The legislation that mandated ASPE’s national evaluation of SCHIP required that the study include a survey of those who, though eligible for SCHIP (or Medicaid), are not enrolled. ASPE is interested in understanding more about the characteristics of such children and their families, and about the reasons they are not insured.

To carry out this component of our evaluation, ASPE will build on an existing survey. Using an instrument called the State and Local Area Integrated Telephone Survey (SLAITS), the CDC’s National Center for Health Statistics (NCHS) is fielding a survey for the Maternal and Child Health Bureau to assess the prevalence of children with special health care needs in every state and the District of Columbia. The large number of households that will be screened to identify special needs children provides an ideal platform for identifying low-income households (<200%FPL) that include uninsured children – that is, households that include children who appear to be eligible for Medicaid or SCHIP but are not enrolled in any health insurance. These households will receive a cluster of questions developed by ASPE, designed to assess the families’ knowledge of, attitudes toward, and experience with SCHIP and Medicaid. Findings from this survey will provide critical new data about the populations that Medicaid and SCHIP have not reached successfully, improving our ability to guide future program changes, educational campaigns, and outreach strategies. In particular, the project will address the following questions:

Barriers to Enrollment

• What are the principal barriers to enrollment in Medicaid and SCHIP? To what extent are state Medicaid eligibility and enrollment practices and procedures a barrier to participation?
• Do strategies to prevent substitution of SCHIP for private coverage (e.g., waiting periods) create an unnecessary barrier to enrollment for children?
• Why are some eligible children not enrolled in Medicaid and SCHIP?

Access and Utilization

• What experiences do children who are eligible but uninsured have in seeking and obtaining services?
• What proportion of children who are eligible but uninsured have a usual source of care or medical home?
• How satisfied are those who are eligible but uninsured with the health services they obtain?

Awareness of Medicaid and SCHIP

• How do different outreach strategies affect families’ knowledge of public programs and motivation to enroll?

The survey was in the field for a period of 12 months that began in October, 2000. It is expected that parents and guardians of approximately 9,850 completed the Medicaid/SCHIP section of the interview. This sample is sufficiently large to support sub-group comparisons and analyses of the eligible-but-uninsured at the national level, and possibly some state-level analyses in states with the highest anticipated sample size. Analyses based on the first six months of data will be incorporated in the report to Congress due in early 2003. More information about the survey, including copies of the survey instrument, are available on-line at http://www.cdc.gov/nchs/slaits.htm.

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