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Retention Resource List

This list features a compilation of resources on topics related to retaining eligible children and adults in Medicaid and SCHIP.

Presentations
Reports

Presentations

 

Medicaid and SCHIP Retention: A Roadmap for Moving Ahead Using Health Information Technology – February 2009

Retention Initiative Group Conference Call held on Wednesday, February 4, 2009, 12:30 – 2:00 pm [ET].

Presenter: Beth Morrow, Staff Attorney, National Health Program, The Children’s Partnership


The presentation focused on strategies for using health information technology to maintain continuous Medicaid and SCHIP coverage more simply, efficiently and effectively.

Reducing Procedural Closures at Renewal to Improve Medicaid and SCHIP Retention – June 2008

Retention Initiative Group Conference Call held on June 11, 12:30 – 2:00 pm [ET].

Presenter: Ruth Kennedy, Medicaid Deputy Director and LaCHIP Director for the Louisiana Department of Health & Hospitals

The presentation focused on Louisiana’s approaches to simplifying and improving the renewal process for both clients and caseworkers. Under her leadership Louisiana Medicaid is advancing toward paperless renewals through use of phone renewals, e-renewals, administrative renewals and ex parte renewals.

 

Reports

 

Automated Client Tracking System Summary Report, January 1, 2001-June 30, 2002 – July 2002

Covering Connecticut’s Kids & Families, Children’s Health Council

Staff from four local pilot projects provide application assistance and help families living within their targeted communities with the renewal process. The work done by staff is collected in an automated tracking system.

 

Children in the United States with Discontinuous Health Insurance Coverage (The New England Journal of Medicine vol. 353, no. 4) – July 2005

Lynn M. Olson, Suk-fong S. Tang and Paul W. Newacheck

A sample of 26,955 children under 18 years of age from the 2000 and 2001 National Health Interview Surveys was analyzed. Children with discontinuous health insurance coverage were compared with those who were uninsured all year and with those who had public or private full-year coverage.

 

Churn, Churn, Churn: How Instability of Health Insurance Shapes America’s Uninsured Problem – November 2003

Pamela Farley Short, Deborah R. Graefe and Cathy Schoen, The Commonwealth Fund

An analysis of health insurance coverage in America reveals a complex and troubling picture of insurance instability and gaps in coverage over time. Eighty-five million people, or 38 percent of the population under age 65, were uninsured at some point from 1996 through 1999, based on findings from a survey that followed people's health coverage for four years.

 

Churning in Medicaid Managed Care and Its Effect on Accountability (Journal of Health Care for the Poor & Underserved) – February 2004

Gerry Fairbrother, Aparna Jain, Heidi Park, Mehran Massoudi, Arfana Haidery, Bradford Gray

There is concern that churning in Medicaid excludes children from the accountability system for managed care because they may not meet the one-year continuous enrollment requirement. This study explores the effect of churning in measuring childhood immunization coverage rates under the current accountability system.

 

Consequences of States' policies for SCHIP disenrollment - State Children's Health Insurance Program - Statistical Data Included (Health Care Financing Review) – Spring 2002

Andrew W. Dick, R. Andrew Allison, Susan G. Haber, Cindy Brach and Elizabeth Shenkman

The analyses presented in this article are a product of the Child Health Insurance Research Initiative (CHIRI) (Agency for Healthcare Research and Quality, 2001a). The collaborative nature of CHIRI allows comparable results to be reported in several States, increasing the strength of findings, and allowing explanations of the consequences of State policy choices.

 

Context or Composition: What Explains Variation in SCHIP Disenrollment? (Health Services Research 39, no. 4, pt. 1) – August 2004

Julie Phillips, Jane Miller, Joel Cantor and Dorothy Gaboda

The objective of this report is to investigate (1) the relative contributions of family and contextual characteristics to observed variation in disenrollment rates from the State Children's Health Insurance Program (SCHIP), and (2) whether context explains observed family-level patterns.

 

Continuous Coverage: Removing Barriers to Children's Health Care (Trends in Public Health, Issue Brief no. 8) – May 2002

Carol Irvin, Deborah Peikes, Chris Trenholm and Nazmul Khan, Mathematica Policy Research, Inc.

This brief is based on Mathematica’s study of continuous coverage for children in the Medicaid program. Using 1994-1995 Medicaid enrollment and payment data from California, Michigan, Missouri, and New Jersey, they examined discontinuous coverage among children and modeled the likely impacts for states that choose to implement the continuous coverage option.

