MCHPRC: Publications

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SCHIP

Reports:

SCHIP Programs More Likely to Increase Children's Cost Sharing than Reduce Their Eligibility or Benefits to Control Costs.

by Harriette B. Fox and Stephanie J. Limb, Fact Sheet No. 4, 6 pages,

April 2004.

This fact sheet reports on the SCHIP program changes that states have made over the last 16 months in response to budget shortfalls. It examines policy changes in eligibility and enrollment, covered benefits, and cost-sharing requirements and is based on information from SCHIP directors in all 50 states with SCHIP programs in March 2004. It shows that despite difficult financial circumstances, nearly all states are protecting their SCHIP programs from cuts in eligibility and benefits but many are asking parents to contribute more to the cost of children's coverage, usually in the form of new or higher premiums. Importantly, also, some states have taken steps to increase either enrollment or benefits.

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Eligibility, Benefits, and Cost-sharing in Separate SCHIP Programs
by Harriette B. Fox, Ruti G. Levtov, and Margaret A. McManus. Report, 34 pages, October 2003.
This report describes eligibility, benefit, and cost-sharing policies in 36 separate SCHIP programs. Detailed state tables are included on SCHIP and Medicaid income eligibility levels, SCHIP benefit policies, and premium, copayment, and coinsurance amounts. The information is based on an analysis of state plan documents, managed care contracts, and provider and member manuals, as well as telephone interviews and email correspondence with state SCHIP agency staff.

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State SCHIP Requirements and Innovations for Children with Special Health Care Needs
by Harriette B. Fox, Stephanie J. Limb, and Margaret A. McManus, September 2002.
This report examines SCHIP policies and practices affecting children with special health care needs in states serving children through managed care organizations. The report contains information on covered services, managed care organization enrollment and benefit responsibilities, definition and identification of children with special health care needs, and contract provisions concerning specialty care. The analysis was based on an examination of state managed care contract documents and telephone interviews with SCHIP officials.
Available from the Center for Health Care Strategies.

Few States Report S-CHIP Program Cuts Before the End of FY 2002
by Harriette B. Fox, Mary B, Reichman, and Margaret A. McManus, Fact Sheet No. 1, 4 pages, January 2002.
This fact sheet provides information on SCHIP program changes in fiscal years 2002 and 2003 as a result of federal and state budgetary reductions. The information, which covers cost-saving measures pertaining to both administrative functions and enrollment, benefit, cost sharing, and other program policies, is based on a brief survey of SCHIP program directors conducted in November and December of 2001.
Download a free pdf of this report.

