Stateline Story

States' Children's Health Insurance Programs Get Good Report

  • June 17, 1999
  • By Sunny Kaplan

WASHINGTON -- Nearly one million children from low-income families are getting healthcare benefits under states' Children's Health Insurance Programs, or CHIPs, according to the first government report on the massive program created by Congress in 1997.

In the report, which was released on Monday, The General Accounting Office said states and the federal government have made "considerable progress" in getting the program up and running despite a short implementation period and the challenges of establishing programs outside of Medicaid to insure poor children.

The GAO is the investigative arm of Congress.

When the program was established in 1997, an estimated nine million to 11.6 million children were uninsured -- 15 percent of all kids 18 and under. Nearly half came from families whose parents earn too much to qualify for Medicaid, the government health insurance program for the poor, but not enough to pay for private health insurance.

The newly released enrollment numbers appear to show that one in five of the estimated five million children eligible are enrolled so far, but the state-by-state breakdowns show a less optimistic view.

For instance in California, the state with the most uninsured children, 63,000 out of 1.8 million had been enrolled in the first 10 months of the program. Texas enrolled only 39,000 kids out of nearly 1.5 million without insurance in the first 6 months of its program.

The GAO cautioned against measuring the program's success on its enrollment figures and comparing figures across states because all programs started at different times. For instance Alabama was the first state to get its plan approved in January 1998. Alaska and Vermont didn't receive HHS approval of their plans until December 1998.

"Since CHIP is not yet fully operational, any evaluation of its success based on early enrollment data alone is clearly premature," said Kathryn G. Allen, associate director of GAO's Health Financing and Public Health Issues Branch.

Allen was one of the authors of the report.

Forty percent of the participants enrolled in programs as of December 1998 were in New York, Pennsylvania and Florida, all of which had existing programs when the CHIP legislation was passed.

New York had about 271,000 kids enrolled, Florida 60,000 and Pennsylvania nearly 70,000.

The GAO looked at whether states had sufficient flexibility to design effective CHIP programs; whether they considered statutory options such as extending coverage to adults in families with children; whether they developed innovative outreach strategies to reach potential participants; and how they tailored strategies to avoid "crowd-out" (dropping private insurance to enroll in public insurance.)

It focused on 15 states that used a variety of options to provide insurance to children, and were spread out geographically. Those states were: California, Colorado, Connecticut, Florida, Massachusetts, Michigan, Missouri, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont and Wisconsin.

Findings from the report showed:

  • States were almost equally divided when it came to choosing among the three CHIP options: insuring kids by expanding Medicaid coverage, covering children under separate, state-designed programs, or combining the two. Some states have expanded CHIP eligibility to kids in families whose incomes are up to 300 percent of the federal poverty level -- $49,350 -- such as in Connecticut, Missouri and Vermont.
  • A growing number of states are exploring options to cover low-income families, as well as children, and subsidize insurance coverage through employers. But, as of April 1, only Massachusetts and Wisconsin had received HHS approval to use CHIP funds to cover adults in families with children.
  • Many states are developing innovative outreach strategies to publicize CHIP programs and to provide families with applications and program information. Outreach strategies include media campaigns, school-based initiatives and local community-designed efforts. "The publicity is attracting not only children eligible for CHIP but also far greater numbers of those who are eligible for Medicaid but not enrolled," the report said.
  • It is unclear how state strategies to avoid "crowd-out" are working thus far. Most states are screening kids to ensure that those who are Medicaid-eligible are enrolled in that program, and that those who have previous private coverage undergo a waiting period before dropping that coverage, such as in California and Rhode Island.

CHIP funds, a total of $48 billion over 10 years, first became available to states in October 1997. The plan marked the biggest federal investment in health insurance since Medicare and Medicaid were established 34 years ago.

Washington and Wyoming are the only two states that have not yet submitted plans to the Health Care Financing Administration (HCFA), but in their 1999 legislative session Wyoming adopted the necessary legislation to do so.

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