 

Costs of Enrolling Children in Medicaid and SCHIP (Health Affairs) January/February 2004

Gerry Fairbrother, Melinda J. Dutton, Deborah Bachrach, Kerry-Ann Newell, Patricia Boozang and Rachel Cooper

As a way of saving Medicaid dollars, many states are reintroducing administrative hurdles into the enrollment process to deter people from enrolling. This study finds that administrative tasks associated with enrollment absorb sizable amounts of funds.

 

Demographics of Disenrollment from SCHIP: Evidence from NJ KidCare (Journal of Health Care for the Poor and Underserved vol. 15, no. 1) – February 2004

Jane Miller, Dorothy Gaboda, Joel Cantor, Tami M. Videon and Yamalis Diaz

SCHIP provides health insurance coverage for children in low-income families. Although there is evidence of substantial disenrollment from SCHIP, few studies have examined how disenrollment varies by demographic characteristics. This study uses data from administrative records of all 41,881 children enrolled prior to April 2000 in NJ KidCare (New Jersey's SCHIP) separate state plans for families with incomes between 133% and 350% of the Federal Poverty Level.

 

Does Context Affect SCHIP Disenrollment? Findings from a Multilevel Analysis (Abstract Academy Health Services Research Health Policy Meeting, 19: 15) – 2002

Jane Miller, Julie Phillips, Dorothy Gaboda, Joel Cantor and Michelle Walsky

Preliminary studies of SCHIP disenrollment in New Jersey reveal wide variation across counties, with more than a two-fold difference in rates between the highest and lowest disenrollment counties. This study uses hierarchical linear ("multilevel") models to analyze how family attributes and contextual factors such as programmatic, socioeconomic and demographic characteristics explain observed variation in disenrollment rates from an SCHIP program.

 

Dynamics In Medicaid And SCHIP Eligibility Among Children In SCHIP’s Early Years: Implications For Reauthorization (Health Affairs 26, no. 5) – 2007

Anna S. Sommers, Lisa Dubay, Linda J. Blumberg, Fredric E. Blavin and John L. Czajka

Two-thirds of children in the United States were income-eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five children were income-eligible for both programs, and 73% of children ever eligible for SCHIP were eligible at other times for Medicaid. As SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to assure that uninsured children are enrolled in and retain the coverage for which they are eligible.

 

Easing Benefit Enrollment and Retention by Reducing the Burden of Providing Verification – December 2005

Liz Schott and Sharon Parrott, Center on Budget and Policy Priorities

Requiring verification is a central way for states to ensure that benefits are provided to eligible families and in the correct amounts. Yet verification requirements also are one of the biggest barriers that low-income families face in accessing and retaining benefits.

 

E-Health Snapshot: A Look at Emerging Health Information Technology for Children in Medicaid and SCHIP Programs – November 2008

Beth Morrow, The Children’s Partnership and The Kaiser Commission on Medicaid and the Uninsured

This E-Health Snapshot summarizes the array of health information technology (HIT) that is being developed and deployed by Medicaid and SCHIP. It highlights for policy-makers, philanthropists, program planners, and other stakeholders the outcomes that can be achieved through HIT and provides insights into the lessons learned from other states’ experiences.

 

Enrolling Eligible Children and Keeping Them Enrolled – 2003

Donna Cohen Ross and Ian T. Hill

This article details the efforts that states have made to increase enrollment in Medicaid and SCHIP, and it offers recommendations for strengthening these efforts.

 

An Examination of Children in Public Health Insurance in New York City Through Facilitated Enrollment (Journal of Urban Health: Bulletin of the New York Academy of Medicine 81, no. 2) – June 2004

Gerry Fairbrother, Jennifer Stuber, Melinda Dutton, Roberta Scheinmann, Rachel Cooper

A cohort of families was followed through the enrollment process for Medicaid and Child Health Plus in New York City to determine success in enrollment and the time it takes to enroll. Families were recruited into the study by enrollers in community-based organizations and managed-care organizations.

 

From Medicaid to Uninsured: Drop-Out among Children in Public Insurance Programs (Health Services Research) – February 2005

Benjamin D. Sommers

This paper examines the enrollee retention of Medicaid and CHIP in an attempt to determine the extent to which drop-out is a problem for the programs, and what demographic and policy factors make disenrollment more likely.

 

Guidelines for Collecting, Analyzing and Displaying Health Coverage Outcomes Eligibility Data, 2nd ed. – October 2003

Vicki C. Grant and Nicole Ravenell, Southern Institute on Children and Families

The purpose of this paper is to serve as a brief “how-to” guide on conducting a review of health coverage eligibility data. The paper describes who should be involved, the process and the data elements needed to conduct an analysis of decisions on Medicaid and SCHIP eligibility.

