Instability of Public Health Insurance Coverage for Children and Their Families: Causes, Consequences, and Remedies

Abstract

This report examines the extent, causes, and consequences of instability in public coverage programs for children and families. It focuses particularly on the phenomenon of "churning," which occurs when individuals lose and regain coverage in a short period of time. It also looks at strategies to make public program coverage more stable for children and families. Findings are drawn from a variety of sources, including national and state-based studies, roundtable discussions and interviews with stakeholders and experts, and an examination of the effect of state and local policies on instability and churning in four states: Louisiana, Rhode Island, Virginia, and Washington. The experiences of these states demonstrate that coverage instability can be averted to a significant degree by adopting key policies and procedures, like limiting the frequency of required renewals; developing easy, seamless transitions among public coverage programs; and setting affordable limits on premium costs. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Fund publications are available online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund's Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 935.iii CONTENTS

Medicaid At The Ten-Year Anniversary Of SCHIP: Looking Back And Moving Forward

“…20 However, states do not always pursue these strategies, or they might abandon or curtail them when state budgets are under pressure, because effective strategies will result in additional coverage costs. 21 This is a particular problem for Medicaid, given that the federal government pays a lower share of coverage costs compared with its payments to SCHIP.…”

Inadequate Cancer Screening: Lack of Provider Continuity is a Greater Obstacle than Medical Mistrust

“…21–26 La Veist et al showed that mistrust toward health care organizations leads to failure to take medical advice and to keep follow-up appointments, 27 while Brookhart et al showed that provider continuity is positively associated with medical adherence. 28 Given that medical mistrust and lack of provider continuity are thought to be more common among racial minorities and low-income populations, 25,29–32 their potential role in the observed cancer mortality disparities among these groups should be explored.…”

Medicaid and CHIP Children’s Healthcare Quality Measures: What States Use and What They Want

“…16,17 From the authors' extensive ongoing interactions with Medicaid and CHIP officials, it seems that many more states would like to measure performance on this dimension, both for its utility in assessing enrollment efforts and because continuous enrollment is a prerequisite for valid measurement of quality of care. 18 Availability of services also is included in CHIPRA specifications for the initial core set of pediatric quality measures, and the NASHP survey reflects considerable state concern in this area. Roughly two thirds of states reported inadequate provider capacity in either or both of their S-CHIP or M-CHIP programs.…”