S-CHIP Managed Care Contracting
by Harriette B. Fox and Margaret A. McManus Report, 30 pages, December 2000. Available from the Kaiser Family Foundation (1-800-656-4533; package code 2235).
This report examines the managed care contracting issues confronting five states (California, Connecticut, Maryland, Missouri, and Utah) during the first year of SCHIP implementation. The report compares contract provisions regarding provider networks, service access, and quality reporting among the five states, two of which relied on Medicaid programs and three of which relied on commercial health insurance programs. The report includes detailed tables on the states´ benefits and cost-sharing requirements, along with a description of each state´s program. Information was obtained primarily through on-site interviews with key S-CHIP officials and reviews of state managed care contract documents.
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S-CHIP Administration and Accountability
by Margaret A. McManus and Harriette B. Fox. Report, 31 pages, December 2000. Available from the Kaiser Family Foundation (1-800-656-4533; no package code 2234).
This report describes how five states (California, Connecticut, Maryland, Missouri, and Utah) administered their SCHIP programs during the first year of implementation. It examines these states´ program design and administrative decisions and the implementation challenges they faced concerning enrollment, premium collection, tracking cost sharing, and quality oversight. Detailed tables on benefits and cost-sharing requirements and a description of each state’s program are provided. Information was obtained primarily through on-site interviews with key SCHIP officials and reviews of state managed care contract documents.
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Access to Care for S-CHIP Adolescents
by Harriette B. Fox, Margaret A. McManus, and Stephanie J. Limb. Report, 45 pages, December 2000. Available from the Kaiser Family Foundation (1-800-656-4533; package code 2243).
This report examines S-CHIP implementation issues and challenges affecting access to care by adolescents in five states (California, Connecticut, Maryland, Missouri, and Utah). The report describes special S-CHIP contract provisions pertaining to adolescents and examines provider network availability, service coverage, and access to primary care, dental care, family planning services, and mental health services. Also included in the analysis are issues pertaining to the use of health risk assessments, cost sharing, and confidentiality. Detailed tables on benefits and cost-sharing requirements and a description of each state’s program are provided. Information was obtained primarily through on-site interviews with S-CHIP officials, managed care organization officials, providers, and families.
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Access to Care for S-CHIP Children with Special Health Needs
by Harriette B. Fox, Margaret A. McManus, and Stephanie J. Limb. Report, 64 pages, December 2000. Available from the Kaiser Family Foundation (1-800-656-4533; package code 2226).
This report presents findings from a five-state study of S-CHIP implementation issues and challenges affecting access to care by children with complex physical, developmental, behavioral, and emotional conditions. The report examines access to pediatric specialty and mental health networks; access to covered services, including mental health treatment and prescription drugs; and the operation of two states´ wrap-around benefit programs for children with special needs. Also examined are cost-sharing requirements, plan selection, and the use of health risk assessments. The report provides detailed tables on enrollment, benefits, and cost-sharing requirements as well as a description of each state’s program. Information was obtained primarily through on-site interviews with S-CHIP officials, managed care organization officials, providers, and families.
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An Analysis of States´ CHIP Policies Affecting Children with Special Health Care Needs
by Harriette B. Fox, Regina R.Graham, Margaret A.McManus, and Christine Y. Chen. Issue Brief No. 5, 62 pages, April 1999, $40.00.
This issue brief examines how S-CHIP plans, approved as of January 31, 1999, were structured with respect to eligibility, benefits, plan arrangements, and cost-sharing policies to serve children who have special health care needs. The report includes detailed state tables on each of these topics and includes information on carve-out policies, quality assurance requirements, and insurance arrangements. Information for the report was obtained through an extensive analysis of the 48 approved S-CHIP applications, including state responses to HCFA´s questions and conditions; all S-CHIP contract documents constituting the managed care contract with insurers; and interviews of S-CHIP program directors.
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Cost-Sharing Options Under the State Children´s Health Insurance Program
by Harriette B. Fox, Margaret A. McManus, Jack Rodgers, and Kathy-Jo B. Hayden. Issue Brief No. 3, 16 pages, March 1998, $25.00.
This issue brief examines four cost-sharing options available to states, including premiums, deductibles, copayments or coinsurance, and the five percent cost-sharing maximum.
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New Estimates of Children with Special Health Care Needs and Implications for the State Children´s Health Insurance Program
by Paul W. Newacheck, Kristen Marchi, Margaret A. McManus and Harriette B. Fox. Fact Sheet No. 4, 2 pages, March 1998, $10.00.
This fact sheet provides national estimates of the number and characteristics of uninsured children with existing special health care needs whose family incomes are below 200% of the federal poverty level, based on the National Health Interview Survey.
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The Potential for Crowd Out Due to CHIP: Results from a Survey of 450 Employers
by Harriette B. Fox and Margaret A. McManus. Fact Sheet No. 3, 4 pages, March 1998, $10.00.
This fact sheet analyzes 1998 survey results from 450 small, medium, and large employers regarding their likely responses to CHIP. It also includes a variety of state strategies to prevent employers from eliminating or reducing coverage for CHIP-eligible children.
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Plan and Benefit Options Under the State Children´s Health Insurance Program
by Harriette B. Fox, Margaret A. McManus, Regina R. Graham and Ruth A. Almeida. Issue Brief No. 2, 15 pages, January 1998, $25.00.
Read this document as a Web page.
This issue brief examines each of the five state child health insurance benefit options: Medicaid, benchmark coverage, benchmark-equivalent coverage, Secretary-approved coverage, and direct services under a waiver. Also included are tables on benefits in: the standard federal employees benefit plan, state employees´ benefit plans in five selected states, and the largest commercial HMO benefit plans in five selected states.
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Eligibility Options Under the State Children´s Health Insurance Program
by Harriette B. Fox, Margaret A. McManus, Ruth A. Almeida, and Regina R. Graham. Issue Brief No. 1, 13 pages, December 1997, $25.00.
This issue brief analyzes six different state options related to eligibility policies for CHIP. These include income options, access-to-care coverage options, age and income options, disability and income options, geographic and income options, and family coverage options.
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Early Assessments of SCHIP’s Effect on Access to Care for Adolescents
by Harriette B. Fox, Margaret A. McManus, and Stephanie J. Limb
Journal of Adolescent Health. Vol. 32, no.6, pp. 40-52, supplement to June 2003.
This article examines implementation issues and challenges affecting access to care for adolescents during the first year of SCHIP operation in five states (California, Connecticut, Maryland, Missouri, and Utah).

Access to Health Care for Children with Special Health Care Needs.
by Paul W. Newacheck, Margaret A. McManus, Harriette B. Fox, Yun-Yi Hung, and Neal Halfon. Pediatrics. Vol. 105, No. 4 Pt 1, pp. 760-66, April 2000.
This article presents findings from the 1994-1995 National Health Interview Survey on Disability on the number of U.S. children who have an existing special health care need and their health insurance status. It also describes differences in access for children with and without health insurance coverage. Policy implications for the State Children´s Health Insurance Program are discussed.