Amy J. Davidoff, PhD, Genevieve Kenney, PhD, and Lisa Dubay, ScM. Health Policy Center, Urban Institute, 2100 M Street N.W., Washington, DC 20037, 202-261-5259, adavidof@ui.urban.org

By 2001 all states implemented SCHIP expansions, often accompanied by extensive outreach and enrollment simplification. Several studies have assessed the impacts of SCHIP on coverage; this study focuses on children with special health care needs (CSHCN) and considers impacts on both coverage and access to care. We used a pre-post design to examine changes before and after SCHIP implementation. The treatment group consisted of newly eligible CSHCN, defined as children with reported diagnoses of serious chronic conditions or reported activity limitations caused by chronic health conditions. Comparison groups included children with incomes slightly above SCHIP eligibility thresholds. Multivariate regression models controlled for child characteristics, local economic conditions and state. Data were from the 1997- 2001 National Health Interview Survey. Treatment and comparison groups were identified using an algorithm that replicates the eligibility determination process. SCHIP was associated with a 10 percentage point increase in public coverage, and a 6 point decrease in the probability of being uninsured. SCHIP resulted in a 9 percentage point decline in unmet need, particularly for dental care. There was an increase in the probability of dental and eye care visits, and out-of-pocket spending on healthcare decreased. We failed to find effects on other service use. Further progress may require targeted outreach to CSHCN and improvements in SCHIP service delivery systems. Given the current fiscal environment and the fact that CSHCN have not been protected from cutbacks, the recent progress documented in this study may be reversed.

Learning Objectives: At the conclusion of this paper, the listener will

• Understand how the SCHIP expansions affected insurance coverage differently for children with and without special health care needs.
• Identify changes in access to care and use of services associated with the SCHIP expansions, and how they differ for children with special health care needs.
• Identify policy issues for CSHCN, associated with state cutbacks in SCHIP enrollment.

Keywords: Children With Special Needs, Access to Health Care

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.