In October 2009, Alabama expanded eligibility in its Children’s Health Insurance Program (CHIP), known as ALL Kids, from 200 to 300 percent of the federal poverty level (FPL). Dr. David J. Becker, associate professor in the department of health care organization and policy at the University of Alabama at Birmingham, examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100 to 200 percent FPL) and assessed the impact of expansion on total program expenditures. Co-investigators in the study include UAB department colleagues Dr. Justin Blackburn, assistant professor; Dr. Michael A. Morrisey, professor emeritus; Dr. Bisakha Sen, professor; Dr. Meredith Kilgore, professor and chair; and Dr. Nir Menachemi, professor; along with UAB alumna Ms. Cathy Caldwell, director of the Bureau of Children’s Health Insurance in the Alabama Department of Public Health.
The researchers compared unadjusted mean person-month-level expenditures and utilization of expansion enrollees and various categories of existing enrollees and used a two-part modeling strategy to examine differences after controlling for enrollee characteristics. They used probit models to examine adjusted differences in reenrollment behavior by eligibility category.
Results indicate that 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 percent of ALL Kids enrollment and expenditures.
The team concluded that expansion population was characterized by moderately higher health expenditures and utilization, and by 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.
“Enrollment, Expenditures, and Utilization After CHIP Expansion: Evidence From Alabama” is published in the May-June issue of the journal Academic Pediatrics.