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For Low-Income Children, Findings Reveal CHIP to Be a Vital Resource | Commentary

Between 1997 and 2012, uninsured rates among low-income children fell from 25 percent to 13 percent despite recession conditions that separated many families from employer-sponsored coverage and left them with fewer resources to purchase coverage on their own. Our findings attribute this persistent decline to Medicaid and the Children’s Health Insurance Program, whose coverage rates among children increased from 41 percent to 63 percent over the same 15-year period.

Mathematica Policy Research and our partner, the Urban Institute, recently completed a congressionally mandated evaluation of CHIP that began in 2010, and our evaluation found CHIP to be successful in almost every area examined. The program expanded health insurance coverage to the population it is intended to serve, increased their access to needed health care, and reduced the financial burdens and stress on families associated with meeting children’s health care needs. These positive impacts and others were found for children and families in states with different CHIP program structures and features, across demographic and socioeconomic groups, and for children with different health needs.

Our evaluation included 10 states — Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah and Virginia — that reflect diverse program designs and represented 53 percent of the nation’s uninsured children and 57 percent of children enrolled in CHIP at the time states were selected in 2010. We used survey, case study, focus group and state program data to rigorously assess CHIP’s effectiveness in those states. Our key findings include the following:

• Since CHIP was enacted, coverage rates improved for all racial/ethnic and income groups and coverage disparities narrowed significantly for Hispanic children, whose uninsured rate dropped from 34 percent to 17 percent. Between 1997 and 2012, the coverage disparity between non-Hispanic white and Hispanic children narrowed from 13 percent to 5 percent.

• A majority of CHIP enrollees received preventive care. More than 85 percent of children enrolled in CHIP had seen a doctor or health care professional in the past 12 months, and 80 percent had a preventive physical exam. These rates are comparable to children with private insurance and well above the rates for uninsured children.

• CHIP mitigated the stress involved with maintaining children’s health. Most parents (96 percent) reported being confident that they could get health care to meet their child’s needs, with more than 80 percent reporting little or no stress about meeting those needs. These rates were substantially higher than what was reported by parents of uninsured children.

• Compared with private coverage, parents of CHIP enrollees reported greater confidence, reduced stress and lower financial burdens associated with meeting their child’s health care needs, as well as better access to dental care. CHIP enrollees were more likely than children with private coverage to have dental benefits and a regular source of dental care. The parents of children enrolled in CHIP reported having substantially less trouble paying their child’s medical bills — only 8 percent of CHIP parents reported having such trouble, versus 31 percent of parents with privately insured children.

As CHIP’s future is debated in the coming months, lessons from this evaluation can ensure that decisions about CHIP policies and programs are grounded in objectivity and rigorous research. Given CHIP’s proven success, the question remaining for policymakers is how to build upon CHIP’s accomplishments to achieve additional coverage, access and quality gains for children.

Mary Harrington is a vice president at Mathematica Policy Research. Her research focuses on evaluating safety net providers, delivery systems, Medicaid and the Children’s Health Insurance Program.

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