Child Health Insurance Program - Issues on its failure and success

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Author: Golam Md. Munir

Article source: http://www.articledeshboard.com/. Used with author's permission.

1. What is CHIP?
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In 1997, Congress enacted the State Children's Health Insurance Program (SCHIP), offering States over $40 billion in Federal matching funds to provide health care coverage to low-income uninsured children2. The purpose of CHIP is to reduce the number of uninsured children by state's own program, extending Medicaid or both. The success or failure of this new health care initiative is likely to rest on the numbers of children states are able to enroll. It is clear that this will require a concerted outreach effort to identify uninsured children already eligible for Medicaid as well as children newly eligible for CHIP. Low participation rates in Medicaid-only programs and even lower participation rates in state-funded programs suggest that enrolling significant numbers of children will require much more than opening the door to eligibility.

2. Why eligible families can't take advantage of CHIP?
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Over 4 million of America's 11 million uninsured children are eligible for Medicaid coverage. The rate is falling. Eligible families have not taken advantage of CHIP because:
" Lack of information: About one third of the parents do not know about the available existence, benefit and services of CHIP, such as:
" The benefits of preventive care,
" Obtaining services under the Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) program for children.
" Misinformation about this public insurance program: Parents don't know that a child could get Medicaid even if the parents live together and did not know about the availability of transitional Medicaid after a parent gets off welfare because of work;
" No activities were designed to help enrolled families use available services. No outreach program was funded by the state to extend outreach services.
" Limited funding and enrollment caps;
" A difficult application process;
" Complex and restrictive eligibility rules;
" Premiums and enrollment fees;

3. What can be done1?
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3.1. Expanding eligibility is not enough to ensure coverage. Aggressive outreach efforts including funding such program are needed as well;
3.2. Once outreach is ensured following issues should be addressed:
" lack of transportation,
" Clinic hours that conflict with work schedules,
" Lack of child care for siblings,
" Overcrowded clinics with long delays,
" Doctors' unwillingness to see Medicaid or other low-income patients, and
" Concern that care is unresponsive to medical needs or interpersonally disrespectful.

4. To address these issues, following strategies could be taken by states:
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" Financial incentives to enrollees,
" Public awareness campaigns (such as media campaign) regarding the importance of preventive health care and where to get it,
" Grassroots outreach through home visiting and community health advisors,
" Transportation services,
" Improving provider participation and training,
" Making clinics, provider sites, and staff more user-friendly,
" Care coordination for children, and
" Information systems that permit regular review of encounter data.

Sources:
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1. Outreach Strategies in the State Children's Health Insurance Program; A Special Report from Families USA, June 1998
2. Coordinating Publicly Funded Healthcare Coverage for Children;

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