This list features a compilation of resources on topics related to retaining eligible children and adults in Medicaid and SCHIP.
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.
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
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
Churn, Churn, Churn: How Instability of Health Insurance Shapes America’s
Uninsured Problem – November 2003
Farley Short, Deborah R. Graefe and Cathy Schoen, The Commonwealth Fund
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) –
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
Dick, R. Andrew Allison, Susan G. Haber, Cindy Brach and Elizabeth Shenkman
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
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
Deborah Peikes, Chris Trenholm and Nazmul Khan, Mathematica Policy Research,
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
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.
Disenrollment from SCHIP: Evidence from NJ KidCare
(Journal of Health Care for the Poor and Underserved vol. 15, no. 1) –
Dorothy Gaboda, Joel Cantor, Tami M. Videon and Yamalis Diaz
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.
Affect SCHIP Disenrollment? Findings from a Multilevel Analysis
(Abstract Academy Health Services Research Health Policy Meeting, 19: 15)
Jane Miller, Julie Phillips,
Dorothy Gaboda, Joel Cantor and Michelle Walsky
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.
Anna S. Sommers, Lisa Dubay, Linda J. Blumberg, Fredric E. Blavin and John L.
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
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
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.
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
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
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
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
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
Fairbrother, Heidi Park Emerson and Lee Partridge
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.
D. Sommers, PhD Program in Health Policy, Harvard Medical School
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
Instability of Public Health Insurance Coverage for Children and Their
Families: Causes, Consequences, and Remedies –
and Cindy Mann, The Commonwealth Fund
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.
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) –
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.
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
Simpson, Gerry Fairbrother, Stephaine Hale and Charles Homer
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
Perry & Associates, Inc. (LSPA)
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
VanLandeghem and Cindy Brach, Agency for Healthcare Research and Quality
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
and Donna Cohen Ross, Center on Budget and Policy Priorities
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
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
Taylor, Catherine McLaughlin, Anne Warren and Paula Song
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
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.
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
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.