1. Potential of Medicaid and SCHIP Expansions To Increase Insurance Coverage for CSHCN Amy Davidoff, Ph.D. Alshadye Yemane, B.A. The Urban Institute American Public Health Association Annual Meeting San Francisco, November 2003 Funding provided by a grant from the Maternal and Child Health Bureau

2. Background  Public insurance plays key role for CSHCN Special eligibility mechanisms for disabled children, medically needy Broad scope of benefits highly desirable Higher public coverage rates overall  SCHIP expansions - key for low income uninsured  Little known about differential eligibility, participation patterns for CSHCN Unique characteristics may affect eligibility Participation patterns may differ Program features, e.g. crowd-out provisions expected to be particularly strong deterrent

3. Background (cont) Family Opportunity Act (S. 321)  Permits public insurance buy in for severely disabled children  Various program designs Expansions to 250% vs. 300% FPL Medicaid vs. SCHIP buy-in

4. Research Objectives  Describe patterns of Medicaid, SCHIP eligibility for CSHCN  Examine participation patterns for CSHCN  Simulate eligibility & participation under FOA proposals

5. Sources of Data  National Health Interview Survey (NHIS) Household survey Non-institutionalized civilian population in U.S. Pooled data from 2000 and 2001  Federal and state Medicaid and SCHIP eligibility rules

6. Identifying CSHCN  MCHB Definition of CSHCN  NHIS elements replicate CSHCN Screener (Bethell et al. 2002). Captures children who have: Regular need/use for prescription drugs; Elevated need/use of services Need/use special therapies (RT, OT, PT) Limitations in normal activities Emotional, behavioral or developmental condition that requires counseling or therapy  Consequences associated with health condition lasting or expected to last 12 months  12 % of children identified as CSHCN on NHIS

7. Identifying Medicaid & SCHIP eligibles Algorithm replicates eligibility determination process  Determine monthly earnings, relevant expenses for disregards Calculate “countable” income  Determine eligibility for Medicaid or SCHIP Determine categorical eligibility Compare federal & state specific income thresholds to countable income  Simulate FOA eligibility assuming existing rules, new income thresholds

8. Methods  Descriptive comparison of eligibility, participation for CSHCN, other children  Multivariate linear probability models estimate effects of child, parent, program characteristics on participation Separate models for CSHCN, other children Regression coefficients used to simulate participation under FOA expansions

9. Patterns of Public Insurance Eligibility

10. Waiting Periods, Premiums – Likely Barriers?  19 % all eligible, 72 % SCHIP eligible CSHCN face waiting periods  Among SCHIP eligible CSHCN with waiting period 27 % publicly insured 10 % uninsured > waiting period 60 % with private insurance  Among uninsured SCHIP eligible CSHCN 80 % faced waiting period ¾ uninsured longer than waiting period  20 % eligible CSHCN have premium requirements

11. Public insurance participation rates higher for eligible CSHCN

12. Participation in Family Opportunity Act expansions depends on program design

13. Discussion  SCHIP expanded public insurance eligibility to large group of CSHCN SCHIP expansions affected fewer CSHCN, allowed other children to catch up Few uninsured remain ineligible Policy focus on enrollment, retention  Participation generally higher among CSHCN but few significant structural differences in participation behavior difference in participation due partly to different characteristics of eligible CSHCN

14. Discussion (continued)  Participation rates generally lower for SCHIP programs. May be related to Program characteristics: waiting periods, benefits, managed care provisions More recent implementation Characteristics of eligible children Need further research on role of program design & implementation  Family Opportunity Act could add additional eligible CSHCN Participation rates depend on program design