SCHIP Ten Years Later: What Have We Learned?

1. SCHIP Ten Years Later:What Have We Learned? Cindy Mann, Executive Director Center for Children and Families Georgetown University Health Policy Institute www.ccfgeorgetown.org crm32@georgetown.edu State Health Research and Policy Interest Group Academy Health, February 2007

2. Key Questions • Would states take up SCHIP option? • Would families enroll? • How would SCHIP affect uninsurance rates? • Would children have access to needed care? • Would block grant funding work?

3. Would States Take Up the Option and Would Families Enroll?

4. Major Advances • Every state had a SCHIP program within 2 years of enactment • Pre-SCHIP, 3 states covered children of all ages up to at least 200% of FPL; today, all but 10 states do so • Major change in paradigm: outreach and simplification • Participation rates 65-68% in SCHIP; higher in poverty-related Medicaid

5. But Progress Uneven and Challenges Remain • 8 states froze enrollment • Most states dropped outreach and some halted or reversed simplification efforts • In 2004-2005 enrollment grew modestly nationwide; many states had strong growth while 9 states saw declines • 84% of the decline was in two states (Texas, Florida) • Studies have found that large share of the children who disenroll are uninsured; many appear eligible

6. How Would SCHIP Affect Uninsurance Rates?

7. Trends in the Uninsured Rate of Low-Income Children, 1997 - 2005 Source: Georgetown CCF analysis based on data from the National Health Interview Survey, November 2006. Beginning in 2004, the NHIS changed its methodology for counting the uninsured. This results in the data for 2004 and later years not being directly comparable to the data for 1997 – 2003.

8. Coverage Gains Over the Past Decade Have Come Equally from Medicaid & SCHIP Enrollment of Children in Public Coverage (Millions) 34.0 32.3 30.8 27.2 25.2 23.5 22.3 21.0 Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.

9. Coverage Disparities Continue but Narrow “(C)ontinued growth in public coverage has been a major factor in improving rates of health coverage for children. These changes have been particularly dramatic for minority children.” (AHRQ, September 2006)

10. Are Children Getting The Care They Need?

11. Percent of Poor and Near-Poor Children with a Usual Place of Care Poor Children* Near-Poor Children* *Poverty status is based on family income and family size using the U.S. Census Bureau poverty thresholds for 2002. Federal Poverty Level (FPL) in 2002 in the 48 contiguous states and the District of Columbia is $15,020 for a family of three. Source: National Health Interview Survey, 2003.

12. Meeting Children’s Needs • NYS study showed sharp decline in asthma attacks, asthma physician visits, and asthma-related hospitalizations • Study of three states (NY, Florida, California) generally shows improved access to care and reduced rates of hospitalizations for ambulatory care sensitive conditions

13. Meeting Children’s Needs • Children with special needs more likely to have unmet needs, which “may in part be attributable (to reliance) on commercial insurance norms in designing free standing SCHIP programs.” (CHIRI, September/October 2004) • Certain services– particularly mental health services– are more likely to be limited

14. Meeting Children’s Needs • Significant differences between Hispanics/non-Hispanics regarding parent’s perception of quality and between English and Spanish speakers on having a usual source of care • Cost-sharing experience is mixed

15. Can Block Grant Funding Work?

16. Stay Tuned: SCHIP Spending Compared to Annual Allotments (in billions) Source: 1998-2007 data from Chris Peterson. SCHIP Original Allotments: Funding Formula Issues and Options. Congressional Research Service (October 2006). FY2006 and FY2007 spending are projected.