Citation URL: http://www.urban.org/JenniferSullivan

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that all children have access to comprehensive health insurance coverage. The report describes the governance structure for the CHI; its financing; enrollment growth (for all three public programs); access to services; use and cost of services for all three public programs; satisfaction on the part of both parents and providers; prior insurance and crowd-out; and the effect the initiative has had on hospital finances. Areas identified as needing attention include improving access to after-hours and dental care; increasing the use of preventive service; and developing new sources of financing for the CHI.

State policymakers are using the flexibility built into Title XXI to manage their SCHIP programs, cutting or expanding as fiscal conditions permit. This conclusion is based on our third annual survey of SCHIP directors in the 13 ANF states, which explored the impacts of budget pressures on child health insurance policies in 2004. On the plus side, several states reversed previous cuts; for example, every ANF state that capped enrollment in 2003 lifted the cap in 2004. However, states kept many of their prior years' cuts in place during '04, and some imposed new restrictions.

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