1. What Happens to Children Who Lose Public Health Insurance? Presented by Janet B. Mitchell, Ph.D. Susan G. Haber, Sc.D. Sonja Hoover, M.P.P. RTI International Presented at Children’s Health Services Research Annual Meeting June 25, 2005 Boston, MA 411 Waverley Oaks Road ■ Suite 330 ■ Waltham, MA 02452-8414

2. High Rates of SCHIP Disenrollment Little is known about what happens to those children. Even less is known about what happens to children who leave premium assistance programs. Do these programs provide bridge to non-subsidized private health insurance? If not, what happens to these children?

3. Oregon’s Twin Programs Oregon has two programs to provide health insurance for low-income children: SCHIP Family Health Insurance Assistance Program (FHIAP), a premium assistance program Eligibility requirements are identical: <= 170% of FPL Allowed us to compare outcomes for children disenrolled from the two programs Why did they leave the program? Did children transition to private health insurance, or did they become uninsured? Were they able to access health care services?

4. Program Overview SCHIP Medicaid “look alike” No premiums or copayments Only children are covered FHIAP Covers entire family Subsidy used for ESI or individual market health insurance Family pays 5%-30% of premium, depending on income Family pays all plan coinsurance amounts

5. Data Sampled both currently enrolled and recently disenrolled children from each program Excluded children transitioning from SCHIP to Medicaid Telephone survey in English and Spanish, 2002 SCHIP sample=1,206 children including 417 disenrollees FHIAP sample=339 children including 88 disenrollees Response rate=55%

6. Characteristics of Children

7. Why Is Child No Longer Enrolled?

8. Why Did Parent Not Reapply?

9. Why Did Child No Longer Qualify?

10. Insurance Outcomes for Children

11. Access Outcomes for Children

12. Logistic Regression Analysis of Childrens’ Outcomes

13. Conclusions Neither program provided a complete bridge to (non- subsidized) private health insurance. While FHIAP disenrollees were more likely to be insured, absolute levels were low for both groups of children. Loss of eligibility (real or perceived) was the primary reason for loss of public insurance coverage. Becoming uninsured reduced access to care for all disenrolled children.

14. Policy Implications Due to high premium costs and lack of access to ESI, many low-income working families are uninsured. Policymakers may want to consider raising income eligibility ceiling for SCHIP and premium assistance programs.