SCHIP: THE FIRST DECADE Coverage, Benefits and Quality

1. SCHIP: THE FIRST DECADECoverage, Benefits and Quality Debbie I. Chang, MPH January 13, 2007

2. States enacted major coverage expansions for children. SCHIP has exceeded its enrollment goal of 5 million children. The uninsured rate of low-income children has dropped by one-third from 1997-2005. Non-entitlement status of separate plans contributed to coverage expansions Crowd out has been less of a problem than expected. Racial disparities in access were reduced Eligibility gaps remain. Many children are eligible for SCHIP but still not enrolled. Coverage of adults introduces trade-offs. New Medicaid citizenship documentation requirements (DRA) will impact SCHIP COVERAGESuccessesChallenges

3. Many states enhanced the benchmark benefit package to add specific benefits for children. While covered by SCHIP, enrollees’ access to primary care is good. Enrollees received more preventive services; Enrollees had fewer unmet needs; and Enrollees reported better access to and communication with providers. Need to increase number of preventive visits among enrollees. Concerns have been raised that some states have adopted as their benchmarks state employees’ plans that are health savings accounts. Some separate programs limit or exclude services needed by children with special needs. As with other health plans, focusing on emerging health threats (e.g., childhood obesity) is a challenge in SCHIP. BENEFITSSuccessesChallenges

4. Surveys show that parents are generally satisfied with SCHIP. Attention has focused on monitoring and tracking enrollment data. CMS requested that states report on 4 performance measures: Well-child visits, 1st 15 months Well-child visits, 3 to 6 years Use of appropriate asthma medication Children’s access to primary care practitioners. The vast majority of states are engaged in some performance measurement. One evaluation found that enrollees had fewer asthma attacks after enrollment. Although most states reported at least one child measure, no single measure was reported by all states. There was wide variation in reporting methodologies. Emphasis has been on preventive and primary care measures and less so on inpatient care. Individual level enrollment data and claims-level utilization data would be helpful in monitoring SCHIP performance. Additional data is needed to assess the implications of program design features (e.g., benefit package, cost-sharing arrangements) on access to care. QUALITY/DATASuccessesChallenges

5. Nemours Health and Prevention Services Planting the seeds for better health Contact us: www.Nemours.org/GrowUpHealthy Debbie I. Chang, MPH Senior Vice President and Executive Director DChang@nemours.org 302.444.9127