Medicaid and SCHIP Coverage: Findings from California and North Carolina

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

The text below is an excerpt from the complete document. Read the full paper in PDF format.

Abstract

This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Introduction

A number of recent studies have examined access and use experiences of children enrolled in SCHIP. These studies consistently show that SCHIP enrollment improves access to and receipt of care for children who enroll in SCHIP. Other studies have examined the extent to which SCHIP is substituting for ESI (Allison et al., 2003; Hughes, Angeles, and Stilling, 2002; Sommers et al., 2007), finding that a small percentage of children transfer directly from private coverage to SCHIP.

In contrast, less research has been conducted recently on Medicaid Programs for children. It is important to examine access issues under Medicaid, which covers 25 million children (Kaiser Commission on Medicaid and the Uninsured, 2006). Medicaid is also the most important source of coverage to poor children in this country, insuring close to 60 percent living below the Federal poverty level (FPL).

There have been ongoing concerns about access to care under Medicaid related to low payment to providers and other factors. However, past studies have found that Medicaid enrollees fare better than their uninsured counterparts and that they enjoy better access than low income children with private coverage in some service areas because of the broader benefits and narrower cost-sharing requirements in Medicaid.

Historically, substitution of public for private coverage has been far less of a concern within the Medicaid Program than within SCHIP. While SCHIP legislation mandates that States implement policies to discourage substitution at enrollment, no such mandate exists for Medicaid. For example, children eligible for Medicaid and covered by employer insurance are not required to fulfill waiting periods before enrollment.1 Previous research has found some evidence of substitution for private coverage by the Medicaid Program—referred to as crowdout (Blumberg, Dubay, and Norton, 2000; Cutler and Gruber, 1997; Dubay and Kenney, 1996).

Here we examine parental coverage patterns and access to care for children enrolled in Medicaid and SCHIP, and we assess impacts of Medicaid enrollment for children in California and North Carolina. This analysis was done as part of a congressionally mandated evaluation of SCHIP that examined 10 States that included supplemental analysis of Medicaid Programs for children in 2 States. California and North Carolina were selected for the supplemental Medicaid study because they each have a major separate SCHIP component, which provides a contrast between the programs, and because they both had enrollment files that could support the study.

(End of excerpt. The entire paper is available in PDF format.)

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Usage, posting and reprint of materials on the UI web site:

Most publications may be downloaded free of charge from the web site in PDF format. This information may be used and copies made for research, academic, policy or other non-commercial purposes. Proper attribution is required.

Copyright of the written materials contained within the Urban Institute website is owned or controlled by the Urban Institute. Posting UI research papers on other websites is permitted subject to prior approval from the Urban Institute—contact paffairs@urban.org.

If you are unable to access or print the PDF document please contact us or call the Publications Office at (202) 261-5687.