within the state. Such surveys have also been found to be useful for obtaining more detailed data on the low-income population.
Since each state has developed its own procedures for implementing SCHIP, it is very difficult to combine state-by-state data on eligibility, enrollment, or disenrollment to obtain national estimates or to make valid comparisons among states. Thus, there is no standard against which those administering a state program can assess their results. Some of the participants indicated that they found comfort in the fact that, even with different methodologies, comparisons of data among states seemed to reveal similar results. One of the most helpful aspects of the workshop is that it created an increased awareness of these problems and led to a sharing of information among state representatives on program aspects that seemed to be successful.
An issue that was raised time and again during the workshop was the lack of information on the reasons why those eligible for SCHIP were not enrolling and why those due for renewal in the program were not renewing. Such information is crucial for reducing the rolls of the uninsured. Some of the participants stated that they have begun to conduct sample surveys among those who have dropped out of the program at renewal time to determine the reasons for these disenrollments. This has enabled them to find ways of reinsuring these children and of preventing such disenrollments in the future.
There was considerable discussion in the workshop of the value of using federal programs, such as the National School Lunch Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program, and the Food Stamp Program as vehicles for increasing enrollment in SCHIP. The majority of the children in those programs are also eligible for SCHIP, and the application forms are much simpler than those for SCHIP. At least two of the states have used this approach successfully, but they had to work through the problem of creating an additional burden for a system that was set up for another purpose.
Because of the narrow window for income eligibility, there is tremendous movement back and forth between coverage by SCHIP and coverage by Medicaid. Many workshop participants cautioned that one cannot understand the issues of enrollment and disenrollment in SCHIP, without taking Medicaid into account. Even though the income gap between these two programs varies considerably among states, all of the states face the problem of how to deal with the continual churning between these programs.