Health Insurance :: CMS releases SCHIP report showing increases in enrollment, coverage, and access for low-income children nationwide

A report on the State Children’s Health Insurance Program (SCHIP) showing increases in program enrollment, coverage, and access to health care among low-income, uninsured children was released today by the Centers for Medicare & Medicaid Services (CMS).

Analysis in the report shows SCHIP contributed to recent improvements in children’s health insurance coverage, enabling low-income children to achieve and maintain an increased level of health coverage during the late 1990s and early 2000s.

“The report underscores what a clearly defined federal program can achieve. SCHIP has contributed greatly to the health and well-being of low-income and uninsured children,” said CMS Acting Administrator Kerry Weems. “This is why the Administration wants the SCHIP program reauthorized. We want to see those successes continue. At the same time, we believe state efforts should be directed at children most in need.”

The report, “National Evaluation of the State Children’s Health Insurance Program: A Decade of Expanding Coverage and Improving Access” examined four broad areas: progress toward reducing the number of uninsured low-income children; access to health care; outreach, enrollment, and retention; and lessons from the field.

Among the findings is that substitution of private coverage by SCHIP, known as crowd out, does occur. Under one measure of substitution of coverage, the report found the magnitude of SCHIP-eligible children dropping private coverage or declining to take up private coverage potentially at levels up to 56 percent. Since this study was completed, the Congressional Budget Office estimated the rate of substitution under SCHIP and Medicaid to be approximately 33 percent for the reauthorization legislation currently being considered by the Congress.

“As the report notes, the effect of crowd out is to shift children to public coverage from private coverage, thus increasing federal spending without increasing the number of the insured,” added Weems.

Additional report findings included:

Reducing the Number of Uninsured Low-Income Children: SCHIP contributed to improvements in children’s health insurance coverage, including substantial reductions in the number and rate of uninsured children; without SCHIP, the number and rate of uninsured children would have risen substantially, rather than fallen. Notably, between 1997 and 2003, Hispanic children matched the gains in coverage recorded by non-Hispanic white and black children, showing the same proportionate reduction in their uninsured rate.

Access to Health Care in SCHIP: Access to care has improved for children enrolled in SCHIP, although some gaps remain, and access varies among states.

Outreach, Enrollment, and Retention in SCHIP: Retention in SCHIP exceeds 75 percent in most states, similar to the experience in the individual market and traditional Medicaid. States embraced the flexibility that SCHIP offered, and enrollment grew rapidly in the early years.

Lessons from the Field: States tailored their SCHIP programs to their particular context, resources, and needs. The flexibility allowed under SCHIP legislation let states design and modify their programs, building on their own lessons learned as well as on the experiences of other states.

The report also made important recommendations that will be useful to policymakers as SCHIP reauthorization legislation is debated. These recommendations were derived from the evaluation of the program. They include the need to maintain SCHIP as a non-entitlement program and to preserve the option for states to offer flexible benefit packages rather than the rigid benefit design of the traditional Medicaid program.


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