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Experience in Florida SCHIP may provide lessons for other States' reenrollment requirements

Florida's "passive re-enrollment" policy, which does not require parents to take steps to prove that their children are still eligible for the State Children's Health Insurance Program (SCHIP), results in a significantly lower percentage of children losing coverage than in States that require parents to verify periodically their children's eligibility, according to a new study. This research is part of a set of studies being conducted under the Child Health Insurance Research Initiative (CHIRI™), jointly sponsored by the Agency for Healthcare Research and Quality, the David and Lucile Packard Foundation, and the Health Resources and Services Administration.

Researchers compared the effects of reenrollment policies in four States: Florida, Kansas, New York, and Oregon. All but Florida have active reenrollment policies that require parents to inform the States on a periodic basis about their children's eligibility. Florida, however, requires children's families to notify the State only if changes occur that affect eligibility and to keep paying the monthly premium to maintain enrollment status.

The study found that only 5 percent of children in Florida's SCHIP fell off the rolls at reenrollment, compared with one-third to one-half of children in Kansas, Oregon, and New York. The authors concluded that passive reenrollment contributed to the lower disenrollment rate observed in Florida compared with the States that have active reenrollment policies. Nearly all other States have active reenrollment policies, while only a few States currently have passive reenrollment policies in place.

The study also found that up to one-quarter of the children who dropped from the SCHIP programs of Oregon, Kansas, and New York at the time they were required to reenroll returned within 2 months.

According to first author Andrew W. Dick, Ph.D., of the University of Rochester's School of Medicine and Dentistry, Rochester, NY, the rapid return of these children indicates that administrative issues such as active reenrollment and other requirements may have been the reason for their disenrollment, while others who did not reenroll may have obtained health care coverage from other sources.

A significant number of children were still in SCHIP 2 years after their original enrollment, although many of these were disenrolled at least once during this period. The researchers observed that many children use SCHIP as temporary coverage (1 year or less) because a substantial number were initially enrolled for relatively short periods of time, and many did not return at a later date.

Details are in "Consequences of States' policies for SCHIP disenrollment," by Dr. Dick, Andrew Allison, Ph.D., Susan G. Haber, Sc.D., and others in the June 2002 issue of Health Care Financing Review 23(3), pp. 65-88.

Reprints (AHRQ Publication No. 02-R070) are available from the AHRQ Publications Clearinghouse.

For more information about the findings of the "SCHIP disenrollment and State policies," select CHIRI™ Issue Brief.

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