What Happens to Children Who Lose Public
Health Insurance?
Presented by
Janet B. Mitchell, Ph.D.
Susan G. Haber, Sc.D.
Sonja Hoover, M.P.P.
RTI International
Presented at
Children’s Health Services Research Annual Meeting
June 25, 2005
Boston, MA
411 Waverley Oaks Road
■
Suite 330
■
Waltham, MA 02452-8414
High Rates of SCHIP Disenrollment

Little is known about what happens to those
children.

Even less is known about what happens to children
who leave premium assistance programs.

Do these programs provide bridge to non-subsidized
private health insurance?

If not, what happens to these children?
Oregon’s Twin Programs

Oregon has two programs to provide health insurance for low-income
children:
 SCHIP
 Family Health Insurance Assistance Program (FHIAP), a premium
assistance program

Eligibility requirements are identical: <= 170% of FPL

Allowed us to compare outcomes for children disenrolled from the two
programs
 Why did they leave the program?
 Did children transition to private health insurance, or did they
become uninsured?
 Were they able to access health care services?
Program Overview

SCHIP

FHIAP

Medicaid “look alike”

Covers entire family

No premiums or copayments


Only children are covered
Subsidy used for ESI or
individual market health
insurance

Family pays 5%-30% of
premium, depending on
income

Family pays all plan
coinsurance amounts
Data

Sampled both currently enrolled and recently disenrolled
children from each program

Excluded children transitioning from SCHIP to Medicaid

Telephone survey in English and Spanish, 2002

SCHIP sample=1,206 children including 417 disenrollees

FHIAP sample=339 children including 88 disenrollees

Response rate=55%
Characteristics of Children
SCHIP
Child's race/ethnicity (%)
White
Hispanic
Other
68.2
24.4
7.4
FHIAP
*
80.7
9.9
9.4
Parents are married (%)
68.7
78.4
At least one parent employed (%)
84.9
87.2
* Statistically different from SCHIP children at p<.05.
Why Is Child No Longer Enrolled?
Did not reapply at all
SCHIP
FHIAP
31.9%
27.7%
Started but did not finish, or did not send in, application
9.7
13.5
Sent in application, but program did not receive it
7.5
1.9
50.9
56.9
Reapplied but child no longer qualified
Why Did Parent Not Reapply?
SCHIP
FHIAP
Did not think child eligible any longer
36.1%
10.1%
Child got private insurance
Child enrolled in OHP
No longer needed assistance with premiums
39.8
n/a
n/a
n/a
24.8
37.2
Paperwork was too difficult/too much hassle
Forgot or missed the deadline
7.2
7.4
0.0
0.0
Could not afford the premiums
n/a
9.7
Why Did Child No Longer Qualify?
SCHIP
FHIAP
81.2%
81.4%
Did not have all the needed paperwork
6.6
4.8
Child got private insurance
Other
2.3
9.9
1.7
12.1
Family's income or assets too high
Insurance Outcomes for Children
SCHIP
Child is currently insured (%)
FHIAP
32.6
53.2**
Type of health insurance (% distribution)
Private insurance from employer or union
Private insurance purchased from insurer
CHAMPUS/other military
Indian Health Service
Other
85.8
6.3
2.1
2.8
3.1
*
69.9
25.3
0.0
1.1
3.8
Family must pay premium for this insurance (% yes)
79.8
88.6
Premium is big or moderate financial hardship (%)
Family would have kept child in program if possible
(% yes)
67.0
67.1
89.4
85.2
** Statistically different from SCHIP children at p<.01.
* Statistically different from SCHIP children at p<.05.
Access Outcomes for Children
SCHIP
FHIAP
Usual source of care (% distribution)
Same source as when enrolled
Different source of care
None
67.9
17.7
14.5
75.4
16.4
8.1
Child has seen physician since disenrolling (% yes)
45.6
74.1*
Unmet need for physician care since disenrollment
(% with)
19.0
10.1
* Statistically different from SCHIP children at p<.01.
Logistic Regression Analysis of Childrens’
Outcomes
Insured
Has Usual
Source of
Care
Has Same
Usual Source
of Care
Seen
Physician
Unmet Need
for Physician
Care
FHIAP
2.26*
0.93
1.08
2.84*
0.76
Currently insured
FHIAP*insured
n/a
n/a
4.45**
1.00
0.98
1.37
4.21**
1.10
0.32**
0.59
** Significant at the .01 level.
* Significant at the .05 level.
Conclusions

Neither program provided a complete bridge to (nonsubsidized) private health insurance.

While FHIAP disenrollees were more likely to be
insured, absolute levels were low for both groups of
children.

Loss of eligibility (real or perceived) was the primary
reason for loss of public insurance coverage.

Becoming uninsured reduced access to care for all
disenrolled children.
Policy Implications

Due to high premium costs and lack of access to ESI,
many low-income working families are uninsured.

Policymakers may want to consider raising income
eligibility ceiling for SCHIP and premium assistance
programs.