Experience in Florida SCHIP May Provide Lessons for Other States' Re-Enrollment Requirements

Press Release Date: June 17, 2002

Florida's "passive re-enrollment" policy, which does not require parents to take steps to prove that their children are still eligible for the State Children's Health Insurance Program (SCHIP), results in a significantly lower percentage of children losing coverage than in States that require parents to verify periodically their children's eligibility, according to a new study published in the Spring 2002 issue of Health Care Financing Review. The research is part of a set of studies being conducted under the Child Health Insurance Research Initiative (CHIRI™), jointly sponsored by the Agency for Healthcare Research and Quality (AHRQ), the David and Lucile Packard Foundation, and the Health Resources and Services Administration.

Researchers compared the effects of re-enrollment policies in four States: Florida, Kansas, New York, and Oregon. All but Florida have active re-enrollment policies that require parents to inform the States on a periodic basis about their children's eligibility. Florida, however, requires children's families to notify the State only if changes occur that affect eligibility and to keep paying the monthly premium to maintain enrollment status.

The study found that only five percent of children in Florida SCHIP fell off the rolls at re-enrollment, as compared to one-third to one-half of children in Kansas, Oregon, and New York. The authors concluded that passive re-enrollment contributed to the lower disenrollment rate observed in Florida as compared to the States with active re-enrollment policies. Nearly all other States have active re-enrollment policies. Currently, only a handful of States have passive re-enrollment policies in place.

"States are focusing on ensuring that all eligible children enroll in and stay covered by SCHIP so we can minimize breaks in coverage that can disrupt the continuity and quality of care," said HHS Secretary Tommy G. Thompson. "Florida's experience clearly shows that States must continue their efforts to streamline and simplify their enrollment and re-enrollment procedures."

The study also found that up to one-quarter of the children who dropped from the SCHIP programs of Oregon, Kansas, and New York at the time they were required to re-enroll returned within two months.

"The rapid return of these children indicates that administrative issues such as active re-enrollment and other requirements may be the reason for their disenrollment, while others may have obtained health care coverage from other sources," speculated Andrew W. Dick, Ph.D., of the University of Rochester's School of Medicine and Dentistry, Rochester, NY, who led the research.

A significant number of children were still in SCHIP two years after their original enrollment, although many of these were disenrolled at least once during this period. Researchers observed that many children use SCHIP as temporary coverage (one year or less) because a substantial number were initially enrolled for relatively short periods of time and many did not return at a later date.

"This study shows that States can choose policies that will significantly lower their disenrollment rates," said Eugene Lewit, Ph.D., senior program manager at the Packard Foundation. "Even without implementing passive re-enrollment, a policy of redetermining eligibility at 12 months instead of 6 months will help children maintain coverage."

Details of the new study are in "The Consequences of States' Policies for SCHIP Disenrollment," published in the June 2002 issue of Health Care Financing Review. For copies of a CHIRI™ issue brief about the findings, select "SCHIP Disenrollment and State Policies," call the AHRQ Publications Clearinghouse at 1-800-358-9295, or send an E-mail to AHRQPubs@ahrq.hhs.gov.

Over the next two years, CHIRI™ will supply policymakers with information on how to improve access to, and the quality of, health care for low-income children. Future CHIRI™ studies will examine what happens to children who disenroll from SCHIP.

For more information, please contact Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov) or Bob Isquith, (301) 427-1539 (RIsquith@ahrq.gov).

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