State Children’s Health Insurance Program (SCHIP)

1. State Children’s Health Insurance Program (SCHIP) • Created in 1997 with enactment of Title XXI of the Social Security Act • Generous federal fiscal participation; wide latitude to states for program design; evaluation mandated • Phase I – Medicaid Expansion (February 1998) • Phase II – ALL Kids: State-designed plan (Oct 1998) • Phase III – ALL Kids Plus: Expanded coverage for children with special needs enrolled in ALL Kids APHA Annual Meeting Philadelphia 11/12/02

2. Alabama Children’sHealthcare Coverage 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 APHA Annual Meeting Philadelphia 11/12/02

3. Effect on the UninsuredOctober 1998 – June 2002 • 1997 base-line estimate showed 173,012 uninsured children. • As of June 2002, 163,975 children have been enrolled in one of the three programs. APHA Annual Meeting Philadelphia 11/12/02

4. Data Sources • First Year Enrollee Retrospective Survey • Conducted by University of Alabama at Birmingham, School of Public Health, Department of Maternal and Child Health • Survey Population: 26,242 Children enrolled in ALL Kids FY 99 • Data collected between November 1999 and February 2000 • Survey Sample: • Random Sample of 6,200 Parents of ALL Kids Children • 3,738 (60%) surveys returned • Pediatric Health History • Completed by child’s parents at time of enrollment • Collected information on birth and medical history, medical problems, current medications, mental health, and preventive health history • Merged Data Set • Retrospective Survey and Pediatric Health History data were merged using the child’s Social Security number APHA Annual Meeting Philadelphia 11/12/02

5. POPULATION (n=26,242) No Fee 75% (income <150% of FPL) Male - 51% White - 64% Black - 34% Other - 2% 0-12 months - <1% 1-5 years - 12% 6-12 years - 48% 13-18 years - 39% ALL Kids Characteristics: First Year Enrollees • RETURNED (n=3,738) • No Fee • 63% (income <150% of FPL) • Male - 51% • White - 64% • Black - 33% • Other - 3% • 0-12 months - 1% • 1-5 years - 16% • 6-12 years - 49% • 13-18 years - 34% APHA Annual Meeting Philadelphia 11/12/02

6. Identifying Children and Youth With Special Health Care Needs • Five screening questions were used on the survey • 27% were identified as CYSHCN by answering yes to at least one of the screening question • Our sample consisted of low-income parents who sought health insurance for their child. • In 1998 Newacheck et al. examined a cross-section of the population in the NHIS-D survey and found a child disability prevalence rate of 18%. • Among those NHIS-D families at or below the federal poverty level, the rate of child disability was 24%. APHA Annual Meeting Philadelphia 11/12/02

7. Summary Characteristics of CYSCHN and Their Families • Characteristics of CYSHCN and their families compared to those without special needs • More below 150% of Federal Poverty Level • Fewer parents were high school graduates • More CYSHCN among older children, especially adolescents • More males • No differences between racial/ethnic groups APHA Annual Meeting Philadelphia 11/12/02

8. Summary Results for CYSHCN • Compared to children without special needs, proportionately more CYSHCN were more likely to experience improved access to care after enrolling in CHIP • Usual source of sick care • small difference between groups (p = .022) • No differences on routine care • Other measures (needing care, waiting too long for care, specialty, dental, and vision care, and prescriptions • CYSHCN had significantly greater access after CHIP • Significant odds ratios ranged from 1.3 for waited too long for dental care to 3.8 neededspecialty care, but couldn’t get it APHA Annual Meeting Philadelphia 11/12/02

9. Summary Results for Other Vulnerable Populations • Schoolagers and adolescents • Compared to preschoolers more likely to experience improvement in getting medical, dental, vision, specialty care and prescriptions; more likely to have a usual source of care; and less likely to wait longer than needed for medical, dental, or vision care • Race/Ethnicity • For 6 of 10 access and need measures, African American children were 25%-33% more likely to experience improvement compared to Caucasian children APHA Annual Meeting Philadelphia 11/12/02

10. Summary • Children and youth with and without special needs reported improved access to care on nearly all items measured • Among all families that reported problems with access to a usual source of care, waiting too long for care, or getting specialty, vision, dental and prescription services before ALL Kids, from 19% (specialty) to 52% (dental) reported improved access after enrolling in ALL Kids APHA Annual Meeting Philadelphia 11/12/02

11. Conclusions and Implications • More children and youth with and without special needs have health insurance in Alabama than before SCHIP • Access to health care has improved for all children in ALL Kids • More children have a regular health care provider • Fewer children are going without needed medical care • Medical care can be accessed in a more timely manner APHA Annual Meeting Philadelphia 11/12/02

12. Conclusions and Implications • Compared to those without a special needs child, families who perceive their child as having a special health care need experienced significantly more improved access to health care and less unmet need after enrolling in CHIP (older children and AA children also experienced more improvement) • In Alabama there is a large network of providers available (BC/BS has 85% of insurance market) and a rich benefit package • Families who need and know about affordable and accessible health insurance will respond to outreach efforts • Despite preliminary indications of improved access to care for CYSHCN who enroll in CHIP, we do not know if substantial gaps in services for this population still exist. On-going investigation is needed regarding the effectiveness of ALL Kids and ALL Kids Plus to meet the needs of CYSHCN. • Differences may exist among families who enrolled in subsequent years of ALL Kids • Unknown consequences for future expansion because of federal and state budget issues APHA Annual Meeting Philadelphia 11/12/02