Parental eligibility and take-up of SCHIP: The roles of parental health and employment

Background: To improve coverage and retention of low income children in New Jersey's State Children's Health Insurance Program, eligibility for coverage was extended in 2000 to parents of enrolled children up to 200% of the Federal Poverty Level (FPL) who were not covered by employer sponsored insurance (ESI) or eligible for Medicaid. New Jersey was one of the first states to obtain Section 1115 Medicaid waivers to cover parents. Although there has been research about the effects of parental expansion on children's take-up and retention in SCHIP, and access and utilization among parents and children, little research has been conducted about which parents actually enroll in (take up) SCHIP.

Methods. Data from the 2003 NJ FamilyCare Family Health Survey are used to describe patterns of eligibility and take-up among parents of children enrolled in NJ FamilyCare (NJFC) – New Jersey's SCHIP initiative. We calculated eligibility status for each parent based on type of insurance, whether uninsured parents had other insurance within the 6-month lookback period, and whether they reported being eligible for ESI. We calculate take-up only among NJFC-eligible parents to differentiate the two steps that determine the share of parents who enroll among those in the income-eligible range.

Results: Sixty-four percent of one-parent households had an eligible parent, of whom 78% enrolled. In households with both parents present, three-quarters had at least one parent who was eligible for NJFC, and of those with at least one eligible parent, about 60% enrolled one or both parents. Regardless of family structure, households without a parent working full-time were more likely to have an NJFC-eligible parent, but take-up among eligibles varied by parental employment only in two-parent households. Parental eligibility was higher in households with one or more parent having at least one serious or morbid health symptom, but take-up varied by health status only in two-parent households.

Conclusions: Overall, among those with incomes below 200% of the FPL who had at least one child in NJFC, 50% of single-parent households and 45% of two-parent households had a parent enroll in the program. In each of the subgroups studied, some parents who appeared to be eligible for NJFC did not enroll. These findings suggest the need to increase awareness of parental eligibility criteria and reduce barriers to enrollment among those eligible if state coverage programs are used as a means of extending health insurance to low-income parents as well as their children.