6
Workshop Highlights
One of the basic goals of SCHIP istoreduce the number of children from low-income families who are without health insurance. That number has remained at almost 12 million nationwide. This may be due, in part, to the fact that SCHIP is a young program that did not begin until FY 1998, and the last 2 of the 50 states and the District of Columbia were accepted into the program during FY 2000. Although states were allowed three years to spend SCHIP funds appropriated for a given fiscal year, as of late in FY 2000, $1.9 billion of the $4 billion appropriated for FY 1998 remained unspent. This situation was due primarily to the fact that the states began their programs after the SCHIP legislation went into effect on October 1, 1997. The workshop focused on the issues of eligibility, the rate at which children who were eligible were actually enrolled in the program, and the extent to which those who were enrolled were retained in the program when time for renewal of insurance coverage arrived.
The Center for Medicaid and Medicare Services uses the March supplement of the Current Population Survey to estimate the number of children in low-income families that are eligible for SCHIP. These estimates are then used in a formula to determine the allocation of SCHIP funds among the states. Since the size of the Current Population Survey sample for most states is too small to permit valid analysis of eligibility data within a state, as many as 27 states have conducted their own surveys to obtain estimates that are useful for directing outreach efforts to specific geographic areas
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.
Cynthia Shirk of the Centers for Medicare and Medicaid Services spoke of its plans to convene a group to consider whether it would be possible to develop a set of core national performance measures for SCHIP that would be easily administered. Such an effort is clearly needed, not only to provide national data, but also to provide the state programs a set of benchmarks against which they can compare their own data. Evidence was presented that seemed to indicate that the numbers of enrollments were increasing and that the numbers of disenrollments were decreasing. However, there has been little change in the rate of enrollment as of a point in time. The workshop discussions helped to put into perspective some of the measures that are needed to improve this situation.
