Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
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11 Using Uninsured Data to Track State CHIP Programs--John McInerney
11 Using Uninsured Data to Track State CHIP Programs--John McInerney
Pages 141-153
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From page 141... ...
CHIP gave states an attractive option to help reduce the population of low-income uninsured children, which was in excess of 20 percent in the years leading up to the program's enactment. Combined with a generous federal contribution, the block grant program helped states provide comprehensive and affordable coverage to children with family income too high for Medicaid but too low to afford private insurance coverage.1 Throughout the program's history, data on the uninsured rate of children has played an important role in funding and the evaluation of pro gram success.
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From page 142... ...
Nationally, over 22 percent of low-income children with family incomes below 200 percent of the federal poverty line (FPL) were without health insurance in 1997 (Georgetown University Center for Children and Families, 2006)
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From page 143... ...
ADMINISTRATIVE DATA SHOW PROGRAM ENROLLMENT INCREASES BUT CURRENT POPULATION SURVEy DATA SHOW RISE IN UNINSURED Virginia's CHIP enrollment dramatically increased in the years following the creation of FAMIS. In 2001, fewer than 38,000 were enrolled 4 One change was adding coverage for low-income pregnant women through the FAMIS MOMS program beginning in 2005 for women with family income up to 150 percent of poverty (beginning when Medicaid coverage ends at 133 percent of FPL)
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From page 144... ...
However, between 2004 and 2006 -- a period during which FAMIS enrollment increased steadily -- CPS data show that the percentage of low-income uninsured children in Virginia actually increased by nearly 4 percentage points (this increase, however, was not statistically significant) (Cook, Kenney, and Lawton, 2010)
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From page 145... ...
But between 2004 and 2006, ESI coverage in Virginia declined sharply for all incomes (Cook, Kenney, and Lawton, 2010. LESSONS FOR STATE POLICy MAKERS, ANALySTS, AND ADVOCATES Although, in Virginia, CPS data do not reflect the CHIP enrollment gains evident in administrative data between 2004 and 2006, in most states survey and administrative data have shown a negative relation ship between CHIP enrollment gains and the uninsured rate for children as measured by survey data.
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From page 146... ...
Survey data can be a helpful indicator in program evaluation, but they were not always an efficient metric in determining CHIP funding allocations. 8 Federal match rates for CHIP run between 65-85 percent.
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From page 147... ...
A key concern of state policy makers and other children's health advocates and analysts was the lack of a reliable and uniform data source to measure whether a particular state had actually covered 95 percent of eligible children in CHIP and/or Medicaid.9 CMS did not provide states with a definitive data source or method to determine compliance. The CPS would have been the logical choice, but its small sample size and tendency to underreport Medicaid and CHIP coverage concerned the states.
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From page 148... ...
a data source and methodology to determine compliance. Lesson 2 -- State Analysts and Advocates Are Key in Disseminating Information to Policy Makers, the Media, and the Public State groups often lack the resources and capacity to collect and produce survey data, instead relying on national state-specific surveys by the Census Bureau and comprehensive analysis of census and other uninsured data by national experts.
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From page 149... ...
Public insurance coverage in Virginia increased, according to Census Bureau estimates, but only by less than 1 percentage point. In Virginia, the CPS data suggested that the biggest reason for the decline in the uninsured rate was the increase in ESI coverage for children, which rose from 61.1 percent in 2007 to 69.2 percent in 2008, even though a major recession was under way.
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From page 150... ...
Lesson 3 -- More Data Are Needed State Surveys Help Fill Gaps, But Are Not Done Regularly in Each State Although the CPS and the ACS state data are not without flaws, they are the only options for many states in examining uninsured data for children. Most states have produced at least a few state surveys of the uninsured over the past decade, but only a few produce them on a yearly basis.
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From page 151... ...
For example, every 2 years, the Virginia Health Care Foundation funds a report by the Urban Institute examining the CPS data and looking at uninsured rates using various demographics like age, gender, and income. The Urban Institute compares the results in Virginia with survey data dating back to 2000.
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From page 152... ...
The state interprets the Health Insurance Portability and Accountability Act pri vacy rules to prohibit the release of enrollment data for jurisdictions with fewer than 20,000 enrollees. This means that data can be released only for the biggest counties or with counties grouped into regional data.
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From page 153... ...
FINAL REMARKS From its inception, CHIP has been very successful at providing access to health insurance for low-income children and families. Uninsured data, both census state-level data and state-produced surveys, have provided valuable information for states to evaluate the program, but they have limits.
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