Discontinuity of coverage for Medicaid and S-CHIP children at a transitional birthday.

RESEARCH OBJECTIVE: To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). DATA SOURCES: Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. STUDY DESIGN: The likelihood of dropping public coverage after the reference birthday is modeled for children turning age 6 compared with a control cohort of children turning age 9 controlling for demographic and geographic differences between enrollees. PRINCIPAL FINDINGS: Over 17 percent of 6-year-olds versus only 7 percent of the control cohort dropped coverage. After controlling for other factors (e.g., race/ethnicity, prior enrollment, and geographic region) having lower historical expenditures is predictive of dropping coverage among all children, although the unadjusted effect is stronger among children enrolled in PeachCare before their sixth birthday. Only 1 percent of Medicaid children who remained covered transitioned to PeachCare. CONCLUSIONS: Turnover at transitional birthdays identifies a common pathway for children into the ranks of the uninsured. Facilitating continuous enrollment would retain in the programs children with lower than average expenditures. This may be one of the more cost effective ways of reducing the number of uninsured children in Georgia.

The stigma of public programs: does a separate S-CHIP program reduce it?

Previous studies suggest access to and satisfaction with care may be different for enrollees in S-CHIP and Medicaid, but it is unclear whether those differences are fully explained by socioeconomic characteristics of the enrollees. We analyze access and satisfaction of three groups of children: Medicaid enrolled, S-CHIP enrolled, and children who are income eligible for Medicaid but carry a card similar to the state's S-CHIP children's card. Both enrollees and providers may believe that these children are enrolled in S-CHIP despite the fact that reimbursement is through the state's Medicaid system. Results indicate that the same network of providers treat, or are perceived by families to treat, the three groups differently. They support the notion that some of the differences in satisfaction between S-CHIP and Medicaid enrollees are related to unmeasured characteristics (for example, income) of the families in the different programs, but that programmatic identity contributes substantially to differential care experience.