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

Abstract #69424

Beverly Mulvihill, PhD¹, Janet M. Bronstein, PhD², Francis X. Mulvihill, PhD², Anita Jackson, BA³, and Cathy Caldwell, MPH⁴. (1) Department of Maternal and Child Health, School of Public Health, 320 Ryals Building, 1665 University Boulevard, Birmingham, AL 35294-0022, (205)975-7942, bmulvihi@uab.edu, (2) School of Public Health, University of Alabama at Birmingham, RPHB 330, 1665 University Blvd, Birmingham, AL 35294, (3) School of Public Health, Department of Maternal and Child Health, University of Alabama at Birmingham, 1665 University Boulevard Room 320, Birmingham, AL 35294-0022, (4) Children's Health Insurance Program, Alabama Department of Public Health, 201 Monroe Street, Montgomery, AL 36103

Objective: This study examined three years of enrollment in the Phase II nonMedicaid component of SCHIP in Alabama, ALL Kids. Demographic characteristics of cohort groups and their previous experience with the health care system are compared. Methodology: Data Collection. The data were collected through a retrospective survey of first-year enrollees in ALL Kids, from surveys of new enrollees in Year 2 and Year 3, and from a brief Pediatric Health History (PHH) collected at the time of the child’s enrollment into the program. Participants. For the first year, mail survey data were collected from a random sample (n=6,200) of 25,748 first year ALL Kids’ enrollees (return rate: 60% [n=3,740]). For the second and third years a survey was sent to all new enrollees with a return rate of 62% (n=3,219) and 55% (n=4,110), respectively. Analysis. Relevant demographic variables, family income, race, age of child, education level of respondent, and an urban/rural measure, were chosen to describe characteristics of the sample for each year. Enrollee groups were compared on measures of access to care and unmet need (insurance issues, needed and waited for medical care, dental, vision, specialty, prescriptions; and having a usual source of care), sources of how they heard about ALL Kids and the amount of “crowd out”, that is, those who dropped other insurance to enroll in SCHIP. Chi-squares were used to determine overall significant differences and specific differences between cohort groups. Results: More families with income in the 150-200% FPL range enrolled in Year 3 of the program (Yr 1 – 37%; Yr 2 –36%; Yr 3 – 48%). Year 1 enrollees accessed information about the program mostly from schools (Yr 1 – 48%; Yr 2 – 20%; Yr 3 – 23%). Later enrollees accessed information more often from health care providers (Y2 1 – 35%; Yr 2 – 51%; Yr 3 – 46%), more had previous insurance (Yr 1- 72%; Yr 2 – 80%; Yr 3 – 81%) and a usual source of care (Yr 1 – 61%; Yr 2 82%; Yr 3 – 83%), and fewer had unmet needs (Yr 1 – 67%; Yr 2 – 64%; Year 3 – 63%) before enrolling in ALL Kids. Conclusions: The experience of enrolling children in ALL Kids in Alabama indicates that outreach strategies influence who hears about the program and subsequently enrolls. Whether family (such as income or education) or program characteristics (such as, outreach) exert more influence on families’ decisions to enroll in programs is an area for future investigation.

Learning Objectives:

• After attending this session, participants will be expected to: 1)describe differences noted among 3 cohort groups of SCHIP enrollees; 2)recognize at least 3 factors that may influence enrollment in SCHIP; and 3)apply lessons learned in the first 3 years of Alabama's SCHIP to other similar programs.

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.