Health Insurance Coverage for Low-income Children
Enrollment and Disenrollment Experiences of Families Covered by CHIP

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Abstract

Objective

To understand why families enroll in and disenroll from Children's Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling.

Methods

We conducted a large household telephone survey in 2012 of CHIP enrollees and disenrollees in 10 states. We used survey responses to assess the perceptions and experiences of families with the CHIP application and renewal process. In addition, we combined the survey data with CHIP/Medicaid administrative data to analyze coverage outcomes of children after disenrolling.

Results

A large majority of recent CHIP enrollees had positive impressions of the application process; 89% found the process very or somewhat easy, and 90% of those receiving assistance found it very helpful. Families had similarly favorable impressions of the renewal process, including those recently disenrolling from CHIP. After disenrolling, children were far more likely to gain Medicaid coverage (49%) than private insurance (18%), while a sizable percentage were uninsured (32%). The likelihood of becoming uninsured was especially high among 18- and 19-year-olds (62%), who lost CHIP coverage due to their age.

Conclusions

Satisfaction with the CHIP application and renewal process is high among those with recent coverage, consistent with efforts by many states to simplify these processes for families. Medicaid is a critical source of coverage for those leaving CHIP, a role that may only increase as states expanding Medicaid through the Affordable Care Act create a new coverage option for older teens losing CHIP eligibility.

Section snippets

Methods

The data for this study were drawn from a telephone-based survey of parents of 12,197 CHIP enrollees and disenrollees in 10 states fielded by Mathematica Policy Research from January 2012 through March 2013 as part of the CHIPRA-mandated evaluation of CHIP. The states included were Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia. These states were selected because they utilize diverse approaches to providing health insurance coverage for children,

How Do Families Learn About CHIP, and Why Do They Apply?

Nearly one-third (29%) of new CHIP enrollees reported that a friend or family member was the most important source of information in deciding to apply for coverage (Table 1). This was followed by a hospital or other health care provider (19%), a government agency (18%), or various forms of media, such as television or radio commercials (10%). When asked why they ultimately applied for coverage, just over a third (35%) cited affordability—that CHIP was more affordable than other health insurance

Discussion

This analysis found that most families had a positive view of both the CHIP application and the renewal process—a finding that extends even to those who were disenrolled from the program. Across the 10 study states, most CHIP families reported both of these processes to be somewhat to very easy to complete, and among those who obtained assistance completing the process, nearly all reported that it was helpful. Families also appeared to be rapidly taking up the online application option, where

Acknowledgments

This research was supported by the US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, under contract HHSP23320095642WC/HHSP23337021T. The views expressed in this report are those of the authors and do not necessarily represent those of the US Department of Health and Human Services, the Office of the Assistant Secretary for Planning and Evaluation, the Urban Institute, or Mathematica Policy Research.

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    Citation Excerpt :

    The data set did not differentiate race and ethnicity, but because about 95% of Louisiana's population identifies as either non-Hispanic white or non-Hispanic black/African American [11], we limited our analysis of race to white and black. There was a disproportionately lower number of 18- and 19-year-old enrollees in this cohort than those of younger ages, consistent with declining Medicaid enrollment among adolescents who are approaching age cutoffs for children's Medicaid eligibility [12,13]. We were unable to account for variables affecting dates at which enrollments ceased or follow their claims data for reliable study outcomes.

The authors declare that they have no conflict of interest.

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