Factors affecting sustained enrollment in Virginia's SCHIP/Medicaid programs for children at annual redetermination

Background: Virginia's SCHIP/Medicaid Programs for children require reenrollment annually to maintain coverage. Enrollees commonly drop out of the program at annual reenrollment and subsequently reenroll at a later date, called churning. The negative impacts of churning include coverage gaps for children, increased administrative costs, and loss of time for both enrollees and the program staff. This project investigated reasons for churning and barriers to reenrollment.

Methods: Participants were families that had received assistance on their original enrollment from a local child health coalition, that were due for renewal of coverage in the previous 12-18 months. A survey was used to identify churners, as well as barriers to successful contact.

Results: There were no significant comparisons between churners and non-churners. However, a large volume of families were discovered to be unreachable, which may explain why Virginia experiences such a high rate of churning. A total of 624 phone calls were made with 63 completed surveys, including 16% with valid phone numbers, and over 44% disconnected/wrong numbers. Over 17% reported a move at least once in the past year, and 36% reported at least one lapse in coverage. The mean length of lapse was 5 months.

Conclusions: Although this study set out to investigate churning, it provided information on barriers to successful contact and renewal. This population's transience is moderately high with very high occurrences of successful contact. Key findings include a link between retention rates and contact information, which has implications for state policy change.