Abstract
Objective
To assess how the Children's Health Insurance Program (CHIP) affects outcomes for
children with special health care needs (CSHCN).
Methods
We used data from a survey of parents of recent and established CHIP enrollees conducted
from January 2012 through March 2013 as part of a congressionally mandated evaluation
of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement
Initiative's CSHCN screener. We compared the health care experiences of established
CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately
insured recent CHIP enrollees, controlling for observable characteristics.
Results
Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey
(response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey
states, about one-fourth of CHIP enrollees had a special health care need. Compared
to being uninsured, parents of CSHCN who were established CHIP enrollees reported
greater access to and use of medical and dental care, less difficulty meeting their
child's health care needs, fewer unmet needs, and better dental health status for
their child. Compared to having private insurance, parents of CSHCN who were established
CHIP enrollees reported similar levels of access to and use of medical and dental
care and unmet needs, and less difficulty meeting their child's health care needs.
Conclusions
CHIP has significant benefits for eligible CSHCN and their families compared to being
uninsured and appears to have some benefits compared to private insurance.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Report to the Congress on Medicaid and CHIP: June 2014.Medicaid and CHIP Payment and Access Commission, Washington, DC2014
- A new opportunity to define health care reform for children.JAMA Pediatr. 2014; 168: 503-504
- Children's health care and the Patient Protection and Affordable Care Act: what's at stake?.JAMA Pediatr. 2014; 168: 505-506
- Children with special health care needs enrolled in the State Children's Health Insurance Program (SCHIP): patient characteristics and health care needs.Pediatrics. 2003; 112: e508
- A new definition of children with special health care needs.Pediatrics. 1998; 102: 137-139
- Identifying children with special health care needs: development and evaluation of a short screening instrument.Ambul Pediatr. 2002; 2: 38-48
- Prevalence and characteristics of children with special health care needs.Arch Pediatr Adolesc Med. 2004; 158: 884-890
- Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.Pediatrics. 2004; 113: e109-e115
- Role of insurance for children with special health care needs: a synthesis of the evidence.Pediatrics. 2006; 118: e1027-e1038
- Progress in ensuring adequate health insurance for children with special health care needs.Pediatrics. 2009; 124: 1273-1280
- The future of health insurance for children with special health care needs.Pediatrics. 2009; 123: e940-e947
- Are We Responding to Their Needs? States' Early Experiences Serving Children With Special Health Care Needs under SCHIP.Urban Institute, Washington, DC2001 (Available at:) (Accessed January 29, 2015)
- SCHIP's impact in three states: how do the most vulnerable children fare?.Health Aff (Millwood). 2004; 23: 63-75
- Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program.Ambul Pediatr. 2007; 7: 10-17
- Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.Pediatrics. 2006; 117: 486-496
- Effects of the State Children's Health Insurance Program expansions on children with chronic health conditions.Pediatrics. 2005; 116: e34-e42
- The Experiences of SCHIP Enrollees and Disenrollees in 10 States: Findings from the Congressionally Mandated SCHIP Evaluation.(Princeton, NJ: Mathematica Policy Research) Urban Institute, Washington, DC2005 (Available at:) (Accessed January 29, 2015)
- CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings.(Report submitted to the Office of the Assistant Secretary for Planning and Evaluation) Mathematica Policy Research, Ann Arbor, Mich2014 (Available at:) (Accessed on January 28, 2015)
Henry J. Kaiser Family Foundatation. Number of children ever enrolled in the Children's Health Insurance Program (CHIP). Available at: http://kff.org/other/state-indicator/annual-chip-enrollment. Accessed June 3, 2014.
- Methods for the 2012 Survey of Medicaid and CHIP Enrollees and Disenrollees: Report submitted to the US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.Mathematica Policy Research, Washington, DC2014
- The Children's Health Insurance Program Reauthorization Act evaluation findings on children's health insurance coverage in an evolving health care landscape.Acad Pediatr. 2015; 15: S1-S6
- Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.Pediatrics. 2004; 113: 1529-1537
National Center for Health Statistics. National Survey of Children's Health. Available at: http://www.cdc.gov/nchs/slaits/nsch.htm. Accessed June 3, 2014.
National Center for Health Statistics. National Survey of Children with Special Health Care Needs. Available at: http://www.cdc.gov/nchs/slaits/cshcn.htm. Accessed June 3, 2014.
- CHIP—evolving to meet the needs of children.Acad Pediatr. 2015; 15: S19-S27
- Improving coverage for children under health reform will require maintaining current eligibility standards for Medicaid and CHIP.Health Aff (Millwood). 2011; 30: 2371-2381
- A national profile of caregiver challenges among more medically complex children with special health care needs.Arch Pediatr Adolesc Med. 2011; 165: 1020-1026
- Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care.Pediatrics. 2006; 117: 1184-1196
- Understanding factors associated with work loss for families caring for CSHCN.Pediatrics. 2009; 124: S392-S398
- Comparison of Benefits and Cost Sharing in Children's Health Insurance Programs to Qualified Health Plans.Wakely Consulting Group, Englewood, Colo2014
- A Comparative Review of Essential Health Benefits Pertinent to Children in Large Federal, State, and Small Group Health Insurance Plans: Implications for Selecting State Benchmark Plans.American Academy of Pediatrics, Elk Grove Village, Ill2012
- Validity of maternal report of acute health care use for children younger than 3 years.Arch Pediatr Adolesc Med. 2005; 159: 167-172
Article info
Publication history
Accepted:
February 4,
2015
Received:
November 2,
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.
