Who Are the Children Enrolling in SCHIP and Medicaid?

Findings from the HealthWave Evaluation Project

6 Min Read

Sep 01, 2003


Robert F. St. Peter, M.D.,

R. Andrew Allison, Ph.D.,

Charles L. Betley, M.A.


Key Points

This report describes characteris­tics of children entering SCHIP and Medicaid, as well as charac­teristics of their families.

    • SCHIP was designed to provide insurance coverage to children in low-income, working families earning too much to qualify for Medicaid, but unable to afford pri­vate insurance.
    • Consistent with this intent, 87 percent of enrollees in SCHIP had at least one employed parent. Medicaid enrollees’ parents were less likely to be employed; never­theless, two-thirds (68 percent) of Medicaid children had at least one working parent.
    • SCHIP enrollees lived in house­holds whose head attained higher educational levels; they also were more likely than children in Medicaid to have family incomes above the federal poverty level.
    • Because Medicaid allows younger children to qualify for coverage with higher family incomes, it tended to enroll more young children. SCHIP enrolled larger proportions of older chil­dren and adolescents.
    • Demographic measures show SCHIP serves children of low-income, working families, consis­tent with the design of the program. Medicaid serves a younger popula­tion with greater economic needs.


In 1997, Congress created the State Children’s Health Insurance Program (SCHIP) under Title XXI of the Social Security Act. SCHIP provides federal funds to state programs of health insurance for uninsured, low-income children who are not eligible for Medicaid. Medicaid covers children in very low-income families, including families transitioning from welfare to work, along with having special eligibility categories for disabled and low-income adults with high medical expenses. States are permitted to use SCHIP funds to expand Medicaid plans, establish a health insur­ance program with benefits similar to employment-based coverage, or a com­bination of both. The SCHIP program in Kansas, originally a separate program, was integrated in 2001 with the state’s Medicaid program, under the name HealthWave.

Children must meet age and family income standards to be eligible; Medicaid income thresholds allow enrollment with family income up to 150 percent of federal poverty levels (FPL) up to age one, 133 percent FPL up to age six, and 100 percent FPL between ages six and 19. SCHIP extends coverage to children with incomes up to 200 percent of the FPL.

Key Findings

Children enrolling in SCHIP were more likely to have employed parents and reside in households with greater educational attainment and comparatively higher incomes, than children enrolling in Medicaid.

SCHIP covers a larger proportion of children whose parents are employed full-time than Medicaid. Compared to 47 percent of Medicaid enrollees, 68 percent of SCHIP children had at least one parent who was employed full-time. The large proportion of full-time workers among SCHIP parents raises the question: to what degree does the program provide insurance coverage for working families for whom private employment-based coverage may be an option? Future Research Briefs will address this question.

Bar chart: SCHIP and Medicaid most parents of public health insurance enrollees are employed

Large proportions of Medicaid-eligible families also participate in the labor force; only 32 percent of Medicaid children are in families where neither parent is working.

SCHIP enrollees tend to live in households whose heads achieved greater lev­els of education than those of Medicaid enrollees.  Among children enrolling in SCHIP, 36 percent lived in households where the head of household attended at least some college or were college graduates, compared with 26 percent of children in Medicaid. The difference in the eligibility criteria of SCHIP and Medicaid is also reflected in the relative difference in family incomes of enrollees.

For children enrolling in Medicaid, 81 percent were in families below 150 percent FPL, compared with only 68 percent of children enrolling in SCHIP. Consistent with these other socioeconomic advantages, SCHIP enrollees were somewhat more likely to reside in two-parent house­holds (55 percent vs. 45 percent in Medicaid). Differences between the programs in enrollees’ race and eth­nicity and their experience of language barriers will be explored in later Research Briefs.

Chart showing SCHIP families have higher education, greater income, and are more likely to have two parents

SCHIP children tend to be older than Medicaid children.

Because children under the age of six are allowed to enroll in Medicaid at higher family income lev­els, children enrolling in SCHIP were more likely to be older children and adolescents.

SCHIP provides larger numbers of older children access to Kansas health programs. The programs should assure that providers are available to meet the special health care needs of adolescents, such as counseling for at-risk behaviors.

Most enrollees in both SCHIP and Medicaid reside in urban areas, but Medicaid enroll­ment is more heavily urban.

Bar Chart showing SCHIP tends to enroll older children than Medicaid

Program enrollment is propor­tionate to the share of the total Kansas population (85 percent) residing in urban areas and densely settled rural counties (those with 20 or more persons per square mile). Most children newly enrolling in SCHIP (81 percent) and Medicaid (86 percent) lived in these counties.

Discussion and Policy Implications

Although SCHIP and Medicaid are both health insurance programs directed at low-income children, their enrollees differ in a number of ways that are consistent with the policies for gaining eligibility for each program.

Families with children in SCHIP are of somewhat higher socioeconomic status than families with children enrolled in Medicaid; SCHIP children live in families with greater educational attainment, more work force par­ticipation, and relatively greater incomes.

Children newly enrolled in SCHIP also tend to be older, which is consistent with the age differences in program eligibility. SCHIP provides health insurance for low-income families who may have improved their economic status (relative to most Medicaid fam­ilies) as they and their children mature. Although most children enrolling in SCHIP have parents who are employed full-time, SCHIP provides access to health insurance coverage that may not be available or affordable at their place of employment.

Quote: Although SCHIP and Medicaid are both health insurance programs directed a low-income children, their enrollees differ in a number of ways that are consistent with the policies for gaining eligibility in each program.

About Kansas Health Institute

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.

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