APHA Annual Meeting Philadelphia 11/12/02 State Children’s Health Insurance Program (SCHIP) Created in 1997 with enactment of Title XXI of the Social Security Act Generous federal fiscal participation; wide latitude to states for program design; evaluation mandated Phase I – Medicaid Expansion (February 1998) Phase II – ALL Kids: State-designed plan (Oct 1998) Phase III – ALL Kids Plus: Expanded coverage for children with special needs enrolled in ALL Kids

APHA Annual Meeting Philadelphia 11/12/ Alabama Children’s Healthcare Coverage

APHA Annual Meeting Philadelphia 11/12/02 Effect on the Uninsured October 1998 – June base-line estimate showed 173,012 uninsured children. As of June 2002, 163,975 children have been enrolled in one of the three programs.

APHA Annual Meeting Philadelphia 11/12/02 Data Sources First Year Enrollee Retrospective Survey –Conducted by University of Alabama at Birmingham, School of Public Health, Department of Maternal and Child Health –Survey Population: 26,242 Children enrolled in ALL Kids FY 99 –Data collected between November 1999 and February 2000 –Survey Sample: Random Sample of 6,200 Parents of ALL Kids Children 3,738 (60%) surveys returned Pediatric Health History –Completed by child’s parents at time of enrollment –Collected information on birth and medical history, medical problems, current medications, mental health, and preventive health history Merged Data Set –Retrospective Survey and Pediatric Health History data were merged using the child’s Social Security number

APHA Annual Meeting Philadelphia 11/12/02 ALL Kids Characteristics: First Year Enrollees POPULATION (n=26,242) No Fee 75% (income <150% of FPL) Male - 51% White - 64% Black - 34% Other - 2% 0-12 months - <1% 1-5 years - 12% 6-12 years - 48% years - 39% RETURNED (n=3,738) No Fee 63% (income <150% of FPL) Male - 51% White - 64% Black - 33% Other - 3% 0-12 months - 1% 1-5 years - 16% 6-12 years - 49% years - 34%

APHA Annual Meeting Philadelphia 11/12/02 Identifying Children and Youth With Special Health Care Needs Five screening questions were used on the survey 27% were identified as CYSHCN by answering yes to at least one of the screening question –Our sample consisted of low-income parents who sought health insurance for their child. –In 1998 Newacheck et al. examined a cross-section of the population in the NHIS-D survey and found a child disability prevalence rate of 18%. –Among those NHIS-D families at or below the federal poverty level, the rate of child disability was 24%.

APHA Annual Meeting Philadelphia 11/12/02 Summary Characteristics of CYSCHN and Their Families Characteristics of CYSHCN and their families compared to those without special needs –More below 150% of Federal Poverty Level –Fewer parents were high school graduates –More CYSHCN among older children, especially adolescents –More males –No differences between racial/ethnic groups

APHA Annual Meeting Philadelphia 11/12/02 Summary Results for CYSHCN Compared to children without special needs, proportionately more CYSHCN were more likely to experience improved access to care after enrolling in CHIP –Usual source of sick care small difference between groups (p =.022) –No differences on routine care –Other measures (needing care, waiting too long for care, specialty, dental, and vision care, and prescriptions CYSHCN had significantly greater access after CHIP Significant odds ratios ranged from 1.3 for waited too long for dental care to 3.8 needed specialty care, but couldn’t get it

APHA Annual Meeting Philadelphia 11/12/02 Summary Results for Other Vulnerable Populations Schoolagers and adolescents –Compared to preschoolers more likely to experience improvement in getting medical, dental, vision, specialty care and prescriptions; more likely to have a usual source of care; and less likely to wait longer than needed for medical, dental, or vision care Race/Ethnicity –For 6 of 10 access and need measures, African American children were 25%-33% more likely to experience improvement compared to Caucasian children

APHA Annual Meeting Philadelphia 11/12/02 Summary Children and youth with and without special needs reported improved access to care on nearly all items measured –Among all families that reported problems with access to a usual source of care, waiting too long for care, or getting specialty, vision, dental and prescription services before ALL Kids, from 19% (specialty) to 52% (dental) reported improved access after enrolling in ALL Kids

APHA Annual Meeting Philadelphia 11/12/02 Conclusions and Implications More children and youth with and without special needs have health insurance in Alabama than before SCHIP Access to health care has improved for all children in ALL Kids –More children have a regular health care provider –Fewer children are going without needed medical care –Medical care can be accessed in a more timely manner

APHA Annual Meeting Philadelphia 11/12/02 Conclusions and Implications Compared to those without a special needs child, families who perceive their child as having a special health care need experienced significantly more improved access to health care and less unmet need after enrolling in CHIP (older children and AA children also experienced more improvement) –In Alabama there is a large network of providers available (BC/BS has 85% of insurance market) and a rich benefit package –Families who need and know about affordable and accessible health insurance will respond to outreach efforts –Despite preliminary indications of improved access to care for CYSHCN who enroll in CHIP, we do not know if substantial gaps in services for this population still exist. On-going investigation is needed regarding the effectiveness of ALL Kids and ALL Kids Plus to meet the needs of CYSHCN. –Differences may exist among families who enrolled in subsequent years of ALL Kids –Unknown consequences for future expansion because of federal and state budget issues