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SCHIP: What's Happening? What's Next?
Wendy J. Wolf, M.D., M.P.H., Senior Policy Fellow, Office of the Administrator, Agency for Health Care Policy and Research (AHCPR) and the Health Resources and Services Administration (HRSA), Rockville, MD.
Alan Weil, J.D., M.P.P., Director, Assessing the New Federalism Project, The Urban Institute, Washington, DC.
John Holahan, Ph.D., Director, Health Policy Research Center, The Urban Institute, Washington, DC.
This session gave workshop participants an opportunity to tell researchers what areas need additional exploration. A partial list is included.
- How many children who are eligible for Medicaid or State Children's Health Insurance Program (SCHIP) actually enroll? What will the take-up rate be, knowing that there are some people that will not participate no matter what?
- Support research to improve the quality of health care and translate research into practice (TRIP).
- SCHIP program variations are a natural lab. How do eligibility policies, benefits, crowd-out mechanisms, delivery systems, and cost-sharing affect program participation?
- Explore public insurance dynamics and how they affect the whole insurance system.
- How to keep people from dropping out of insurance and increase utilization for prevention.
- Mental health utilization and its effectiveness, what services are necessary to include in a benefit package and how to get the family more involved.
- Outreach effectiveness.
- How to involve providers in outreach.
- How SCHIP can "fix" Medicaid.
- What will happen in a bad economy if the uninsured rate is going up in a good economy?
- Is an insured child less expensive than an uninsured child?
- Does crowd-out really occur and should we be that concerned with it if it means insuring children?
Messages State participants said they would take home with them from the workshop included:
- Some people do not want to enroll in Medicaid because they have had bad experiences with it in the past or are opposed to being enrolled in a publicly funded program.
- Some people would rather pay for a portion of their health care than get it for free.
- There is flexibility with SCHIP, and the Health Care Financing Administration (HCFA) will help in any way possible to get a State's program approved and implemented.
- SCHIP is an evolving program, and States need hands-on information.
- Many States are in the "same boat" in that they are trying to figure out which outreach methods give them the "biggest bang for the buck" and are trying to involve community-based organizations and advocates.
- SCHIP is just one piece of the puzzle that must fit in with Medicaid, but won't complete the picture because there will still be children uninsured at higher income levels (200 percent of the Federal poverty level [FPL] and above).
- It is important to manage the expectations of SCHIP's effects because absent SCHIP, it is impossible to know what would have occurred to the rates of uninsurance with welfare reform and Temporary Assistance for Needy Families (TANF) disenrollment.
Current as of May 1999
SCHIP: What's Happening? What's Next? Workshop Summary, May 26-28, 1999, User Liaison Program. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/news/ulp/ulpchip.htm