 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Rebecca E. Goldstein, ScM and Emily Feinberg, Sc D. Bureau of Family and Community Health, Massachusetts Department of Public Health, 250 Washington Street, 5th floor, Boston, MA 02108, 617-624-5548, rebecca.goldstein@state.ma.us
Under SCHIP, states have the option of expanding their Medicaid program or creating a separate state program. Separate state programs, which exist in about half of the states, have been more successful in enrolling children, but little is known about the impact of program design on continuity of coverage. We investigated the movement between children enrolled in the state’s Medicaid program and a state program, Massachusetts Children's Medical Security Plan (CMSP), which covers 14,000 children whose family income exceeds the state’s Medicaid/SCHIP eligibility criteria. The study used data from a survey of 750 CMSP participants, who were children under the age of 19 with family incomes >200% of the federal poverty limit (FPL)and had enrolled in CMSP between August 15 - November 15, 2000. Study participants were interviewed within 6 months of enrollment and again approximately 6 months later. We conducted analyses to track the movement of children between Medicaid/SCHIP and CMSP. CMSP offers a comprehensive benefit package for preventive and specialty care but limited coverage for other services. Children with incomes >200% FPL paid a modest premium. About half (49%) of newly-enrolled CMSP participants had Medicaid as their most recent health insurance. Of these, 64% enrolled in CMSP without a gap in coverage, 19% had a gap of < 3 months, 6% 3-6 months, 11% > 6 months. The factor most strongly associated with a gap in coverage was age >13 years. Income change was the primary reason for loss of Medicaid coverage. At follow-up approximately a year after enrollment, about half of CMSP participants whose most recent insurance prior to enrollment was Medicaid remained enrolled. Of those disenrolled, 40% re-enrolled in Medicaid, 56% enrolled in ESI, and 4% became uninsured. Our study provides evidence of significant churning between the state’s Medicaid/SCHIP program and the separate state program that covers children whose income exceeds SCHIP eligibility criteria. In a state where Medicaid and the state program share a common application form and point of entry, relatively few children who enrolled in CMSP experienced significant gaps in coverage when leaving Medicaid. The large proportion of children enrolled in CMSP who were transitioning from Medicaid suggests the need for administrative procedures and data systems that promote continuity of coverage. Creating a seamless interface between Medicaid and separate state programs will be critical to maintaining enrollment, particularly during the re-verification process. Further research is needed to determine if the enrollment-disenrollment dynamics are similar among children moving between Medicaid and separate state SCHIP programs.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to
Keywords: Access to Health Care, Health Insurance
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.