Urban Institute Policy Briefs Suggest Public Education, Fewer Enrollment Barriers Key to Involving More Children in CHIP Programs

To "significantly reduce the number of uninsured children" in the United States, three policy briefs released by the Urban Institute July 2 as part of its Assessing the New Federalism project call for increased public education about the Medicaid and CHIP programs and a reduction in enrollment barriers. Researchers analyzed the 1999 National Survey of America's Families -- a "nationally representative survey that over-samples the low-income population and provides state-specific data on 13 states" -- to assess parental knowledge of Medicaid and CHIP. Researchers found that 32% of parents of low-income uninsured children "lack[ed] basic information" about Medicaid and CHIP. "Only two years after its passage, the good news is that half of all low-income children had parents who had heard of [CHIP]," Urban Institute researcher Lisa Dubay said, adding, "Unfortunately, there is much confusion about eligibility rules. For instance, many parents incorrectly believe they have to be on welfare in order to sign up for SCHIP and Medicaid." According to the briefs, 22% of low-income parents "felt they did not need or want insurance coverage for their children," but many of these children "were not receiving recommended levels of preventive care."

Knocking Down Barriers
Researchers also found that 10% of parents of low-income uninsured children cited "administrative hassles as a primary concern" in accessing Medicaid and CHIP; 11% said they "had applied for the program but [their children] were not enrolled"; and 18% said their children had some sort of public health coverage in the prior 12 months but were uninsured at the time of the survey. In addition, researchers found that enrollment waiting periods, designed by states to prevent crowd-out -- in which the availability of public insurance leads private employers to drop coverage -- "may act as an enrollment barrier for families who meet income eligibility criteria but may be in costly or less-comprehensive private health insurance." Researchers suggest that eliminating enrollment barriers, such as face-to-face interviews, would boost CHIP and Medicaid enrollment, as would increased outreach programs by states. Genevieve Kenney, co-author of one of the policy briefs, said, "Given all these barriers, if we are to make a large dent in the number of uninsured children, states may need to go beyond current outreach efforts and administrative reforms and consider improving public program access and quality, and educating parents about the importance of well-child visits" (Urban Institute release, 7/2).

Crowd-out 'Not Occurring to Significant Degree,' More Study Needed
In another brief, authors studied 18 states to look at the steps used to prevent crowd-out. According to the brief, 17 of these states have "implemented numerous and varied strategies to limit crowd-out in response to the high degree of initial concern over its potential and federal requirements to address the issue ..." The brief adds that 12 of these states took a "fairly aggressive approach to crowd-out and implemented waiting periods ranging between two and six months." The other states, typically with previous experience covering children, implemented "less aggressive polices." The authors conclude that "early qualitative experiences in the states suggest is not occurring to a significant degree. Clearly, however, further quantitative analysis is needed to build more solid evidence of the magnitude of crowd out" (Lutzky/Hill, "Has the Jury Reached a Verdict? Early Experiences with Crowd Out Under SCHIP," 7/2).

On the Web
All three policy briefs -- "Why Aren't More Uninsured Children Enrolled in Medicaid or SCHIP?" by Genevieve Kenney and Jennifer Haley; "How Familiar Are Low-Income Parents with Medicaid and SCHIP?" by Genevieve Kenney, Jennifer Haley, and Lisa Dubay; and "Has the Jury Reached a Verdict? Early Experiences with Crowd Out Under SCHIP," by Amy Lutzky and Ian Hill -- are available online.