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Increased Family Cost-Sharing in SCHIP: How Much Can Families Afford?. Betsy Shenkman Bruce Vogel Institute for Child Health Policy Department of Epidemiology and Health Policy Research University of Florida June 25, 2005. Project Purposes.

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Increased Family Cost-Sharing in SCHIP: How Much Can Families Afford?

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Increased Family Cost-Sharing in SCHIP: How Much Can Families Afford?

Betsy Shenkman

Bruce Vogel

Institute for Child Health Policy

Department of Epidemiology and

Health Policy Research

University of Florida

June 25, 2005


Project Purposes

  • To examine the responsiveness of disenrollment to premium changes and child health and sociodemographic characteristics in one state SCHIP;

  • To calculate a price elasticity for families in the short-term


Study Setting

  • Florida Healthy Kids Program

    • 5-19 year olds between 101% FPL and 200% FPL receive subsidized premiums

    • Family share prior to July 1, 2003 was $15 per family per month (PFPM)

    • Termination due to non-payment of premium after two months

    • Until July 1, 2004, passive renewal process used; so overall disenrollment in the program relatively low


Program Changes

  • Premiums increased on July 1, 2003 from $15 per PFPM to $20 PFPM for all families receiving subsidized premiums

  • The Center for Medicare and Medicaid Services (CMS) – exceeded Federal cost sharing limits for families at or below 150% FPL

  • October 1, 2003 – premiums reduced back to $15 PFPM for those at or below 150% FPL; remained at $20 PFPM for those above


Study Time Frame and Sample

  • Time frame for analyses – March 2003 through March 2004

  • Disenrollees – Children enrolled for at least two months and disenrolled for at least two months during the time period


Data

  • Enrollment files – months enrolled, age, gender, address information, subsidy level

  • Health care claims and encounter data linked to enrollment files

  • Clinical Risk Groups used to classify children into health status categories

    • Healthy, Significant Acute, Minor Chronic, Moderate, and Major Chronic Conditions


Analyses

  • Cox proportional hazards models were used to estimate the responsiveness of disenrollment to premium changes, age, sex, income, CRG health status category, and months enrolled.


Disenrollees From Healthy Kids N=237,178

  • Percent disenrollees


Key Findings

  • With the $20 premium increase, families 2x as likely to disenroll as before increase

  • The Price elasticity for the disenrollment hazard rate of 2.2, was calculated

  • Given this price elasticity, a 10% increase in the monthly premium would produce a 22% increase in the disenrollment hazard rate

  • An increase in the premium from $15 per month to $20 per month (a 33% increase), would increase the disenrollment hazard rate by approximately 73%, or from a baseline hazard rate of 1.4% to 2.4%


Key Findings

  • Families at or below 150% FPL 35% more likely to leave compared to higher income

  • Rural areas 6% more likely to leave than those in urban areas

  • Health status an important predictor – 8% to 17% less likely to disenroll with significant acute or chronic condition than those who are healthy


Conclusions

  • In the short-term, families are very price sensitive

  • Cannot determine if this is an equilibrium response but

  • Saw a large effect that perhaps could be moderated across time


Policy Implications

  • Premium increases need to be considered very carefully

  • At least in the short-term can have a strong impact

  • Can differentially affect certain groups of children


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