During the past decade, states and private insurers have taken a variety of steps to extend health insurance coverage to low-income children. These strategies have included expansions of Medicaid, the development of state-sponsored programs involving subsidies for private coverage, state support for privately sponsored programs, and privately sponsored initiatives designed by private insurers and health plans. Although the majority of these programs have not been evaluated systematically, they have helped to reduce the number of uninsured children. Yet more than 11 million children are still uninsured.
With the new SCHIP legislation, some of these programs may be replicated, and several new and innovative programs also may be designed and implemented. One of the most fundamental questions for each of these programs concerns eligibility. As these and other state programs continue to be implemented and modified in the years ahead, it will be important to monitor the extent and impact of coverage as well as of coverage substitution (IOM, 1998).
Even with full subsidies for coverage, whether Medicaid or another type of program, there are still eligible children who do not enroll in any program. Much more needs to be learned about the ways in which families make decisions about health insurance coverage and about the financial and nonfinancial factors that influence their decisions about how to spend the family's financial resources. Along with more research about families, there is a need for better outreach strategies, more widespread and culturally sensitive public education efforts, streamlined enrollment processes, and other approaches that will support families and caretakers and help them to make the best decisions about their children's health care.
In the child health area, states have undertaken a variety of projects to improve their services and promote "best practices" in the healthy development of children. In recent years, states also have taken many steps to improve their accountability to their citizens, including providing better public information on the performance of state programs. SCHIP offers states flexibility in program design. In return for that flexibility in design, the committee believes that states have the responsibility to implement the program as fully as possible, to provide as much public information as possible about the program, and to coordinate SCHIP with other state and private programs in the states to maximize children's opportunities to receive access to care.
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