Who Are the Children Enrolling in SCHIP and Medicaid?

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.

Introduction

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.

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.

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.

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.