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CHIRI™ studies children enrolled in the State Children's Health Insurance Program

The State Children's Health Insurance Program (SCHIP), enacted by Congress in 1997, provides health insurance coverage to low-income children who lack private health insurance coverage but are ineligible for Medicaid. In 2001, one in four U.S. children was insured by Medicaid or SCHIP.

Researchers taking part in the Child Health Insurance Research Initiative (CHIRI™), launched in 1999 to study which health insurance and delivery features work best for low-income children, recently examined children newly enrolled in SCHIP in five States (comprising 30 percent of SCHIP enrollees in 2001) with separate SCHIP programs. The result is the first collection of articles that report on the characteristics of new SCHIP enrollees and their health care experiences prior to enrolling in SCHIP.

The CHIRI™ findings indicate that SCHIP is indeed insuring the population intended by Congress: children from low-income working families who were uninsured for a substantial period of time; children who lost private insurance coverage, usually due to high insurance costs or a parent's job change, or became ineligible for Medicaid, either due to increased family income or children aging out of age-based eligibility categories. Findings from CHIRI™ projects in the study States show that: nearly two-thirds to three-quarters of SCHIP enrollees lived in working families with incomes equal to or below 150 percent of the Federal poverty level ($27,600 per year for a family of four); many children were uninsured the entire year prior to SCHIP enrollment; although most children had received health care services in the year before SCHIP enrollment, one-fourth to almost one-half of new enrollees had unmet health care needs; between 17 and 25 percent had a special health care need; and a significant proportion of new SCHIP enrollees were black or Hispanic.

CHIRI™ is cosponsored by the Agency for Healthcare Research and Quality, The David and Lucile Packard Foundation, and the Health Resources and Services Administration. More findings can be found in a December online supplement to the journal Pediatrics. The supplement, "Children who enroll in SCHIP: Findings on demographics and prior health care experiences from the Child Health Insurance Research Initiative (CHIRI™)," was edited by AHRQ's Cindy Brach, M.P.P., and the Packard Foundation's Eugene M. Lewit, Ph.D. A CHIRI™ Issue Brief, Who's Enrolled in SCHIP? highlights key findings from the studies for policymakers.

The following AHRQ-supported research papers are included in the online supplement:

  • Brach, C., Lewit, E.M., VanLandeghem, K., and others, "Who's enrolled in SCHIP? An overview of findings from the Child Health Insurance Research Initiative (CHIRI™)" e499; reprints AHRQ Publication No. 04-R015.
  • Szilagyi, P.G., Shenkman, E., Brach, C., and others, "Children with special health care needs enrolled in SCHIP: Patient characteristics and health care needs" e508; reprints AHRQ Publication No. 04-R017.
  • Shone, L.P., Dick, A.W., Brach, C., and others, "The role of race and ethnicity in SCHIP in four States: Are there baseline disparities, and what do they mean for SCHIP?" e521; reprints AHRQ Publication No. 04-R016.
  • Shenkman, E., Youngblade, L., and Nackashi, J., "Adolescents' preventive care experiences before entry into SCHIP" e533.
  • Dick, A.W., Klein, J.D., Shone, L.P., and others, "The evolution of SCHIP in New York: Changing program features and enrollee characteristics" e542.
  • Rosenbaum, S., and Budetti, P., "Low-income children and health insurance: Old news and new realities" e551.

Three additional papers on survey methods in States are presented as technical appendixes. To access the Pediatrics supplement and CHIRI™ Issue Brief (AHRQ Publication No. 04-0015) select CHIRI™.

Reprints of AHRQ staff-authored articles are available from the AHRQ Publications Clearinghouse.

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