Congressionally Mandated Evaluation of the State Children's Health Insurance Program: Final Cross-Cutting Report on the Findings from Ten State Site Visits

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Abstract

This report synthesizes findings from case studies conducted in 2001 and 2002 in ten states selected for the Congressionally Mandated Evaluation of SCHIP: California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas (Hill et al. 2002).  Discussion addresses such issues as program design, outreach and enrollment strategies, benefits, service delivery systems, cost sharing, crowd out prevention, parental coverage, financing, and coordination of SCHIP and Medicaid.  Overarching conclusions identify lessons learned from effective implementation.

Introduction

In August 1997, Title XXI of the Social Security Act was signed into law, creating the State Children’s Health Insurance Program (SCHIP), an ambitious federal-state initiative aimed at extending health insurance coverage to many of the nation’s estimated 10 million low-income uninsured children. Approximately $40 billion in federal funds was made available for fiscal years 1998 through 2007, allotted to the states based on a formula that considers both the number of low-income uninsured children residing in each state, and each state’s health care costs relative to other states. Two years after the creation of SCHIP, Congress mandated an independent federal evaluation of the program as part of the Balanced Budget Refinement Act (BBRA) of 1999. The legislation specified that 10 states be included in the evaluation, for the purposes of assessing the effectiveness of alternative outreach strategies, the coordination of SCHIP with Medicaid, and the effects of cost-sharing on retention, among other issues. Mathematica Policy Research, The Urban Institute, and MayaTech Corporation have teamed to conduct the evaluation, which comprises both quantitative and qualitative analytical components.

During the first year of the evaluation, case studies of the 10 study states represent the major activity of the qualitative assessment. The case studies were designed to provide an in-depth understanding of why states designed SCHIP programs as they did, how the programs were implemented, the challenges faced in the implementation, and the perceived outcomes of these efforts. The case studies will also inform the quantitative assessments included in the evaluation and help researchers better analyze and interpret findings. This report synthesizes the findings from the 10 state case studies, which were conducted between May 2001 and January 2002. (A detailed summary of our case study design and methodology is included in Appendix A.) Chapter II presents background and contextual information about the study states, describing how SCHIP programs and policies were developed. Chapters III through XI follow with detailed assessments of the states’ experiences implementing SCHIP by addressing, in turn, the issues of outreach; enrollment and retention; crowd out; benefits; service delivery systems, utilization, and access; cost sharing; parental coverage and premium assistance programs; financing and fiscal outlook; and the coordination of SCHIP and Medicaid. Chapter XII concludes the report with a summary of cross-cutting conclusions and lessons learned by the states.

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