SCHIP Ten Years Later: What Have We Learned? Cindy Mann, Executive Director Center for Children and...
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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 [email protected] State Health Research and Policy Interest Group Academy Health, February 2007
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Transcript of SCHIP Ten Years Later: What Have We Learned? Cindy Mann, Executive Director Center for Children and...
SCHIP Ten Years Later:What Have We Learned?
Cindy Mann, Executive Director
Center for Children and FamiliesGeorgetown University Health Policy Institute
State Health Research and Policy Interest GroupAcademy Health, February 2007
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?
Would States Take Up the Option and Would Families Enroll?
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
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
How Would SCHIP Affect Uninsurance Rates?
22.3%21.5%
20.1% 20.0%
18.0%
15.8% 15.9%
14.9%15.2%
1997 1998 1999 2000 2001 2002 2003 2004 2005
Uninsured rate of children under 19
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.
Coverage Gains Over the Past Decade Have Come Equally from
Medicaid & SCHIP
21.0 21.4 21.6 21.9 22.6 25.5 26.3 27.8
3.3 4.65.3 6
6.2
1.90.9
1997 1998 1999 2000 2001 2002 2003 2004
Medicaid SCHIP
Enrollment of Children in Public Coverage (Millions)
Source: CCF, Preliminary data. Based on children ever-enrolled over the course of a year.
21.023.5
22.325.2
27.2
32.330.8
34.0
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)
Percentage of Uninsured Children by Race/Ethnicity
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
White, Non-Hispanic
Black, Non-Hispanic
Hispanic
1996 2005
Are Children Getting The Care They Need?
*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.
94.4% 92.8%
61.2%
Public
Private
Uninsured
96.2% 95.5%
67.9%
Percent of Poor and Near-Poor Children with a Usual Place of Care
Poor Children* Near-Poor Children*
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
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
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
Can Block Grant Funding Work?
$3.8
$4.3$4.6
$5.1
$6.0$6.3
$4.2 $4.2 $4.2 $4.2
$0.1
$0.9
$2.7
$1.9
$5.0
$4.1$4.1
$3.2$3.2$3.1
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
SCHIP Spending SCHIP Allotment
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.
