Children's Health Insurance: GAO Review of HHS OIG's SCHIP Studies

This communication from the Goverment Accountability Office (GAO) informs Congress about the results and reliability of recent HHS and Office of the Inspector General (OIG) reviews of SCHIP enrollments. The reviews were conducted to determine levels of inappropriately enrollments. Congress has stipulated that children eligible for Medicaid are not eligible for SCHIP. Congress is also interested in determining the success of the SCHIP program in reducing the number of uninsured children. To gauge the SCHIP program progress in meeting this goal, states may use national data sets such as the Current Population Survey (CPS) or they may conduct their own surveys. 

The OIG examined a sample of state SCHIP files. The OIG estimates from this review that only 1% of children are improperly enrolled in SCHIP. In the course of the review, OIG remarked that 7% of the files lacked complete documentation to support the SCHIP eligibility However, despite the gaps in documentation, other evidence in the files indicated that the enrollments were not inappropriate. The OIG estimated that nationwide inappropriate SCHIP enrollments vary between 0.3% and 2.6% of total SCHIP enrollments.

The OIG conducted a review of Medicaid expansion case files. Ten percent of files were found to have missing eligibility documentation. 

The OIG also noted that states face challenges in measuring the change in the number of low-income, uninsured children in part because the most common data source used, the CPS, has not produced reliable state level estimates in the past. The OIG suggested and the GAO agreed that the Centers for Medicare and Medicaid Services could successfully measure reductions in low-income, uninsured children by completing its own analysis of CPS data.