1. Lisa Dubay, Ph.D., Sc.M. Johns Hopkins Bloomberg School of Public Health and Center for Children and Families ldubay@jhsph.edu Getting to the Finish Line: Where We Have Been, Where We Need to Go, and How to Get There!

2. 2 A Brief History of Childrens Health Insurance Expansions In 1965, Medicaid program enacted as part of the Social Security Act coverage of children initially limited to those in families participating in welfare and those who were disabled In late 1980s, Medicaid was expanded to poverty related infants and children through a series of legislation with these expansions Medicaid was de-linked from welfare In 1997, SCHIP authorized as part of the Balanced Budget Act allowed states to extend public health insurance coverage to uninsured children not eligible for Medicaid as of June 1997

3. 3 But SCHIP Sits on Top of the Medicaid Program SCHIP Eligible Medicaid Eligible Medicaid SCHIP Separate Program SCHIP Medicaid Expansion

4. 4 Coverage of Children Improves Access to Care Source: 1997 National Survey of Americas Families *Statistically different from Medicaid at the 0.05 level using multivariate analyses. 4

5. 5 The Good News and the Bad News: Uninsured Children in 1997 and 2005 19972005 Number of Uninsured Children 10.0 million7.5 million Percentage of All Children Uninsured 13.5%9.7% Percentage of Low Income Uninsured 22.3%14.9% Source: Authors tabulations of 1997 and 2005 National Health Interview Survey

6. 6 Trends in the Percentage of Children Uninsured 1997 – 2005, All Children and Low-Income Children Source: Authors tabulations of 1997-2005 National Health Interview Survey.

7. 7 Eligibility for Public Health Insurance Coverage Expanded with SCHIP Source: National Survey of Americas Families

8. 8 Medicaid and SCHIP Participation: 1997, 1999, 2002 Source: 1997,1999,2002 National Survey of Americas Families Note: Excludes children with private coverage and defined for citizen children ages 0 to 17. 8

9. 9 Who Are the Uninsured Children? Age 0-5 Age 6-12 Age 13-18 White Black Hispanic Other Source: March 2005 Current Population Survey

10. 10 Who Are The Uninsured Children? 2 Full-Time 1 Full-Time Only Part-Time No Worker Self- Employed Less than 25 25-499 500 or More Source: March 2005 Current Population Survey

11. 11 Who Are the Uninsured Children? Midwest West South Northeast Citizen Non-Citizen Source: March 2005 Current Population Survey

12. 12 Most Uninsured Children are Eligible for Public Health Insurance Coverage, 2004 SCHIP Eligible Not Eligible Medicaid Eligible SCHIP Eligible Not Eligible Low-Income Uninsured Children Uninsured Children 12 Medicaid Eligible Source: March 2005 Current Population Survey using July 2004 eligibility rules. 6.5 million 9.0 million

13. 13 Knowledge Gaps Among Low-Income Parents with Uninsured Children, 2002 Heard of Programs and Aware Child Can Participate Without Receiving Welfare Haven't Heard of Medicaid or SCHIP Heard of Programs but Not Aware Child Can Participate Without Receiving Welfare 13 Source: Kenney, Haley and Tebay (2003)

14. 14 Interest in Enrolling in Medicaid and SCHIP is High, 2002 Source: Kenney, Haley and Tebay (2003)

15. 15 But State Issues Exist as Well When states enroll children they face higher costs Economic downturns Overall resource capacity Many states face federal shortfalls under SCHIP currently or in the future These issues make some states reluctant to implement and maintain effective enrollment strategies

16. 16 E nrollment in SCHIP Increases Access to Care Percentage Point Change ** Significant at the.01 level. Source: Urban Institute Analysis of National Survey of America's Families (NSAF).

17. 17 How Do We Get to the Finish Line? Fully fund SCHIP to maintain success of program 24 states estimated to face shortfalls by 2008 36 states estimated to face shortfalls by 2012 Estimated that 1.6 million children would loose coverage Increase funding under SCHIP to allow states to cover eligible but uninsured Identify and implement strategies designed to enroll more children in Medicaid and SCHIP Expand eligibility to ineligible populations

18. 18 Uninsurance Gap Between Low-Income Children and Parents, 1994 to 2004 Source: Tabulations of 1995-2005 Current Population Survey

19. 19 Effects of Covering Parents on Childrens Participation in Medicaid Medicaid Participation Among Poverty-Related Medicaid Eligible Children By Family Coverage Status, 1999 * Different from rate in states with no family coverage at.05 level using multivariate analysis.

20. 20 Covering Parents Leads to Small Increases in Use Among Insured Children 20 Source: 1999 National Survey of Americas Families * Different from low-income insured children with uninsured parent at.05 level using multivariate analysis.

21. 21 We are at a crossroads in childrens coverage ! SCHIP and, its partner, Medicaid, have together worked to significantly lower the number and percent of uninsured children. We should fully fund the SCHIP program to continue this progress and move forward in finding ways to ensure that all uninsured children secure coverage that assures high quality access to care.

22. 22 THANKS ! Lisa Dubay ldubay@jhsph.edu