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Health Care Costs and Financing

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Expanding income eligibility for State Children's Health Insurance Programs would not burden the program

As States consider including children from higher income families for eligibility for their State Children's Health Insurance Programs (SCHIPs), they need to know if the need for services among higher income (HI) children (more than 200 percent of the Federal poverty limit [FPL]) will be different from that of traditional, low-income (LI) Medicaid participants (less than 133 percent of the FPL) or those currently enrolled in SCHIP expansions (134-200 percent of the FPL).

Based on a study of a Massachusetts program similar to SCHIPs, HI children had similar unmet needs for health care at the time of enrollment as children targeted under SCHIP expansions (middle-income or MI children), and fewer unmet needs than those of traditional LI children. Thus, inclusion of HI children would benefit a larger group of children without substantially changing health service use in the program, conclude Emily Feinberg, Sc.D., and her Harvard University colleagues. This study was supported by the Agency for Healthcare Research and Quality (HS10207).

The researchers evaluated a State-financed health insurance program in Massachusetts, the Children's Medical Security Plan (CMSP), which provided coverage to children regardless of income before implementation of SCHIPs. They examined responses to a telephone survey in 1998 and 1999 to assess the program's effects on reported need for different types of health services and unmet need or delays in receiving needed services.

Before enrollment in the program, MI and HI children were significantly less likely than LI children to have unmet needs or delays in care. After CMSP enrollment, there were significant reductions in unmet need among children in all income groups and no significant differences in unmet need by income. After program enrollment, less than 1 percent of enrollees reported unmet needs or delays in care for medical services, and 3 percent reported unmet need or delay for prescription drugs.

More details are in "Family income and the impact of a children's health insurance program on reported need for health services and unmet health need," by Dr. Feinberg, Kathy Swartz, Ph.D., Alan Zaslavsky, Ph.D., and others, in the February 2002 Pediatrics 109(2), p. E29.

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