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SCHIP: What's Happening? What's Next?

Annual Reports & Evaluations


Patricia MacTaggart, M.B.A., Director of Quality and Performance Management, Center for Medicaid and State Operations, Health Care Financing Administration (HCFA), Baltimore, MD.

Trish Riley, M.S., Executive Director, National Academy for State Health Policy, Portland, ME.

Ms. MacTaggart stressed that, according to the Title XXI Statute, State Children's Health Insurance Programs (SCHIPs) must report on insurance coverage, access to care, and use of services by completing and submitting the HCFA quarterly financial and statistical reports, annual reports, and year 2000 evaluation.

In quarterly reports, States are to report expenditure and enrollment information. Expenditures should be broken down by program: Medicaid, Medicaid SCHIP, and State-designed SCHIP. Enrollment information should be broken down by age, service delivery system, and household income.

The annual report, due January 1 of each year, should include progress in reducing the number of uncovered, low-income children and progress in meeting the identified State Plan strategic objectives and performance goals. (It was noted that not all States have submitted their 1999 annual report.)

The Year 2000 State Evaluation should include:

  • An assessment of the effectiveness of the State plan in increasing the number of children with creditable health coverage and an assessment of the effectiveness of other private and public programs in the State.

It should also include:

  • A description and analysis of the characteristics of children and families.
  • Access to or coverage by other health insurance prior to and after eligibility.
  • Service area and time limits for coverage.
  • Quality (structure, process, and outcome and consumer experience).
  • Sources of non-Federal funds.
  • Coordination with other programs.
  • Trends that affect access, affordability, and quality of health care for children.
  • A description of plans for improving availability
  • Recommendations for improving the program.

Ms. Riley presented a draft version of the evaluation framework. The framework, requested by SCHIP directors who attended a National Academy for State Health Policy (NASHP) meeting on SCHIP evaluation in December 1998, was developed by a workgroup of State, HCFA, American Public Health Service Association (APHSA), and National Governor's Association (NGA) representatives to meet the needs of States and the Title XXI Statute requirements for the Year 2000 SCHIP Evaluation. The framework has been reviewed and commented on by SCHIP and Medicaid Directors, key congressional staff, and selected advocates. Comments were integrated into the draft framework.

The purpose of the framework is to:

  • Recognize the diversity of State approaches to Title XXI and allow States flexibility to highlight key accomplishments and progress of their Title XXI programs.
  • Provide consistency across States in the structure, content, and format of the report.
  • Build on data already collected by HCFA quarterly enrollment and expenditure reports.
  • Enhance accessibility of information to stakeholders on the achievements under Title XXI.

A framework for annual reports was also developed by the same group. However, at this meeting, it was recommended to HCFA that the annual report due January 1, 2000, be replaced by the evaluation report that is due March 31, 2000. HCFA is consulting with counsel to resolve this matter. The evaluation workgroup is still meeting to finalize the evaluation framework. It should be finalized by late July.


National Academy for State Health Policy. Framework for Title XXI annual report. Portland (ME): The Academy, 1999 Apr.

National Academy for State Health Policy. Framework for State evaluation of Children's Health Insurance Plan Under Title XXI of the Social Security Act. Portland (ME): The Academy, 1999 Apr.

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