title: Enrollment, expenditures, and utilization after CHIP expansion: evidence from Alabama.
abstract: OBJECTIVE
  In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program (CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100-200% FPL) and assessed the impact of expansion on total program expenditures.
  
  
  METHODS
  We compared unadjusted mean person-month-level expenditures and utilization of expansion enrollees and various categories of existing enrollees and used a 2-part modeling strategy to examine differences after controlling for enrollee characteristics. We used probit models to examine adjusted differences in reenrollment behavior by eligibility category.
  
  
  RESULTS
  Expansion enrollees had higher total monthly expenditures ($10.33, P < .05) than traditional ALL Kids enrollees, including higher outpatient ($5.35, P < .001) and dental ($0.85, P < .01) expenditures but lower emergency department (-$1.34, P < .001) expenditures. Expansion enrollees had marginally lower utilization of emergency department services for low-severity conditions and higher utilization of physician outpatient visits. Expansion enrollees were 4.47 percentage points (P < .001) more likely to reenroll before their contract expiration date than traditional ALL Kids enrollees. As of October 2012, expansion enrollees accounted for approximately 20% of ALL Kids enrollment and expenditures.
  
  
  CONCLUSIONS
  The expansion population was characterized by moderately higher health expenditures and utilization, and more persistent enrollment relative to fee group enrollees who are subject to the same levels of cost sharing and annual premiums. Although states are prohibited from changing program eligibility until 2019, the costs associated with the expansion population will be important to future policy decisions.
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Ala; UAB Lister Hill Center for Health Policy, Birmingham, Ala. Electronic address: dbecker@uab.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Ala; UAB Lister Hill Center for Health Policy, Birmingham, Ala.
authors.forename: Justin
authors.initials: J
authors.lastname: Blackburn
authors.affiliation: Department of Health Policy and Management, Texas A&M University, School of Rural Public Health, College Station, Tex.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morrisey
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Ala; UAB Lister Hill Center for Health Policy, Birmingham, Ala.
authors.forename: Bisakha
authors.initials: B
authors.lastname: Sen
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Ala; UAB Lister Hill Center for Health Policy, Birmingham, Ala.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: Bureau of Children's Health Insurance, Alabama Department of Public Health, Montgomery, Ala.
authors.forename: Cathy
authors.initials: C
authors.lastname: Caldwell
authors.affiliation: Bureau of Children's Health Insurance, Alabama Department of Public Health, Montgomery, Ala.
authors.forename: Chris
authors.initials: C
authors.lastname: Sellers
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Ala; UAB Lister Hill Center for Health Policy, Birmingham, Ala.
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D000293:Adolescent; D000407:Alabama; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D065326:Children's Health Insurance Program; D017047:Cost Sharing; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index
keywords: CHIP; enrollment; expansion; expenditures; utilization