Getting In, Not Getting In, and Why: Understanding SCHIP Enrollment. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies. Occasional Paper.

This study examined the enrollment process for the State Childrens Health Insurance Program (SCHIP) and the outcomes of that process. Data were collected during spring and summer of 2000 through telephone interviews with state program officials from eight states selected based on a variety of demographic and programmatic variables; the states were Alabama, California, Colorado, Florida, Michigan, Missouri, New York, and North Carolina. States had a difficult time producing outcome data and varied considerably in data collection and reporting practices. The major findings include the following: (1) states have implemented many similar strategies for simplifying the SCHIP enrollment process, but simplifications to Medicaid policies and procedures are less extensive; (2) inconsistencies between SCHIP and Medicaid eligibility rules and requirements made enrollment more difficult and confusing for families; (3) in most states, less than half of applicants were approved for SCHIP eligibility, with a large proportion referred to Medicaid; (4) large proportions of SCHIP applications were denied for procedural reasons; (5) SCHIP programs ask families about existing health insurance coverage as part of the application process, and deny coverage to families covered by other insurance; and (6) state SCHIP and Medicaid data systems are highly variable in their capacity to report eligibility outcome data. Implications of these findings for future policy include the need to ensure that appropriate referrals for Medicaid translate into approvals for Medicaid, to consider available alternatives for reducing the number of children denied coverage for procedural reasons or incomplete submissions, to monitor the relationships between public and private health coverage, and to improve states administrative data systems. (A discussion of the limitations of state data systems is appended. Contains 13 references.) (KB)