The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68727

Genevieve Kenney, PhD, Genevieve Kenney, PhD, Jennifer M. Haley, MA, and Lisa Dubay, ScM. Health Policy Center, Urban Institute, 2100 M Street, NW, Washington, DC 20037, 202-261-5568, jkenney@ui.urban.org

Recent evidence suggests that the State Children’s Health Insurance Program (SCHIP) has made significant inroads into the problem of uninsurance for low-income children and that increases in SCHIP and Medicaid enrollment have kept children’s uninsurance from rising in recent years. However, participation in public health insurance programs, historically and recently, has been far from universal. Even with the availability of Medicaid and SCHIP, there are still millions of low-income children without coverage. Thus, it is important to monitor participation in these programs to track the extent to which they are reaching and enrolling eligible children. This is particularly important in light of the unintended decline in Medicaid participation following federal welfare reform in 1996 and the recent economic downturn which threatens the availability of private coverage. In this paper, we use the 1999 and 2002 National Survey of America’s Families to examine participation in both Medicaid and SCHIP among children who are citizens and who do not have private insurance coverage. This analysis builds on a model that simulates eligibility for these programs in each state. In addition, we examine awareness of the existence of Medicaid and SCHIP programs and families’ understanding of the programs’ basic rules (specifically, parents’ understanding that families do not have to participate in welfare for their children to qualify for Medicaid/SCHIP). We investigate changes in both program participation and familiarity with and understanding of the programs over this time period nationally and for different subgroups of children. While about half of SCHIP-eligible children and nearly three-quarters of Medicaid-eligible children participated in 1999, little is known about how these rates have changed as SCHIP programs have matured and economic conditions have worsened. In addition, in 1999, the majority of low-income children had parents who had heard of Medicaid or SCHIP, but about half of those familiar with the programs did not understand that families do not have to participate in welfare to qualify for Medicaid/SCHIP. While anecdotal evidence suggests that SCHIP knowledge is growing as the programs mature, these data are the first to shed light on how familiarity and understanding of Medicaid and SCHIP have evolved over the five years of SCHIP’s existence. Findings on changes in these indicators, overall and for vulnerable subgroups, are critical to policymakers’ attempts to understand why many low-income children remain uninsured and decisions on how to allocate scarce dollars in efforts to increase enrollment.

Learning Objectives:

• 3. Explain the simulation model used to identify Medicaid- and SCHIP-eligible children in the National Survey of America’s Families.
  7. Describe the rates of participation in Medicaid and SCHIP among children in 1999 and 2002 and discuss the implications of these changes for programs’ outreach and enrollment efforts.
  11. Discuss changes in families’ awareness and understanding of Medicaid and SCHIP programs from 1999 to 2002.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.