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Data Needs for the State Children’s Health Insurance Program Data Needs for the STATE CHILDREN’S HEALTH INSURANCE PROGRAM Panel for the Workshop on the State Children’s Health Insurance Program Arleen Leibowitz and Earl S. Pollack, Editors Committee on National Statistics Division of Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, DC
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Data Needs for the State Children’s Health Insurance Program NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. SBR-9709489 between the National Academy of Sciences and the Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 0-309-08463-6 Additional copies of this report are available from National Academy Press, 2101 Constitution Avenue, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area). This report is also available on line at http://www.nap.edu Printed in the United States of America. Copyright 2002 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council (2002) Data Needs for the State Children’s Health Insurance Program. Committee on National Statistics, Arleen Leibowitz and Earl S. Pollack, Editors. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
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Data Needs for the State Children’s Health Insurance Program THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.
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Data Needs for the State Children’s Health Insurance Program PANEL FOR THE WORKSHOP ON THE STATE CHILDREN’S HEALTH INSURANCE PROGRAM ARLEEN LEIBOWITZ (Chair), School of Public Policy and Social Research, University of California, Los Angeles JOSEPH G. ALTONJI, Department of Economics, Northwestern University ROBERT M. GROVES, Survey Research Center, University of Michigan PAUL NEWACHECK, Institute for Health Policy Studies, University of California, San Francisco JOHN E. ROLPH, Marshall School of Business, University of Southern California EARL S. POLLACK, Study Director JAMIE L. CASEY, Research Assistant DANELLE J. DESSAINT, Senior Project Assistant
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Data Needs for the State Children’s Health Insurance Program COMMITTEE ON NATIONAL STATISTICS 2001-2002 JOHN E. ROLPH (Chair), Marshall School of Business, University of Southern California JOSEPH G. ALTONJI, Department of Economics, Northwestern University ROBERT BELL, AT&T Research Laboratories, Florham Park, NJ LAWRENCE D. BROWN, The Wharton School, University of Pennsylvania ROBERT M. GROVES, Survey Research Center, University of Michigan HERMANN HABERMANN, Statistics Division, United Nations, New York JOEL HOROWITZ, Department of Economics, The University of Iowa WILLIAM KALSBEEK, Department of Biostatistics, University of North Carolina ARLEEN LEIBOWITZ, School of Public Policy and Social Research, University of California, Los Angeles RODERICK J.A. LITTLE, School of Public Health, University of Michigan, Ann Arbor THOMAS A. LOUIS, RAND, Arlington, Virginia DARYL PREGIBON, AT&T Laboratories-Research, Florham Park, New Jersey NORA CATE SCHAEFFER, Department of Sociology, University of Wisconsin, Madison MATTHEW D. SHAPIRO, Department of Economics, Survey Research Center, University of Michigan, Ann Arbor ANDREW A. WHITE, Director
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Data Needs for the State Children’s Health Insurance Program Acknowledgments The Panel for the Workshop on the State Children’s Health Insurance Program wishes to thank the many people who contributed to the development of the workshop and to the preparation of this report. The workshop was sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services. Caroline Taplin, of that agency, served as project officer for the workshop. She and Julia Paradise of ASPE were very helpful during the organization and conduct of the workshop and in responding to questions during the preparation of this report. The panel is greatly indebted to the organizers of the individual workshop sessions—Robert Valdez, School of Public Health MCP Hahnemann University; Lynn Blewett, School of Public Health at the University of Minnesota; Ian Hill, The Urban Institute; and Deborah Chollet, Mathematica Policy Research, Inc. Their command of the issues relating to SCHIP and their choice of speakers made the workshop a lively forum for exchange. We would like to thank the state policy makers, who have been working creatively and tirelessly to make the SCHIP program a success, for sharing their knowledge. Thanks are also due to the researchers who are developing the new methods needed to understand this complex program and who are so willing to share not only their findings, but also their methods. The worskhop drew on excellent presentations by Vicki Grant, Southern Institute on Children and Families; Linda Bilheimer, The Robert Wood
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Data Needs for the State Children’s Health Insurance Program Johnson Foundation; Lisa Dubay, The Urban Institute; Thomas Selden, Agency for Healthcare Research and Quality; Ian Hill, The Urban Institute; Hilary Bellamy, Health Systems Research, Inc.; Denise Holmes, Michigan Department of Community Health; Genevieve Kenney, The Urban Institute; David Hanig, Washington Department of Social and Health Services; Robert Gellman, Privacy and Information Policy Consultant; Lynn Blewett, University of Minnesota School of Public Health; Kristen Testa, California Health and Human Services Agency; and Cindy Shirk Center for Medicaid and Medicare Services. The workshop was enriched by the perspectives of many knowledgeable discussants, including Pamela Paul-Shaheen, Center for Advancing Community Health, Michigan; Mary Alice Lee, Connecticut Children’s Health Council; Gestur Davidson, Minnesota Department of Health and Human Services; Steve Norton, Office of Knowledge and Decision Support, New Hampshire; Marilyn Ellwood, Mathematica Policy Research; and Heidi J. Smith, New Jersey FamilyCare. The workshop was also greatly enlivened by the many workshop participants who shared experiences and raised issues from the audience. In arranging the workshop and in preparing this report, the panel was assisted by the very able NAS staff. Earl Pollack, the study director for the panel and coeditor of this report, supported the panel’s work from inception to publication. We would also like to thank Constance Citro, senior project officer, for advice and wise counsel on numerous issues. The panel is very appreciative of the work of Jamie Casey, research assistant for her excellent work in arranging for the workshop, summarizing the workshop discussions and in contributing to the production of this manuscript. We also thank Danelle Dessaint for arranging the logistics for the workshop. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: Larry Bumpass, Center for Demography and Ecology, University of Wisconsin; Emily Feinberg, Health Access Research and
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Data Needs for the State Children’s Health Insurance Program Evaluation, Massachusetts Department of Public Health; Lorraine V. Klerman, The Heller School for Social Policy and Management, Brandeis University; Trish Riley, National Academy for State Health Policy, Portland, Maine; and Nora Cate Schaeffer, Department of Sociology, University of Wisconsin. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Alan Zaslavsky, Department of Health Care Policy, Harvard Medical School. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Finally, I am grateful to my fellow panel members for their generous contributions to both the Workshop and to the writing of this report. I am very appreciative of their willingness to apply their expertise and knowledge to efforts to use data more effectively to improve the State Children’s Health Insurance Program. Their cooperation and congeniality made writing this report a pleasure. Arleen A. Leibowitz, Chair Panel for the Workshop on the State Children’s Health Insurance Program
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Data Needs for the State Children’s Health Insurance Program Contents EXECUTIVE SUMMARY 1 1 BACKGROUND 3 2 ESTIMATING ELIGIBILITY 7 Measuring Income and Prior Insurance, 9 State Surveys, 10 3 COUNTING ENROLLMENT 12 Estimating Enrollment, 12 Reasons for Nonenrollment of Eligible Children, 14 Methods to Improve Enrollment Rates, 15 4 DISENROLLMENT 18 5 CROSS-CUTTING ISSUES 23 Analytical Issues, 23 Data Standardization Issues, 24 Data for Tracking, 25 Evaluation Issues, 25 Qualitative Information, 26
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Data Needs for the State Children’s Health Insurance Program 6 WORKSHOP HIGHLIGHTS 28 REFERENCES 31 APPENDIXES A WORKSHOP AGENDA 33 B WORKSHOP PRESENTATIONS 38 C BRIEF DESCRIPTIONS OF NATIONAL SURVEYS MENTIONED AT THE WORKSHOP 57