 

Harnessing Technology to Improve Medicaid and SCHIP Enrollment and Retention Practices – May 2007
Beth Morro and Dawn Horner, The Children’s Partnership and The Kaiser Commission on Medicaid and the Uninsured

This report explores how technological innovations occurring today in health and other industries can be applied to remove these impediments from Medicaid and SCHIP enrollment and retention practices and, at the same time, make the programs more efficient, freeing up resources to fund coverage for more children. It is based on extensive research about activities underway in states and local communities and interviews with experts in the field.

 

How Stable Is Medicaid Coverage For Children? (Health Affairs 26, no.2) – March/April 2007

Gerry Lynn Fairbrother, Heidi Park Emerson and Lee Partridge

Medicaid coverage patterns in five states were examined for children who were covered as of December 2003. Looking back three years, it was found that Medicaid was a source of continuous coverage for sizable proportions of children (43–66% were covered for two or more years) but a revolving door for others (16–41% had gaps). In all states, gaps were short, from two to four months. Continuity implies that states can demand more of the health care system to improve the quality of care; short gaps imply that policies and procedures should be revisited to reduce gaps for eligible children.

 

The impact of program structure on children's disenrollment from Medicaid and SCHIP (Health Affairs 24, no. 6) – November/December 2005

Benjamin D. Sommers, PhD Program in Health Policy, Harvard Medical School

Program fragmentation might exacerbate disenrollment of children from Medicaid and the State Children’s Health Insurance Program (SCHIP). Using data from 2001–2004, I estimated the number of children who switched programs and the number who "dropped out" of public insurance—becoming uninsured despite continuing eligibility.

 

Instability of Public Health Insurance Coverage for Children and Their Families: Causes, Consequences, and Remedies June 2006

Laura Summer and Cindy Mann, The Commonwealth Fund

This report examines the extent, causes, and consequences of instability in public coverage programs for children and families. It focuses particularly on the phenomenon of "churning." It also looks at strategies to make public program coverage more stable for children and families.

 

Insuring children or insuring families: Do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP? (Journal of Health Economics 25, no. 6) – November 2006

Benjamin D. Sommers, PhD Program in Health Policy, Harvard Medical School

Recent research indicates that 3 million children leave Medicaid or the Children’s Health Insurance

Program (CHIP) each year and become uninsured, despite continuing eligibility. This paper explores the effect of family coverage on drop-out among children in these two programs, using instrumental variables to address the endogeneity of parental and sibling coverage in Medicaid/CHIP.

 

Is There a Hole in the Bucket? Understanding SCHIP Retention, Assessing the New Federalism Occasional Paper No. 67 – May 2003

Ian Hill and Amy Westpfahl Lutzky, The Urban Institute

This is one of a series of reports exploring policy issues that have emerged during states' early implementation of the State Children's Health Insurance Program, or SCHIP. These reports seek to identify important challenges states have faced, explore the availability of data to analyze these issues, provide initial analysis of the effects of alternative policies and implementation strategies, and raise questions for further study.

 

Maintaining the Gains: The Importance of Preserving Coverage in Medicaid and SCHIP – June 2003

Ellen O’Brien and Cindy Mann, Health Policy Institute, Georgetown University

This paper sponsored by Covering Kids & Families presents evidence on why it is important to maintain the gains that have been made over the past several years, and build on the improvements in Medicaid and SCHIP coverage for children and families. Substantial research evidence shows that expanding eligibility for and enrollment in Medicaid and SCHIP have important benefits for the children and families who are directly affected by the program, as well as for the communities in which they live.

 

Medicaid and CHIP Retention: A Key Strategy to Reducing the Uninsured – March 2009
Southern Institute on Children and Families
This report highlights issues associated with Medicaid and CHIP eligibility policies and procedures at renewal and strategies for addressing the issues, including approaches to reducing churning in public heath coverage programs.

 

Periods of Unmanaged Care in Medicaid Managed Care (Article) – August 2005

Gerry Fairbrother, Heidi Park, Arfana Haidery and Bradford Gray

Managing children's care in Medicaid is difficult if they experience inadequate tenures in health plans. Case studies of five states found that children's tenures in health plans were two to four months shorter than their (often short) tenures in Medicaid itself.

 

Protecting Low-Income Children's Access to Care: Are Physician Visits Associated With Reduced Patient Dropout From Medicaid and the Children's Health Insurance Program? (Pediatrics vol. 118, no. 1) – July 2006

Benjamin D. Sommers, PhD Program in Health Policy, Harvard Medical School

Dropout among patients who are enrolled in Medicaid and the Children's Health Insurance Program contributes to a lack of health care access among millions of Americans. The purpose of this study was to determine which, if any, types of clinical contact with physicians are associated with reduced dropout among children who are enrolled in Medicaid and the Children's Health Insurance Program.

