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Data Needs for the State Children’s Health Insurance Program
failure to provide verification, failure to show for an interview appointment, and being uncooperative. A couple of reasons that participants leave the program are that they withdraw or they fail to comply with procedures. Examples of the latter are failure to provide verification, failure to show for interview appointment, failure to return a report, being uncooperative, and failure to apply for other benefits.
Linda Bilheimer, Robert Wood Johnson Foundation
Title: Data Needs for Tracking Children’s Health Insurance Coverage
Low-income families, especially those with income between 100 and 200 percent of the poverty level, have volatile health insurance coverage. Despite expansions of public coverage for children through Medicaid and the State Children’s Health Insurance Program, evidence from the states suggests that turnover and churning persist among children who enroll in public programs. In this presentation, Linda Bilheimer discussed the types of data needed to understand these phenomena better and the data that are currently available from national surveys and state administrative data systems. Longitudinal surveys, such as the Survey of Income and Program Participation (SIPP), are the best tools for tracking coverage changes. The SIPP data are not sufficiently timely to guide current policy decisions, however, nor can they produce state-specific analyses. Nonetheless, they provide important insights into the volatility of insurance status. For example, an analysis by Mathematica Policy Research of the 1992 panel shows that if all children who were uninsured at a point in time became insured, within one year half of that number of children would be uninsured (Czajka and Olsen, 2000). Other national surveys provide snapshots of who participates, who does not, and the reasons why. The presentation suggested a comparison of point-in-time data on enrollees to ever-enrolled data to indicate the degree of stability in SCHIP. Administrative data from the states can throw light on the outcomes of enrollment and eligibility redetermination processes. But many states have difficulty producing data on enrollment outcomes, definitions vary widely among the states, and linking procedural policies to outcomes is difficult. Medicaid eligibility systems were not designed to be management tools. Also, major investments in eligibility data systems are unlikely to be priorities.
A few reasons why children leave SCHIP were also discussed. Some children rotate between Medicaid and SCHIP. Some states can track this behavior, others cannot. It is very difficult for states to track people who