SCHIP Expansion May Present Lower Cost Collection Opportunities

A new report by the Agency for Healthcare Research and Quality (AHRQ) found that children enrolled in Medicaid programs like the State Children's Health Insurance Program (SCHIP) were less likely to use hospital emergency departments.

The findings suggest that hospitals’ bad debt associated with the previously uninsured children declined because of higher enrollment in the public health programs for children. But the positive impact SCHIP programs have on hospital bad debt expense could be short lived.

The report also found that children enrolled in the public insurance health plans were less likely to see a primary care physician for well-child visits and other primary care needs. Researchers say that certain mandates on physicians, such as requiring they see a minimum number of patients, give all SCHIP enrollees open access to care without a referral, and provide office or telephone availability 24 hours a day, seven days a week led some physicians to stop seeing kids enrolled in their state public health plans for children.

The study looked specifically at primary care case management (PCCM) programs in Georgia and Alabama between 1994 and 2000. The expanded State Children's Health Insurance Program signed into law earlier this year aims to boost the number of uninsured children in the government-subsidized insurance plan to 11 million, reducing by nearly half the number of uninsured children in America over the next four years.  

According to AHRQ, more than half of the states operate Medicaid PCCM systems, and about 30 percent of SCHIP enrollees are served by PCCM systems.  The agency said policy makers are interested in the impact the type of delivery system has on low-income children’s access to care.

Health policy experts say the report provides lessons that could avert similar problems surrounding access to care and an unintended health care expense shift back to hospital emergency rooms at a higher cost to taxpayers. And the findings could provide a roadmap for how any universal coverage policies might be implemented.

Experts say it is incumbent that patients have a primary care home to reduce the need for specialty care and emergency room department care.  Meanwhile, lawmakers and health policy experts don’t want to see a repeat of findings in Georgia and Alabama, which showed that well-child care and primary care use declined, partly due to program policies.