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Switching Between SCHIP and Medicaid May Leave Children at Risk of Reduced Access to Care

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Press Release Date: June 9, 2001

Many children enrolled in the State Children's Health Insurance Program (SCHIP) in two states do not stay in the program for long, which may leave some of them without any coverage at certain times, according to new research released today at the Third Annual Meeting of Child Health Services Researchers in Atlanta.

The findings were the first released from the Child Health Insurance Research Initiative (CHIRI™), a set of research projects sponsored by the Agency for Healthcare Research and Quality (AHRQ), The David and Lucile Packard Foundation, and the Health Resources and Services Administration.

Researchers presented their findings on coverage trends in Kansas and Oregon SCHIP programs at the meeting which is affiliated with the annual meeting of the Academy of Health Services Research and Health Policy. They also found that many SCHIP enrollees had previously been recipients of Medicaid, and a significant proportion had transferred from SCHIP to Medicaid. While demonstrating that SCHIP and Medicaid can complement each other, the findings underscore the importance of ensuring seamless transitions between the two programs, which in some states are entirely distinct.

"It is critical that efforts to improve children's access to health care services and the quality of care they receive be based on research and evidence," says Lisa A. Simpson, M.B., B.Ch., AHRQ's deputy director. "These first results from CHIRI™ will help state and federal policymakers improve access to, and the quality of, health care for low-income children."

The researchers found:

  • SCHIP enrollees did not remain in the program for the full period of guaranteed eligibility. In Kansas, 34.5 percent of SCHIP enrollees did not remain enrolled for the full 12 months of continuous coverage. In Oregon, 18 percent of SCHIP enrollees left SCHIP before their 6 months of guaranteed coverage was over.
  • Approximately half of SCHIP enrollees who completed their initial period of eligibility (6 months in Oregon and 12 months in Kansas) did not re-enroll in SCHIP.
  • Many of the children who left SCHIP moved directly into Medicaid: a third in Kansas and 45 percent in Oregon.
  • The large percentages of children who left SCHIP and did not go on Medicaid (55 percent in Oregon and two-thirds of those in Kansas) were either uninsured or had obtained private insurance.
  • A majority of SCHIP enrollees were previously enrolled in Medicaid. In Kansas 74 percent of SCHIP enrollees had prior experience in Medicaid, while in Oregon 54 percent were on Medicaid immediately before enrolling in SCHIP.

Movement among insurers is the norm in the American insurance market, and children in SCHIP appear to be as mobile as their private sector counterparts. While intermittent enrollment in SCHIP is not problematic in and of itself, Susan G. Haber, Sc.D., senior economist at the Center for Health Economics Research, Inc., who presented the results from Oregon, expressed concern for the children who left SCHIP and did not transfer to Medicaid. "Although some of these children may have obtained private insurance coverage, others may be uninsured," said Dr. Haber. "Future CHIRI™ research will tell us what happened to the children who are no longer publicly insured."

"The findings suggest the potential benefits of increased coordination between SCHIP and Medicaid, both in terms of making it easy to transfer between the programs, and structuring their delivery systems to maximize continuity of care," said Kansas Health Institute economist Andrew Allison, Ph.D. The finding that 23 percent of Kansas families who have a child in SCHIP also have a child in Medicaid supports the call for streamlining, added Dr. Allison.

"In states that have different delivery systems for public and private health insurance programs, even children who do not have a break in coverage but move frequently among SCHIP, Medicaid and private coverage, are likely to experience disruptions of care," said Eugene Lewit, Ph.D., Senior Program Manager at the Packard Foundation. "Discontinuity of care may impede access and adversely affect the quality of care delivered as well as health outcomes."

For more information, please contact AHRQ Public Affairs, (301) 427-1364; Karen Migdail, (301) 427-1855 or; or Farah Englert, (301) 427-1865 or


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