Enrollment, expenditures, and utilization after CHIP expansion: evidence from Alabama
| Autor: | Meredith L. Kilgore, Nir Menachemi, Michael A. Morrisey, Bisakha Sen, Chris Sellers, Justin Blackburn, Cathy Caldwell, David J. Becker |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Adolescent Population Severity of Illness Index Children's Health Insurance Program Ambulatory care Policy decision Probit model Health insurance Ambulatory Care Medicine Humans Cost Sharing education Child Dental Health Services education.field_of_study business.industry Infant Newborn Infant Patient Acceptance of Health Care Child Preschool Pediatrics Perinatology and Child Health Alabama Cost sharing Female Health Expenditures business Emergency Service Hospital Poverty level Demography |
| Zdroj: | Academic pediatrics. 15(3) |
| ISSN: | 1876-2867 |
| Popis: | In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program (CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100-200% FPL) and assessed the impact of expansion on total program expenditures.We compared unadjusted mean person-month-level expenditures and utilization of expansion enrollees and various categories of existing enrollees and used a 2-part modeling strategy to examine differences after controlling for enrollee characteristics. We used probit models to examine adjusted differences in reenrollment behavior by eligibility category.Expansion enrollees had higher total monthly expenditures ($10.33, P.05) than traditional ALL Kids enrollees, including higher outpatient ($5.35, P.001) and dental ($0.85, P.01) expenditures but lower emergency department (-$1.34, P.001) expenditures. Expansion enrollees had marginally lower utilization of emergency department services for low-severity conditions and higher utilization of physician outpatient visits. Expansion enrollees were 4.47 percentage points (P.001) more likely to reenroll before their contract expiration date than traditional ALL Kids enrollees. As of October 2012, expansion enrollees accounted for approximately 20% of ALL Kids enrollment and expenditures.The expansion population was characterized by moderately higher health expenditures and utilization, and more persistent enrollment relative to fee group enrollees who are subject to the same levels of cost sharing and annual premiums. Although states are prohibited from changing program eligibility until 2019, the costs associated with the expansion population will be important to future policy decisions. |
| Databáze: | OpenAIRE |
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