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State children's health insurance and premium-subsidy programs do not always provide a bridge to private health insurance

When families' incomes increase and they are no longer eligible for State Children's Health Insurance Programs (SCHIPs) and premium-subsidy programs, many of them are still not able to afford private health insurance premiums without help. Over 85 percent of parents in a study of low-income Oregon families—whose children were disenrolled from the SCHIP Oregon Health Plan (OHP) or Oregon's premium-subsidy program, the Family Health Insurance Assistance Program (FHIAP)—said they would have kept their children in these programs, if possible.

One solution to ensuring children's health insurance coverage would be to raise the income eligibility ceiling for these programs, suggest the study authors. Since their survey was conducted, Oregon has implemented a modest increase in the income limit for both programs, from 170 to 185 percent of the Federal poverty level. In this study, half of children disenrolled from Oregon's SCHIP failed to requalify, because their families made too much money to meet the income eligibility requirements. Many of the remaining children did not reapply, because their parents thought they were no longer eligible. The reasons were similar for children leaving FHIAP.

These programs did not provide a bridge to nonsubsidized private health insurance for these children. Only one-third of OHP children and one-half of FHIAP children (whose parents were better educated and possibly had more access to job-related insurance) had insurance coverage after leaving these programs. Care access for these children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. The study was supported by the Agency for Healthcare Research and Quality (HS10463).

See "What happens to children who lose public health insurance coverage?" by Janet B. Mitchell, Susan G. Haber, and Sonja Hoover, in the October 2006 Medical Care Research and Review 63(5), pp. 623-635.

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