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 Institute
Elizabeth Shenkman, Ph.D., University of Florida
Presented at
AcademyHealth Annual Research Meeting
Boston, MA
June 26, 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%
Yes (above $150% FPL)
No
Yes (above $150% FPL)
- SCHIP
12 months
6 months
12 months
-Poverty-level
Medicaid (PLM)
12 months
6 months
6 months
- TANF
12 months
Variable
6 months
SCHIP Premiums
Recertification
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
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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
KS SCHIP
KS TANF
KS PLM
Percent of Children Remaining Enrolled in PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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 Month Enrolled
KS SCHIP
KS TANF
KS PLM
TX SCHIP
Percent of Children Remaining Enrolled in PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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
KS SCHIP
TX SCHIP
KS TANF
TX TANF
KS PLM
TX PLM
Percent of Children Remaining Enrolled in PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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
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
100
90
80
Percent Re-enrolled
70
60
50
40
30
20
10
0
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
OR TANF
KS TANF
TX TANF
Next Eligibility Category for Returning Disenrollees
SCHIP
TANF
PLM
Other Medicaid
SCHIP
67
5
26
2
TANF
12
36
49
3
PLM
22
20
55
2
SCHIP
39
10
3
TANF
8
39
49
49
PLM
13
15
69
3
SCHIP
57
2
40
<1
TANF
3
57
36
4
11
11
76
1
Kansas
Oregon
4
Texas
PLM
Percent of SCHIP Children Remaining Enrolled:
SCHIP Only vs. PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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 Since Enrolled
KS SCHIP Only
KS PHI
Percent of SCHIP Children Remaining Enrolled:
SCHIP Only vs. PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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 Since Enrolled
OR SCHIP Only
KS SCHIP Only
OR PHI
KS PHI
Percent of SCHIP Children Remaining Enrolled:
SCHIP Only vs. PHI
100
90
80
Percent Remaining Enrolled
70
60
50
40
30
20
10
0
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
OR SCHIP Only
OR PHI
KS SCHIP Only
KS PHI
TX SCHIP Only
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