Congressionally Mandated Evaluation of the State Children's Health Insurance Program: Final Cross-Cutting Report on the Findings from Ten State Site Visits

Contract No.: HHS-100-01-0002 MPR Reference No.: 8782-071 Congressionally Mandated Evaluation of the State Children’s Health Insurance Program Final Cross-Cutting Report on the Findings from Ten State Site Visits December 2003 (Revised June 2004) Ian Hill Corinna Hawkes The Urban Institute Mary Harrington Mathematica Policy Research, Inc. With Ruchika Bajaj, William Black, Nancy Fasciano, Embry Howell Heidi Kapustka, Amy Westpfahl Lutzky Submitted to: U.S. Department of Health and Human Services Office of the Secretary Assistant Secretary for Planning and Evaluation Health Policy Deputy to the Deputy Assistant Secretary for Health Policy Hubert H. Humphrey Bldg., Rm. 442E 200 Independence Avenue, SW Washington, DC 20201 Project Officer: Rob Stewart Submitted by: Mathematica Policy Research, Inc. P.O. Box 2393 Princeton, NJ 08543-2393 (609) 799-3535 and The Urban Institute 2100 M Street, NW Washington, DC 20037 Project Director: Judith Wooldridge iii CONTENTS Chapter Page EXECUTIVE SUMMARY................................................................................................ ix I. INTRODUCTION...............................................................................................................1 II. OVERVIEW OF SCHIP PROGRAM IN THE TEN STUDY STATES ........................... 5 A. FACTORS INFLUENCING POLICY AND PROGRAM DEVELOPMENT IN THE STUDY STATES .......................................................................................... 11 B. ORGANIZATION OF THE REMAINDER OF THE REPORT ............................... 16 III. OUTREACH ..................................................................................................................... 17 A. BACKGROUND AND POLICY DEVELOPMENT ................................................. 17 B. PROGRAM AND POLICY CHARACTERISTICS................................................... 18 C. IMPLEMENTATION EXPERIENCES...................................................................... 25 IV. ENROLLMENT AND RETENTION............................................................................... 31 A. BACKGROUND AND POLICY DEVELOPMENT ................................................. 31 B. PROGRAM AND POLICY CHARACTERISTICS................................................... 32 C. IMPLEMENTATION EXPERIENCES...................................................................... 44 V. CROWD OUT...................................................................................................................59 A. BACKGROUND AND POLICY DEVELOPMENT ................................................. 59 B. PROGRAM AND POLICY CHARACTERISTICS................................................... 61 C. IMPLEMENTATION EXPERIENCES...................................................................... 65 VI. BENEFITS ........................................................................................................................ 71 A. BACKGROUND AND POLICY DEVELOPMENT ................................................. 71 B. PROGRAM AND POLICY CHARACTERISTICS................................................... 74 C. IMPLEMENTATION EXPERIENCES...................................................................... 83 VII. SERVICE DELIVERY SYSTEMS, UTILIZATION, AND ACCESS ............................ 85 A. BACKGROUND AND POLICY DEVELOPMENT ................................................. 85 B. PROGRAM AND POLICY CHARACTERISTICS................................................... 86 C. IMPLEMENTATION EXPERIENCES...................................................................... 96 iv CONTENTS (continued) Chapter Page VIII. COST SHARING .......................................................................................................... 101 A. BACKGROUND AND POLICY DEVELOPMENT.............................................. 101 B. PROGRAM AND POLICY CHARACTERISTICS ............................................... 103 C. IMPLEMENTATION EXPERIENCES .................................................................. 110 IX. PARENTAL COVERAGE AND PREMIUM ASSISTANCE PROGRAMS............... 113 A. BACKGROUND AND POLICY DEVELOPMENT.............................................. 113 B. PROGRAM AND POLICY CHARACTERISTICS ............................................... 113 X. FINANCING AND FISCAL OUTLOOK ..................................................................... 123 A. POLICY DEVELOPMENT AND PROGRAM CHARACTERISTICS ................ 123 B. IMPLEMENTATION EXPERIENCES .................................................................. 125 XI. COORDINATION OF SCHIP AND MEDICAID ......