The 130th Annual Meeting of APHA

Abstract #37730

Sara Rosenbaum, JD, Anne R Markus, JD, PhD, and Colleen Sonosky, JD. Center for Health Services Research and Policy, The George Washington University, 2021 K St, NW Suite 800, Washington, DC 20006

The purpose of this study was to determine the extent to which states used the flexibility accorded under the SCHIP statute to depart from the unique principles of the Medicaid program and adopt more conventional rules of insurance in designing their separately-administered SCHIP programs, with a special emphasis on the implications this departure may have on access to care for children generally and for children with special health care needs in particular. Researchers systematically reviewed the 34 separate state SCHIP plans filed with the federal administration as of December 2000, state SCHIP enabling statutes, and state SCHIP managed care contracts, using instruments structured to categorize program design according to certain critical distinctions between Medicaid and SCHIP. The analysis found that states with separately-administered SCHIP programs varied in their reference to Medicaid principles, but that in three out of four respects-benefits and coverage, service delivery, and consumer safeguards-their insurance design choices had the effect of "tipping" their SCHIP programs away from the Medicaid model of delivering care to children. Whereas the flexibility in program design under SCHIP allows states to extend coverage to higher family income levels, while controlling program expenditures, it also encourages states to use conventional insurance principles in separately-administered SCHIP programs that may lead to the denial of treatment (or serious under-treatment) of children whose health needs exceed actuarial norms, unless states supplement SCHIP coverage with other sources of care, such as Title V and other public health programs.

Learning Objectives:

• To understand critical issues of insurance design in publicly-financed insurance programs and their implications for children's access to care

Related Web page: www.gwhealthpolicy.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.