New Enrollees to SCHIP Bring Unmet Health Care Needs

Waiting Period Would Negatively Affect Health Status of Enrollees

May 05, 2008

Even with prior private health insurance, patients enrolling in the state children’s health insurance program (SCHIP) had unmet health care needs at the time of enrollment. Instituting a waiting period would further prolong these children’s needs to address asthma and other chronic health conditions.

To deter crowd-out, which happens when patients switch to SCHIP when they have the option of private insurance, 35 states require waiting periods to qualify for SCHIP. Waiting periods require uninsured children to go with no insurance for a specified period of time before allowing them to enroll in the state program. New York state’s Child Health Plus SCHIP has never instituted a waiting period. Because of that, the program presents a unique opportunity to study the patients who switch from private insurance.

“First of all, we’ve found that few families switch their children to SCHIP when they have the option of private health insurance – in fact, only 7 percent do,” said Laura Shone, Dr.P.H., M.S.W., an assistant professor of pediatrics at the University of Rochester Medical Center and author of the study being presented during a presidential plenary session at the Pediatric Academic Society meeting in Honolulu, Hawaii, today. “And second, those who do switch have the same unmet health care needs as those who didn’t have insurance when they enrolled.”

Shone said this study shows that families are not “saving up” health problems for SCHIP to address after enrollment. It also shows that waiting periods could harm even those children who have had private insurance. About 57 percent of children, both with and without prior insurance, had unmet health care needs when enrolling in SCHIP. In fact, 10 percent of those who had prior private insurance had asthma and about 7 percent had some other chronic health condition.

Since 1997, the national State Children’s Health Insurance Program has provided health insurance to low-income children who are not eligible for Medicaid and do not have private coverage. Under the Federal law, states received grants of federal dollars to help with costs of insurance expansions, and had several options for how to expand coverage for children using those dollars. New York received federal approval for Child Health Plus, which was created in New York in 1991. The University of Rochester Medical Center has been studying that program since its inception.

Earlier University of Rochester Medical Center research has shown that the program greatly increases children’s access to primary care, preventive care, as well as other needed health care. SCHIP markedly reduces children’s unmet health care needs and reduces pre-existing racial disparities in access, unmet need and continuity of care. Long-term uninsured and lowest-income children, who were most disenfranchised before SCHIP enrollment, demonstrate the most dramatic gains after enrollment in SCHIP. Parents of children with asthma and special health care needs were more satisfied and better able to afford care and medications for their child’s condition once enrolled.

When the program came up for federal renewal last year, the debate over whether to expand the program focused on several aspects. In addition to debating where funding for the expansion would come from, the executive and legislative branches were at odds about whether families would leave private insurance for the public program. The program has been extended but without funding to expand it – and questions remain about whether current funding will continue to cover those already enrolled.

Just last month, New York Governor David Paterson approved a state budget that included an expansion of the program with state funding; several other states are considering following suit.

Since 1997, the national State Children's Health Insurance Program has provided health insurance to low-income children who are not eligible for Medicaid and do not have private coverage.

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