Trends in SCHIP eligibility and coverage for children with special health care needs, 2000-2005

Objective: While many researchers have examined recent trends in SCHIP eligibility and coverage, few studies have focused on children with special health care needs (CSHCN). This study aims to fill this gap in the literature.

Methods: Data on state-specific SCHIP eligibility criteria were merged with the National Survey of CSHCN. In addition to bivariate analyses, a multilevel model was estimated to identify personal characteristics and state policies that significantly affect uninsurance among the SCHIP-eligible CSHCN.

Results: We found that SCHIP eligibility for CSHCN increased slightly between 2000 and 2005 (8.13% vs. 9.52%, ÷2 test, P<0.05). Among the SCHIP-eligible CSHCN, there was a substantial decrease in the uninsurance rate from 21.15% in 2000 to 10.87% in 2005 (÷2 test, P<0.05). After controlling for covariates, our analysis indicated that CSHCN in 2005 were 53% less likely to be uninsured than those in 2000. Our multilevel analysis also identified personal characteristics significantly increasing uninsurance among the SCHIP-eligible CSHCN, including age, income, and speaking a language other than English at home. In terms of state policies, our multilevel model showed that those CSHCN who are from the states that require an asset test at SCHIP enrollment are more likely to be uninsured, and those CSHCN who are from the states that have presumptive eligibility are less likely to be uninsured.

Conclusions: Our results document the dramatic decrease in uninsurance rate among the SCHIP-eligible CSHCN between 2000 and 2005. The uninsurance rate was significantly affected by both personal and state level factors.