 

Reauthorizing SCHIP: Opportunities for Promoting Effective Health Coverage and High-Quality Care for Children and Adolescents – August 2007

Lisa Simpson, Gerry Fairbrother, Stephaine Hale and Charles Homer

This report presents a framework for promoting effective health coverage and achieving high quality in SCHIP and Medicaid through the following strategies: 1) ensuring access to care through eligibility, enrollment, and retention policies, 2) providing a robust benefit package, 3) strengthening provider capacity, 4) measuring performance 5) improving quality, 6) providing incentives for quality and 7) promoting the use of health information technology.

 

Retaining Eligible Children and Families in Medicaid and SCHIP: What We Know So Far – June 2003

Lake Snell Perry & Associates, Inc. (LSPA)

The Covering Kids & Families National Initiative sponsored this review to help inform states, grantees and others working on retention by condensing the insights from many different studies and various experts into one document. LSPA collected and reviewed 51 studies and conducted 24 interviews with leading experts, authors, and Medicaid and SCHIP directors and their staffs.

 

SCHIP Disenrollment and State Policies (CHIRI™ Issue Brief No. 1, AHRQ publication no. 02-0017) – June 2002

Karen VanLandeghem and Cindy Brach, Agency for Healthcare Research and Quality

This CHIRI™ Issue Brief summarizes a study examining the relationship between children who leave the State Children's Health Insurance Program and State policies that affect the rates of disenrollment.

 

Staying Covered: The Importance of Retaining Health Insurance for Low-Income Families – December 2002

Leighton Ku and Donna Cohen Ross, Center on Budget and Policy Priorities

This report analyzes why people lose their insurance over the course of a year. In addition, barriers such as complex eligibility rules and renewal procedures for public insurance, and waiting periods to enroll in employer plans, may prevent many of those who would otherwise be eligible from joining public or private insurance plans.

 

Uninsured and Unstably Insured: The Importance of Continuous Insurance Coverage (Health Services Research 35, no. 1, pt. 2) – April 2000

Cathy Schoen and Catherine DesRoches, The Commonwealth Fund

Compared to the continuously insured, those insured but with a recent time uninsured were at high risk of going without needed care and of having problems paying medical bills. This group was two to three times as likely as those with continuous coverage to report access problems.

 

Who Enrolls in Community-Based Programs for the Uninsured and Why Do They Stay? (Health Affairs Web Exclusive) – April 2006

Erin Fries Taylor, Catherine McLaughlin, Anne Warren and Paula Song

Faced with growing numbers of uninsured, many communities are developing local programs to provide coverage or improved access. This article examines participation and retention in three community programs aimed at low-income uninsured adults. In two of the three programs, the typical participant had no health problems. Improved access to preventive and routine physician care, and increased security about accessing care should the need arise, appeared to be the primary benefits of both initial and continued enrollment.

 

Why Eligible Children Lose or Leave SCHIP, Findings from a comprehensive study of retention and disenrollment – February 2002

Michael Perry and Susan Kannel, Lake Snell Perry & Associates

NASHP commissioned the national research fm of Lake Snell Perry & Associates to conduct an extensive research study that involved six focus groups in three of the seven states and a survey in all seven states. Both current enrollees and lapsed families participated in the study to lend insight into the aspects of SCHIP that help children remain enrolled overtime, and the circumstances that can lead to lapsed coverage.

 

Why Millions Of Children Eligible For Medicaid And SCHIP Are Uninsured: Poor Retention Versus Poor Take-Up (Health Affairs 26, no. 5) – 2007

Benjamin D. Sommers

More than two-thirds of uninsured U.S. children are eligible for public coverage, and most current policy debate assumes that this is largely attributable to poor take-up. This paper explores the contribution of poor retention in Medicaid and the State Children’s Health Insurance Program (SCHIP) to this phenomenon.

 

Why Parents Do Not Re-Enroll Their Children: The Case of a Children’s Health Insurance Program in Southeastern NC – November 2004
Jammie Price, Jennifer Boswell, BA, Melanie Lessard, BA and Katie Wood, BA, Appalachian State University

Nationally, less than 50 percent of children are re-enrolled in the State Children’s Health Insurance programs. To identify why, in 2004 we telephone surveyed parents who did not re-enroll their children in a North Carolina program.

 

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