1. 1 SCHIP: THE FIRST DECADE Coverage, Benefits and Quality Debbie I. Chang, MPH January 13, 2007

2. 2 COVERAGE Successes Challenges  States enacted major coverage expansions for children.  SCHIP has exceeded its enrollment goal of 5 million children.  The uninsured rate of low- income children has dropped by one-third from 1997-2005.  Non-entitlement status of separate plans contributed to coverage expansions  Crowd out has been less of a problem than expected.  Racial disparities in access were reduced  Eligibility gaps remain.  Many children are eligible for SCHIP but still not enrolled.  Coverage of adults introduces trade-offs.  New Medicaid citizenship documentation requirements (DRA) will impact SCHIP

3. 3 BENEFITS Successes Challenges  Many states enhanced the benchmark benefit package to add specific benefits for children.  While covered by SCHIP, enrollees’ access to primary care is good. –Enrollees received more preventive services; –Enrollees had fewer unmet needs; and –Enrollees reported better access to and communication with providers.  Need to increase number of preventive visits among enrollees.  Concerns have been raised that some states have adopted as their benchmarks state employees’ plans that are health savings accounts.  Some separate programs limit or exclude services needed by children with special needs.  As with other health plans, focusing on emerging health threats (e.g., childhood obesity) is a challenge in SCHIP.

4. 4 QUALITY/DATA Successes Challenges  Surveys show that parents are generally satisfied with SCHIP.  Attention has focused on monitoring and tracking enrollment data.  CMS requested that states report on 4 performance measures: –Well-child visits, 1 st 15 months –Well-child visits, 3 to 6 years –Use of appropriate asthma medication –Children’s access to primary care practitioners.  The vast majority of states are engaged in some performance measurement.  One evaluation found that enrollees had fewer asthma attacks after enrollment.  Although most states reported at least one child measure, no single measure was reported by all states. There was wide variation in reporting methodologies.  Emphasis has been on preventive and primary care measures and less so on inpatient care.  Individual level enrollment data and claims-level utilization data would be helpful in monitoring SCHIP performance.  Additional data is needed to assess the implications of program design features (e.g., benefit package, cost-sharing arrangements) on access to care.

5. 5 Nemours Health and Prevention Services Planting the seeds for better health Contact us: www.Nemours.org/GrowUpHealthy Debbie I. Chang, MPH Senior Vice President and Executive Director DChang@nemours.org 302.444.9127