Wisconsin's recent BadgerCare enrollment decline: how administrative rules can set off unanticipated change

The State Children's Health Insurance Program (SCHIP) has been intended to provide healthcare coverage to that group of children previously caught between Medicaid eligibility and adequate access to employer insurance. However, SCHIP can be implemented quite differently across the states, potentially affecting actual enrollment. We review prior studies that have attempted to dissect how the administration of SCHIP impacts enrollment, including a multivariate study by the authors that indicates presumptive eligibility, expanded parent coverage, and 12-month continuous eligibility all contribute to a reduced likelihood of being uninsured. We then detail an administrative policy change in one state, Wisconsin, that yielded unanticipated and dramatic enrollment fluctuations in its SCHIP program, BadgerCare.