Abstract
Objective
In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program
(CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We
examined the expenditures, utilization, and enrollment behavior of expansion enrollees
relative to traditional enrollees (100–200% FPL) and assessed the impact of expansion
on total program expenditures.
Methods
We compared unadjusted mean person-month-level expenditures and utilization of expansion
enrollees and various categories of existing enrollees and used a 2-part modeling
strategy to examine differences after controlling for enrollee characteristics. We
used probit models to examine adjusted differences in reenrollment behavior by eligibility
category.
Results
Expansion enrollees had higher total monthly expenditures ($10.33, P < .05) than traditional ALL Kids enrollees, including higher outpatient ($5.35, P < .001) and dental ($0.85, P < .01) expenditures but lower emergency department (−$1.34, P < .001) expenditures. Expansion enrollees had marginally lower utilization of emergency
department services for low-severity conditions and higher utilization of physician
outpatient visits. Expansion enrollees were 4.47 percentage points (P < .001) more likely to reenroll before their contract expiration date than traditional
ALL Kids enrollees. As of October 2012, expansion enrollees accounted for approximately
20% of ALL Kids enrollment and expenditures.
Conclusions
The expansion population was characterized by moderately higher health expenditures
and utilization, and more persistent enrollment relative to fee group enrollees who
are subject to the same levels of cost sharing and annual premiums. Although states
are prohibited from changing program eligibility until 2019, the costs associated
with the expansion population will be important to future policy decisions.
Keywords
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Article Info
Publication History
Accepted:
January 18,
2015
Received:
May 30,
2014
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
