Issues in Disenrollment in a State Children's Health Insurance (SCHIP)

Problem: The reason some families do not renew in SCHIP is sometimes unknown. Learning more about these families may help programs better understand the reasons for nonrenewal and develop targeted strategies and interventions to retain the coverage of these children.

Methods: This study used administrative data on all children due to renew in Alabama's SCHIP (ALL Kids) from February 2006 through December 2007 (n=124,923). Characteristics of those children who did not renew and for whom there was no known reason for nonrenewal were compared to those who did renew. Data were analyzed using the chi-square statistic.

Results: Families cannot renew with a balance due. Of those who attempted to renew almost 20% owed a premium. In contrast, almost 80% of those who did not attempt to renew had a balance due. Pre-school children were less likely to renew than older children. African-Americans appeared slightly less likely to renew than Whites but controlling for balance due showed that African-Americans were slightly more likely to renew.

Conclusions: Since families who did not attempt to renew were more likely to owe a premium balance than those who renewed, interventions should encourage earlier premium payment. More specific information is needed regarding the characteristics of families who do not attempt to renew and owe a premium. ALL Kids administrators have instituted several strategies to address premium payments such as rewording correspondence, establishing a grace period for payments, and conducting reminder calls, consumer perspectives also should be addressed to increase understanding of their issues.