Following fast-paced growth in the late 1990s, the State Children's Health Insurance Program numbers had started to level off in the past few years as tighter state budgets forced legislators and administrators to scale back spending on the popular program. Despite budget problems, the majority of the states still saw slight enrollment increases. The overall total, however, was decreased by the large number of children that were dropped from the rolls in a few states, most notably Texas, where a combination of program changes went into effect in an effort to save money. Subsequently, the state's rolls lost 147,000 children, a 29 percent decline, between September 2003 and August 2004.
Because of the nature of SCHIP--covering children whose families earn too much money to be eligible for Medicaid but not enough money to purchase private insurance--there is a lot of flux in the population of eligible children as family circumstances change. "SCHIP enrollment really is related to the extent to which states invest in outreach and case finding," says Vernon Smith, a principal with Health Management Associates and the author of a July report for the Kaiser Commission on Medicaid and the Uninsured that tracks the enrollment decline. "When there's not an effort to reach those newly eligible kids, enrollment will level out."
