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Over 5 million eligible children remain uninsured, despite SCHIP enrollment gains

The State Children's Health Insurance Program (SCHIP) began in 1997 and expanded its enrollment criteria in 2001. SCHIP helped to significantly reduce the number of the Nation's uninsured children, yet 5.5 million eligible children remain uninsured.

Julie L. Hudson, Ph.D., and Thomas M. Selden, Ph.D., of the Agency for Healthcare Research and Quality, analyzed 1996 to 2005 data from the national Medical Expenditure Panel Survey. They determined how expansions and cuts in SCHIP would affect the eligibility and coverage of the Nation's children. They calculated that if eligibility thresholds for SCHIP were increased to include children whose families live within 300 percent of the poverty level ($54,510 for a family of three), an additional 1.2 million uninsured children would become entitled to coverage. >Rolling eligibility back to cover just those children in families below 200 percent of the Federal poverty level ($34,340 for a family of three) would cause 700,000 children to lose public coverage.

Despite improvements in coverage over the last decade, they report that 9.1 million (11.7 percent) children remain uninsured in 2004-2005 even though 5.5 million of the uninsured are eligible for public coverage (3.8 million for Medicaid and 1.2 million for SCHIP). Eligible but uninsured children are among the nation's disadvantaged with 36.1 percent living in families with incomes below poverty and another 41.4 percent in families with incomes between 100-200 percent of poverty. They are disproportionately minority and are more likely than average to live with only a single (or no) parent.

Regardless of whether SCHIP expands or contracts, the researchers highlight the importance of reaching out to those children who are currently eligible but not enrolled. They point to a growing literature suggesting that one way to improve take-up among children would be to make more extensive use of schools, school lunch programs, the food stamps program and, other public programs to help identify and, if necessary, automatically enroll children in Medicaid and SCHIP.

See "Children's eligibility and coverage: Recent trends and a look ahead," by Drs. Hudson and Selden in the August 16, 2007 Health Affairs, pp. w618-w629.

Reprints (AHRQ Publication No. 07-R078) are available from the AHRQ Publications Clearinghouse.

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