CHIP scorecard reveals uneven care across states

Two years after the reauthorization and expansion of the Children's Health Insurance Program, a state-by-state scorecard designed to evaluate how the system is working finds wide geographic disparities, according to the Commonwealth Fund.

"Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011" analyzed 20 indicators of how the health system is performing for children in each state. Drawing on the most recently available data, the report compares each state to benchmarks that have already been achieved in one or more states.

The scorecard found that federal and state action on behalf of children has helped preserve, and even expand, health coverage for this group, despite the severe recession. However, it also found that wide differences persist among states when it comes to health insurance coverage, the affordability of healthcare for families, children's receipt of preventive care and treatment, and the opportunity for children to lead healthy lives.

The report finds strong evidence for the value of federal and state policies aimed at improving rates of health insurance coverage. Early expansions of Medicaid at the start of the decade, Medicaid stabilization funds from the American Recovery and Reinvestment Act and the expansion and reauthorization of CHIP in February 2009 allowed states to continue to provide and, in some cases, expand health insurance for children during the economic downturn. And while coverage rates for parents have declined in 41 states over the past decade, children have fared dramatically better, with rates increasing in 35 states over the same period.

[See also: Kaiser survey eyes federal funding for Medicaid, CHIP enrollment]

According to the study, children living in the five top-ranked states – Iowa, Massachusetts, Vermont, Maine and New Hampshire – are more likely to be insured and receive recommended medical and dental check-ups than children living in poorer-performing states like Florida, Texas, Arizona, Mississippi or Nevada.

According to the study, if all states could do as well as the best states:

• 5.6 million additional children would have health insurance;
• 10.2 million more children would receive routine preventive medical and dental check-ups;
• Nearly 600,000 more children would be up to date on their vaccinations; and
• 8.8 million more children would be part of a medical home care delivery process.

[See also: HHS doles out $206M to states for enrolling kids in Medicaid]

"While children were able to gain and keep their health insurance thanks to Medicaid and CHIP, parents lost coverage as the job market deteriorated and cost of health insurance rose to unaffordable levels," said Cathy Schoen, the Commonwealth Fund's senior vice president and co-author of the report. "The study demonstrates how policies designed to maintain children's health insurance and access to healthcare have helped children get the healthcare they need, especially in tough economic times. Yet, because so many parents are uninsured, children and their families will remain at high risk until 2014, when access to health insurance will be expanded to include nearly everyone in the U.S."

While states in New England and the upper Midwest generally rank highest in the scorecard and states across the South and Southwest rank lowest, there are exceptions. For example, 94 percent of children in Alabama are insured, making it a standout among Southern states. North Carolina, meanwhile, has the highest rate of developmental screening – a direct result of an innovative statewide effort. The report notes that when state and local policies target specific issue areas, they are often effective in improving care and outcomes.

The states in the top-ranked quartile for overall performance – Iowa, Massachusetts, Vermont, Maine, New Hampshire, Rhode Island, Hawaii, Minnesota, Connecticut, North Dakota, Pennsylvania, Wisconsin, Kansas and Washington – often perform well on multiple indicators and across dimensions. However, on many indicators there is room for improvement in all states. No state scores in the top 10 for all indicators. Further, the report finds that even leading states still have substantial shortfalls for children.

The report highlights the relationships between different components of states' healthcare systems. Seven of the 13 states that lead on access and affordability also rank among the top states in prevention and treatment. Children in states with the lowest uninsured rates are more likely to have access to a medical home type of healthcare delivery, get preventive care or receive referrals tfor needed care than children in states with the highest uninsured rates.

"A healthy start in life is essential for a child's success," said co-author and Commonwealth Fund Vice President Edward Schor, MD.

"The wide differences in healthcare across the U.S. puts that healthy start in jeopardy for millions of children. We can do better," he said. "What is unique about this scorecard is that it looks at what has been achieved by the top states and holds that performance up as an example for other states – because if it's possible to insure almost all of the kids in Alabama, it should be possible in Texas and Mississippi. State and health care system leaders just need to make it a priority."