dynamics of children’s enrollment in public health insurance: a three-state comparison
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Dynamics of Children’s Enrollment in Public Health Insurance: A Three-State Comparison. - PowerPoint PPT PresentationTRANSCRIPT
Dynamics of Children’s Enrollment in Public Health Insurance: A Three-State Comparison
Presented by Susan G. Haber, Sc.D., RTI International
Andrew Allison, Ph.D., Kansas Health InstituteElizabeth Shenkman, Ph.D., University of Florida
Presented atSeventh Annual Child Health Services Research Meeting
Boston, MA
June 25, 2006
411 Waverley Oaks Road ■ Suite 330 ■ Waltham, MA 02452-8414
Background
Previous studies have shown that many children receive only episodic coverage through SCHIP and Medicaid but they have not looked at enrollment in public health insurance (PHI) more broadly
Study questions How long do children remain enrolled in PHI? Do children who disenroll from PHI re-enroll later? Do children transition between eligibility categories? Do patterns vary across states and eligibility groups?
Characteristics of PHI Coverage for Children
Kansas Oregon Texas
SCHIP Program Type Free-standing Medicaid look-alike Free-standing
SCHIP Income Limit (% FPL)
200% 170% 200%
SCHIP Premiums Yes (above $150% FPL) No Yes (above $150% FPL)
Recertification
-SCHIP 12 months 6 months 12 months
-Poverty-level Medicaid (PLM)
12 months 6 months 6 months
-TANF 12 months Variable 6 months
Study Population
All children with some period of eligibility in SCHIP, PLM, or TANF since the beginning of the state’s SCHIP program Texas limited to selected (primarily urban) areas
Study period Kansas: January 1999 - February 2003 Oregon: July 1998 - January 2002 Texas: May 2000 – August 2003
Data
Linked administrative eligibility data for SCHIP and Medicaid in Kansas, Oregon, and Texas
Constructed record of monthly enrollment in any type of PHI for each child in the study population
One month break in eligibility considered a disenrollment
Analyses focus on first spell of eligibility beginning during study period
Child classified as SCHIP, PLM or TANF based on eligibility category at beginning of spell
Percent of Children Remaining Enrolled in PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950
Number of Months Enrolled
Per
cen
t R
emai
nin
g E
nro
lled
KS SCHIP KS TANF KS PLM
Percent of Children Remaining Enrolled in PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950
Number of Month Enrolled
Per
cen
t R
em
ain
ing
En
rolle
d
KS SCHIP KS TANF KS PLM TX SCHIP
Percent of Children Remaining Enrolled in PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950
Number of Months Enrolled
Per
cen
t R
emai
nin
g E
nro
lled
KS SCHIP KS TANF KS PLMTX SCHIP TX TANF TX PLM
Percent of Children Remaining Enrolled in PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Number of Months Enrolled
Per
ce
nt
Re
ma
inin
g E
nro
lle
d
OR SCHIP OR TANF OR PLM
KS SCHIP KS TANF KS PLM
TX SCHIP TX TANF TX PLM
Percent of TANF Children Re-enrolling in PHI
0
10
20
30
40
50
60
70
80
90
100
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48
Number of Months Since Disenrolled
Per
cen
t R
e-e
nro
lled
OR TANF KS TANF TX TANF
Next Eligibility Category for Returning Disenrollees
SCHIP TANF PLM Other Medicaid
Kansas
SCHIP 67 5 26 2
TANF 12 36 3
49
PLM 22 20 2
55Oregon
SCHIP 39 10 3
49TANF 8 39 4
PLM 13 15 69 3
Texas
SCHIP 57 2 40 <1
TANF 3 57 36 4
PLM 11 11 76 1
Percent of SCHIP Children Remaining Enrolled: SCHIP Only vs. PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950
Number of Months Since Enrolled
Per
cen
t R
emai
nin
g E
nro
lled
KS SCHIP Only KS PHI
Percent of SCHIP Children Remaining Enrolled: SCHIP Only vs. PHI
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950
Number of Months Since Enrolled
Per
cen
t R
emai
nin
g E
nro
lled
OR SCHIP Only OR PHIKS SCHIP Only KS PHI
Percent of SCHIP Children Remaining Enrolled: SCHIP Only vs. PHI
0
10
20
30
40
50
60
70
80
90
100
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49
Number of Months Since Enrolled
Per
cen
t R
emai
nin
g E
nro
lled
OR SCHIP Only KS SCHIP Only TX SCHIP OnlyOR PHI KS PHI TX PHI
Conclusions
Continuity of coverage varies across states and eligibility categories May be due to differences in administrative procedures Need further analysis to understand implications for
continuity of care
Medicaid and SCHIP are complementary programs Many children move between PHI eligibility categories Need to design policies to coordinate application
processes and service delivery as children move between programs