Although families with income low enough are eligible for various publicly funded health insurance programs, research shows that more than three of five uninsured children are eligible for Medicaid or SCHIP but are not enrolled.⁽¹⁰⁾ Many others, moreover, lose their public coverage before regaining it later on. Two Fund reports, as well as an Alliance for Health Reform briefing on Capitol Hill, spotlighted policy solutions to minimize this "churning" in enrollment. Stan Dorn, J.D., and Genevieve Kenney, Ph.D., of the Urban Institute assessed the potential of automatically enrolling children and their parents in SCHIP and Medicaid based on the eligibility determinations of other means-tested programs.⁽¹¹⁾ States are currently prohibited from doing this.

In another report, Laura Summer and Cindy Mann, J.D., of Georgetown University analyzed the causes and consequences of churning in public insurance programs, and state strategies that can reduce it.⁽¹²⁾ The researchers found that targeted policies substantially reduced coverage loss. In Washington State, enrollment declined sharply when families were required to renew their coverage every six months and rebounded when 12-month renewal periods were reinstituted. Premiums also can have a significant effect: in Virginia's public coverage program, 42 percent of children whose families were charged premiums would have lost coverage, due to their families' failure to pay premiums, if the state had followed through with planned sanctions for nonpayment.

With Fund support, Andrew Bindman, M.D., of the University of California, San Francisco, is investigating whether interruptions in Medicaid coverage for adults and children are associated with higher rates of hospital admissions, deaths, and costs for conditions that normally are treatable in primary care settings. Bindman's research will help policymakers determine whether short-term savings from restricting program eligibility and charging premiums might be offset by the costs of avoidable hospitalizations.