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The State Children's Health Insurance Program (SCHIP) was designed to provide health insurance to low-income children and adolescents. Little is known about prior access to care and health care experiences of new SCHIP enrollees. We surveyed Florida and New York new adolescent SCHIP enrollees about their health status, prior health care utilization, access, and unmet needs. Most enrollees were younger (ages 12-16 years), Black or Hispanic, lived in poverty, and were without health insurance the year before SCHIP. Most had a usual source of care (USC) prior to enrollment; Blacks and Hispanics were less likely than Whites to have had a USC. Although 69% of Florida and 80% of New York adolescents reported seeing a physician the year before enrollment, 24% and 40%, respectively, reported unmet health care needs. Only 32% of Florida and 40% of the New York adolescents who were surveyed reported ever having met privately with their clinicians. Many new SCHIP enrollees report unmet needs, disparities in access, and sub-optimal care prior to enrollment. Adolescents' needs should be considered in SCHIP program and quality assurance efforts.

This study provides consistent evidence, from three very diverse states with heterogeneous populations and distinct programs (Florida, Kansas, and New York), that the State Children's Health Insurance Program (SCHIP) increased access to and satisfaction with health care among enrolled low-income children and that vulnerable children-minorities, children and adolescents with special health care needs, and children who were uninsured for long periods of time-shared in these improvements. We highlight some areas to target for future improvement, such as reducing the high levels of unmet needs among special-needs children and increasing preventive care, especially for Hispanic children.