The impact of program structure on children's disenrollment from Medicaid and SCHIP

Program fragmentation might exacerbate disenrollment of children from Medicaid and the State Children's Health Insurance Program (SCHIP). Using data from 2001-2004, I estimated the number of children who switched programs and the number who "dropped out" of public insurance--becoming uninsured despite continuing eligibility. Roughly two million children a year switched programs; 12.5 percent a year dropped out of Medicaid, and 15.6 percent a year dropped out of SCHIP. Children in states with separate SCHIP and Medicaid programs were 45 percent more likely to drop out. This effect persisted after controlling for demographic and policy variables. Administering multiple distinct public insurance programs appears to be counterproductive in terms of retention.