Alabama

1
Alabamas Childrens Health Insurance Program
(CHIP) Access to Care for Children With and
Without Special Needs

• Prepared through a contract with the Childrens
  Health Insurance Program
• Alabama Dept of Public Health
• By
• UAB Department of Maternal and Child Health CHIP
  Evaluation Team
• Beverly A. Mulvihill, PhD, Principal Investigator
• Joseph Telfair, DrPH, Co-Principal Investigator
• Frank Mulvihill, PhD, Project Analyst
• Anita Jackson, BS, Project Coordinator
• Cathy Caldwell, MPH, Data Manager

2
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

3
Program Objective

• To reduce the number of uninsured low income
  children by decreasing financial and
  administrative barriers for low income families
  to obtain health insurance for their children

4
CHIP Time Line
SEPTEMBER Plan Amendment approved - ALLKids Plus
FEBRUARY Phase I - Medicaid expansion began
MAY CHIP Commission meeting, Plan Amendment
submitted - ALLKids
OCTOBER CHIP Commission meeting, Plan submitted
AUGUST BBA Passed/President signed, Workgroup
established. Agency budget hearing
OCTOBER Phase II - ALLKids began
SEPTEMBER CHIP Resolution, Initial appropriation
Commission formed
AUGUST Plan Amendment approved
JANUARY Plan approved - First in nation
OCTOBER ALL Kids Plus begins
1997
1998
1999
5
CHIP Coverage(1998)
Phase II ALL Kids
Medicaid Eligibles
Phase I Medicaid Expansion
Medicaid for Low Income Families
6
Estimate Of Uninsured Children Under 200 Percent
Federal Poverty Level(Alabama-specific data from
the National Survey of American Families, Urban
Institute, 1997)
49,579 100-200 FPL
91,209 lt100 FPL
7
CHIP Program Phases

• Enrollment Phase
• Education Outreach
• Eligibility
• Enrollment
• Renewal
• Disenrollment

• Utilization Phase
• Access Barriers
• Utilization of Services
• Quality of Services
• Consumer Satisfaction

8
CHIP Enrollment Through September 2001(FY
200-2001 Goal 39,000 Sept 30, 2001 39,240)
9
ALL Kids Access to Care 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

10
ALL Kids Characteristics

• 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

11
Identifying Children With Special Health Care
Needs

• Five screening questions were used on the survey
• 27 were identified as CSHCN by answering yes to
  at least one of the screening question
• Our sample consisted of 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 who were at or below
  the federal poverty level, the rate of child
  disability was 24.

12
Children with Special Health Care Needs Screener
Questions

• Does your child require extra or specialized
  medical care, therapies, diet supplies, medical
  equipment, nursing or home health care because of
  a special health need?
• Does your child need more assistance than other
  children the same age with any of the following
  eating, dressing, bathing, moving around, going
  to the bathroom, or playing?
• Does your child need more assistance than other
  children the same age with understanding or using
  language or learning?
• During the past 12 months, have your childs
  activities been limited compared to other
  children the same age because of your childs
  physical health?
• During the past 12 months, have your childs
  activities been limited compared to other
  children the same age because of your childs
  behavioral or emotional health?

13
Income Level of Families Completing Survey
14
Education Level of Persons Completing Survey
15
Age of ALL Kids Child
16
Gender of ALL Kids Child
17
Race of ALL Kids Child
18
Has Health Insurance Ever Been Available
19
Why Child Did Not Have Health Insurance
20
Measuring Differences Between CSHCN and No
Special Needs in Direction of Change Before and
After CHIP

• Diminished Care had more problems accessing
  health care after CHIP than before
• No Difference no change in accessing health care
  after enrolling in CHIP
• Improved Care had fewer problems accessing
  health care after CHIP than before

21
One Person/Group Child Sees When Sick
22
One Person/Group Child Sees for Routine Care
23
Child Needed Care But Could Not Get It
24
Waited Longer Than Should Have For Medical Care
25
Child Needed Specialty Care But Could Not Get It
26
Dental Care
27
Vision Care
28
Prescription Medicine
29
Summary

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

30
Summary (con.)

• Children with and without special needs reported
  improved access to care on nearly all items
  measured
• Compared to children without special needs,
  proportionately more CSHCN experienced improved
  access to care after enrolling in CHIP
• When parents reported having a usual source of
  care for their sick child, there was a small
  difference between the groups, but no differences
  were reported for routine care. On all other
  measures (needing care, waiting too long for
  care, and services such as specialty care,
  dental, vision, and prescription medicine),
  parents of CSHCN reported significantly greater
  access after enrolling in CHIP than their
  counterparts without special needs.

31
Survey Conclusions and Implications

• More children 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
• 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
  after enrolling in CHIP
• 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 CSHCN 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 CSHCN.
• Met FY 2001 goal of having 39,000 children
  enrolled in ALL Kids
• Many families still have not been reached
  continue efforts to decentralize outreach and
  marketing activities