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Census Data on Children's Coverage: What Do They Mean for States?

On August 28, the Census Bureau released new statistics showing that the number of uninsured children increased from 8 million in 2005 to 8.7 million in 2006. The percentage of uninsured children has increased two years in a row, after declining or holding steady thanks in large part to SCHIP, which preserved children's coverage rates even while adult rates were on the rise. A breakdown of the numbers indicates that 19.3 percent of children in families with annual incomes below 100 percent of FPL are uninsured. These findings are particularly ominous given the uncertainty surrounding federal funding levels in coming years for the State Children's Health Insurance Program (SCHIP).

With estimates that a majority of uninsured children—about 5 to 6 million—are actually eligible for but not enrolled in Medicaid or SCHIP, states are placing a greater emphasis on outreach. [1] A national assessment of state outreach strategies in the Summer 2007 issue of Health Care Financing Review describes how states have shifted from conducting outreach as a means of explaining and getting "name brand" recognition for their SCHIP programs, to adapting their campaigns specifically "to close the gaps in reaching hard-to-reach populations." [2] States seek to close enrollment gaps by identifying a target population, refining the message to best catch the attention of that population, and using strategies most likely to reach that population. For example, states are crafting messages promoting eligibility and the value of health coverage, and bringing those messages to schools, health care providers, employers, and community-based organizations. According to the article, they are also developing more formal arrangements with local entities to help reach members of communities, all the while placing a strong emphasis on "retaining existing SCHIP enrollees and encouraging use of services." Target populations include minorities, immigrants, working families, and those living in rural areas.

Also, as employment-based coverage has been steadily declining, states have been picking up some of the slack by expanding eligibility for children (and some adults) in Medicaid and SCHIP. As reported in a recent issue of States in Action and in this issue's Illinois All Kids Snapshot, a number of states are implementing or exploring eligibility expansions and options for families to buy in to public coverage, in order to achieve universal coverage for children.

States' efforts to expand children's coverage and make headway in outreach, enrollment, and retention may be stymied, depending on the outcome of the federal reauthorization of SCHIP. As of September 28, a compromise bill had been approved by the House and Senate that would provide an additional $35 billion in funding over five years, resulting in a total of $60 billion in funding for the program. On October 3, President Bush vetoed the bill, as was expected, given his stated preference for adding only $5 billion to the current $25 billion baseline of funding. The Congressional Budget Office has publicly stated that such a small increase in funding would not allow the program to continue at its current enrollment levels, let alone enable states to address the challenges posed by the latest estimates of uninsured. While there appear to be enough votes in the Senate to override the veto, the same does not hold true in the House of Representatives, making the fate of the compromise bill uncertain as of publication.

[1] Estimates of the Number of Uninsured Children who are Eligible for Medicaid or SCHIP, Letter from Peter Orszag to the Honorable Max Baucus, Congressional Budget Office, July 24, 2007.
[2] S. R. Williams and M. L. Rosenbach, Evolution of State Outreach Efforts Under SCHIP, Health Care Financing Review, Summer 2007 28 (4).

For More Information
See: S. Dorn, Eligible but Not Enrolled: How SCHIP Reauthorization Can Help, The Urban Institute, September 2007.

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