indicate that SCHIP has contributed to a decline in the uninsured rate of low-income children, SCHIP’s target population, and concludes that crowd-out of private coverage under SCHIP is most likely between 25 and 50% of the increase in public coverage. 

This article examines the extent to which enrollees in SCHIP have dropped private insurance to enroll in public coverage.  The analysis shows that only 28% of SCHIP enrollees had private coverage in the six months prior to enrolling in the program. About half of these enrollees lost private coverage involuntarily, implying that 14% of all SCHIP enrollees had private coverage that they could have retained, but many report it is unaffordable.

With the new options in CHIPRA, a new Administration in Washington, and the potential for health care reform on the horizon, the time is right to highlight the most promising federal actions that would close these remaining coverage gaps for uninsured children and adults. This report identifies new strategies as well as some variations in concepts that have been around for many years that could help states get closer to the finish line by enrolling and retaining eligible children and families in Medicaid and CHIP.

This report highlights issues associated with Medicaid and CHIP eligibility policies and procedures at renewal and strategies for addressing the issues, including approaches to reducing churning in public heath coverage programs. The purpose of this report is to share information learned during the Retention Initiative and suggest strategies for improving Medicaid and CHIP retention rates across all states.

Approximately one-third of enrollees in New York State's public health insurance programs fail to complete the annual recertification process and lose coverage despite remaining eligible. The key barriers to recertification include: misconceptions about eligibility, confusion about the recertification process, an abundance of paperwork requirements, language issues, and the complicated nature of their lives.

In 2006, NASHP convened a symposium of state and national child health coverage experts from the public and private sectors to focus on lessons learned over the decade since SCHIP was enacted. This paper revisits the discussions to provide more concrete information for states seeking to take the next step in enrolling more uninsured children who are eligible for Medicaid or SCHIP, but not enrolled.

This research brief highlights findings from a seven-state study examining retention of children in SCHIP and coverage of kids after they leave the program. The report finds that once children enrolled in SCHIP leave public insurance, they are far more likely to become uninsured—and remain uninsured for some time—than they are to obtain private coverage. The findings suggest that the extent to which SCHIP has substituted for private insurance may be well below the rates estimated in some studies.

This report analyzes the potential to enact continuous Medicaid coverage for children in New York State, where two million children are covered by public health insurance programs and 90 percent of the uninsured children are eligible. It reviews the necessary legal authority, recommended design, and potential barriers to implementation that such a plan would entail.

This report highlights states' innovative use of health information technology in their Medicaid and SCHIP programs to improve their ability to reach and enroll eligible children, improve the quality of care for children, increase communications with families, and continue to modernize their programs. Although many of these efforts are still in their early stages, findings to date indicate improvements in access to care, care coordination, case management, and administrative efficiency.

The implementation of a policy change in California that extended for children the Medicaid eligibility redetermination period from 3 to 12 months was associated with an increase in the continuity of children’s Medicaid coverage and a decrease in hospitalizations for ambulatory care sensitive conditions. There was $17 million less in estimated hospitalization costs for ambulatory care sensitive conditions with less frequent eligibility redetermination that partially offset the estimated $150 million in additional costs to Medicaid for providing more continuous coverage.

Over a 2-year period, 53% of children were continuously insured with private coverage, 19% had continuous public insurance, 20% had a single gap in coverage, 2% had multiple gaps, and 6% were continuously uninsured. Compared with children continuously insured through private coverage, children with single or multiple gaps or who were continuously uninsured were significantly more likely to lack a usual source of care, to have no well-child visits, and to have unmet medical or prescription drug needs.

To examine the impact of changing from a passive renewal process to an active renewal process in Florida's State Children's Health Insurance Program (SCHIP) on disenrollment, the researchers looked at administrative records, containing enrollment and demographic data, from January 2004 through February 2006. Children faced almost a 10-fold greater risk of disenrolling in their renewal month under active renewal than under passive renewal. They did not detect differential impacts of the policy change across children with different health status levels.

This brief reports on new research that indicates that increasing the continuity of children’s Medicaid coverage reduces subsequent hospitalizations for chronic health conditions like asthma or diabetes.  The research—a new study conducted by Dr. Andrew Bindman and his associates at the University of California at San Francisco—indicates that improving the continuity of Medicaid coverage through 12-month continuous eligibility can improve children’s health and avert unnecessary hospitalization costs.

Children fail to enroll and/or lose coverage primarily due to misinformation, difficult enrollment and renewal procedures, and inefficient administrative practices. This report explores how technological innovations can be applied to remove these impediments for Medicaid and SCHIP enrollment and retention, while at the same time making the programs more efficient.

This report illustrates the many creative and collaborative ways the Covering Kids & Families coalitions worked to break down barriers to public health coverage for low-income children and adults. From 1997-2002, these coalitions encouraged the adoption of outreach, simplification, and coordination strategies across the states. 

In March 2006, the National Academy for State Health Policy convened a small symposium on child health coverage consisting of state and national public and private sector experts on child health coverage. This brief summarizes key suggestions which emerged during the symposium discussion about lessons learned over the past decade of state efforts to increase rates of child health coverage. Meeting highlights are supplemented with additional information from the current literature, and examples from states.

This report examines the extent, causes, and consequences of instability in public coverage programs for children and families, focusing particularly on the phenomenon of “churning,” which occurs when individuals lose and regain coverage in a short period of time. It also provides strategies that can make public program coverage more stable.

This report reviews the impact of "churning" in California. It finds that over 600,000 children enrolled in Medicaid (Medi-Cal in California) in 2003 had been disenrolled from the program within a three-year period, only to be later re-enrolled. It cost California over $120 million to re-process these eligible Medi-Cal children.

Even as states made headway in enrolling eligible children, anecdotal evidence emerged as early as mid-1999 that large proportions of SCHIP enrollees were losing eligibility, or disenrolling, at the end of their period of coverage. The Urban institute collected information from eight states about their application and eligibility redetermination processes under SCHIP, as well as data on the outcomes of these processes. This report focuses on our findings related to retention.

This report examines reasons why many low-income individuals lose coverage, the effects of insurance loss, and strategies that can help people retain coverage. It shows that every person with public or private coverage at the beginning of a given year retained coverage throughout the next 12 months, the number of low-income children who are uninsured would decline by close to two-fifths over the course of a year. The number of uninsured low-income adults would decline by more than one-quarter.

This issue brief reports on a study of disenrollment from SCHIP by the Child Health Insurance Research Initiative (CHIRI). Looking at disenrollment in Florida, Kansas, New York, and Oregon the authors found that the administrative requirements imposed by states at renewal lead a large share of children to be dropped from coverage. In particular, results show that there is a strong and large association between disenrollment and recertification and that states without passive re-enrollment, approximately one-half of those enrolled at the
time dropped out of SCHIP.

NASHP—with seven states, Alabama, Arizona, California, Georgia, Iowa, New Jersey, and Utah—undertook a project to examine SCHIP disenrollment and how to retain enrollment of those children who continued to be eligible for the program but failed to complete the renewal process or make their premium payments. It provides results from a telephone survey of parents of current SCHIP enrollees and those those who have a lapse in coverage.

This guide by the Centers for Medicare and Medicaid Services (CMS) provides information on federal rules to enroll and retain low-income families and children in health care coverage.