State Children

1
State Childrens Health Insurance Program (SCHIP)

• Created in 1997 with enactment of Title XXI of
  the Social Security Act
• Generous federal fiscal participation wide
  latitude to states for program design evaluation
  mandated
• Phase I Medicaid Expansion (February 1998)
• Phase II ALL Kids State-designed plan (Oct
  1998)
• Phase III ALL Kids Plus Expanded coverage for
  children with special needs enrolled in ALL Kids

2
Alabama ChildrensHealthcare Coverage
0 1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18
3
Effect on the UninsuredOctober 1998 June 2002

• 1997 base-line estimate showed 173,012 uninsured
  children.
• As of June 2002, 163,975 children have been
  enrolled in one of the three programs.

4
Data Sources

• First Year Enrollee Retrospective Survey
• Conducted by University of Alabama at Birmingham,
  School of Public Health, Department of Maternal
  and Child Health
• Survey Population 26,242 Children enrolled in
  ALL Kids FY 99
• Data collected between November 1999 and February
  2000
• Survey Sample
• Random Sample of 6,200 Parents of ALL Kids
  Children
• 3,738 (60) surveys returned
• Pediatric Health History
• Completed by childs parents at time of
  enrollment
• Collected information on birth and medical
  history, medical problems, current medications,
  mental health, and preventive health history
• Merged Data Set
• Retrospective Survey and Pediatric Health History
  data were merged using the childs Social
  Security number

5
ALL Kids Characteristics First Year Enrollees

• POPULATION (n26,242)
• No Fee
• 75 (income lt150 of FPL)
• Male - 51
• White - 64
• Black - 34
• Other - 2
• 0-12 months - lt1
• 1-5 years - 12
• 6-12 years - 48
• 13-18 years - 39

• RETURNED (n3,738)
• No Fee
• 63 (income lt150 of FPL)
• Male - 51
• White - 64
• Black - 33
• Other - 3
• 0-12 months - 1
• 1-5 years - 16
• 6-12 years - 49
• 13-18 years - 34

6
Identifying Children and Youth With Special
Health Care Needs

• Five screening questions were used on the survey
• 27 were identified as CYSHCN by answering yes
  to at least one of the screening question
• Our sample consisted of low-income parents who
  sought health insurance for their child.
• In 1998 Newacheck et al. examined a cross-section
  of the population in the NHIS-D survey and found
  a child disability prevalence rate of 18.
• Among those NHIS-D families at or below the
  federal poverty level, the rate of child
  disability was 24.

7
Summary Characteristics of CYSCHN and Their
Families

• Characteristics of CYSHCN and their families
  compared to those without special needs
• More below 150 of Federal Poverty Level
• Fewer parents were high school graduates
• More CYSHCN among older children, especially
  adolescents
• More males
• No differences between racial/ethnic groups

8
Summary Results for CYSHCN

• Compared to children without special needs,
  proportionately more CYSHCN were more likely to
  experience improved access to care after
  enrolling in CHIP
• Usual source of sick care
• small difference between groups (p .022)
• No differences on routine care
• Other measures (needing care, waiting too long
  for care, specialty, dental, and vision care,
  and prescriptions
• CYSHCN had significantly greater access after
  CHIP
• Significant odds ratios ranged from 1.3 for
  waited too long for dental care to 3.8 needed
  specialty care, but couldnt get it

9
Summary Results for Other Vulnerable Populations

• Schoolagers and adolescents
• Compared to preschoolers more likely to
  experience improvement in getting medical,
  dental, vision, specialty care and prescriptions
  more likely to have a usual source of care and
  less likely to wait longer than needed for
  medical, dental, or vision care
• Race/Ethnicity
• For 6 of 10 access and need measures, African
  American children were 25-33 more likely to
  experience improvement compared to Caucasian
  children

10
Summary

• Children and youth with and without special needs
  reported improved access to care on nearly all
  items measured
• Among all families that reported problems with
  access to a usual source of care, waiting too
  long for care, or getting specialty, vision,
  dental and prescription services before ALL Kids,
  from 19 (specialty) to 52 (dental) reported
  improved access after enrolling in ALL Kids

11
Conclusions and Implications

• More children and youth with and without special
  needs have health insurance in Alabama than
  before SCHIP
• Access to health care has improved for all
  children in ALL Kids
• More children have a regular health care provider
• Fewer children are going without needed medical
  care
• Medical care can be accessed in a more timely
  manner

12
Conclusions and Implications

• Compared to those without a special needs child,
  families who perceive their child as having a
  special health care need experienced
  significantly more improved access to health care
  and less unmet need after enrolling in CHIP
  (older children and AA children also experienced
  more improvement)
• In Alabama there is a large network of providers
  available (BC/BS has 85 of insurance market) and
  a rich benefit package
• Families who need and know about affordable and
  accessible health insurance will respond to
  outreach efforts
• Despite preliminary indications of improved
  access to care for CYSHCN who enroll in CHIP, we
  do not know if substantial gaps in services for
  this population still exist. On-going
  investigation is needed regarding the
  effectiveness of ALL Kids and ALL Kids Plus to
  meet the needs of CYSHCN.
• Differences may exist among families who enrolled
  in subsequent years of ALL Kids
• Unknown consequences for future expansion because
  of federal and state budget issues