Department of Health and Human Services
 
OFFICE OF 

   
INSPECTOR GENERAL 

 
 
 
 
 
 
 
 
ASSESS  ING STATES  PROGRESS 

 
M S C 
IN  EETING  TATE  HILDREN S 

 
 
H I P
EALTH  NSURANCE  ROGRAM 

 
  G  
OALS 

 
 
 
 
 
Daniel R. Levinson 
  
Inspector General 

 
September 2007 
 
OEI-05-07-00330 
   
 
 
Office of Inspector General 

 
http://oig.hhs.gov 
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452,  
as amended, is to  protect the integrity of  the Department of Health and Human Services 
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statutory mission  is  carried  out through  a nationwide network  of  audits, 
investigations, and inspections conducted by the  following operating components:  
Office of Audit Services 
The Office of Audit Services (OAS) provides all auditing services  for HHS, either by  
conducting audits with its  own audit resources or by overseeing audit work done by others.   
Audits examine the performance of HHS programs and/or its grantees and  contractors  
in carrying out  their respective responsibilities and are intended  to provide independent  
assessments of  HHS programs and operations.  These assessments help reduce waste, 
abuse, and mismanagement  and  promote economy and  efficiency throughout HHS. 
Office of Evaluation and Inspections  
The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
HHS, Congress, and the public with timely, useful, and reliable information on 
significant issues.  Specifically, these evaluations focus on preventing fraud,  waste,  or  
abuse and promoting  economy, efficiency, and effectiveness  in departmental programs.  
To promote impact, the reports also present practical recommendations for improving 
program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative  
investigations  of  allegations of wrongdoing  in HHS  programs or to HHS  beneficiaries  
and of unjust enrichment by  providers.  The investigative  efforts  of OI lead to  criminal  
convictions, administrative sanctions,  or  civil monetary penalties.  
Office of Counsel to the Inspector General 
The  Office of Counsel to the Inspector General (OCIG)  provides  general legal services  to  
OIG, rendering  advice and opinions on HHS programs  and operations and providing all 
legal support in OIG's internal operations.   OCIG imposes program exclusions and civil 
monetary penalties  on health care providers and litigates  those actions  within HHS.   
OCIG also  represents OIG in the global settlement of  cases  arising under the Civil False 
Claims Act, develops and monitors corporate integrity agreements, develops compliance 
program guidances, renders advisory opinions on OIG sanctions to  the health care  
community,  and issues fraud alerts  and other industry  guidance.  
   
   
  E X E C U T I V E   S U M M A R Y
OBJECTIVES 
1.  To assess States progress in reducing the number of uninsured 
        
low-income children. 

2.  To assess States progress in meeting performance goals related to 
the State Childrens Health Insurance Program (SCHIP). 
BACKGROUND 
The Balanced Budget Refinement Act of 1999 requires that every           
3 years the  Office of Inspector General (1) evaluate whether States are 
enrolling Medicaid eligible children in their SCHIP programs and           
(2) assess States progress in reducing the number of uninsured              
low-income children, including their progress in meeting the strategic 
objectives and performance goals included in State plans.  This study 
addresses the second  mandate.  The first mandate is addressed in a 
separate study. 
The Balanced Budget Act of 1997 created SCHIP to provide health 
insurance coverage to uninsured low-income children.  To receive 
SCHIP funding, a State must submit a State plan that describes the 
purpose, nature, and scope of its SCHIP program. States must annually 
assess the operation of their State plans in Annual Reports.  In the 
Annual Reports, States  must report their progress in reducing the 
number of uninsured low-income children and meeting performance 
goals. 
To assess States progress in reducing the number of uninsured            
low-income  children, we analyzed the percentage change between          
2002 and 2005 in the number of uninsured low-income children out of 
the total population of low-income children.  To assess States progress 
in meeting their performance goals, we analyzed all performance goals 
listed in States fiscal year (FY) 2006 Annual Reports and compared 
progress to FY 2005. 
FINDINGS 
Nationally  the percentage of uninsured low-income children 
decreased between 2002 and 2005.  Nationally the percentage of 
uninsured low-income children had a statistically significant decrease 
from 20 percent in 2002 to 18.5 percent in 2005.  
 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   i   
   
E X E C U T I V E   S U M M A R Y   
However, no State had  a statistically  significant change in  the 
percentage  of uninsured low-income children.  While each States 
sample showed changes in the percentage of uninsured low-income 
children, none of the changes were significant when projected to the 
entire State at the 90-percent confidence level.  Because of small State 
sample sizes, statistical tests are limited in accurately detecting modest  
changes at the State-level.   
In 2006,  37 States met or made  progress in meeting at  least half of 
their performance goals.  Almost half of the 37 States met or made 
progress in meeting between 50 percent and 74 percent of their goals.  
Of the States that reported progress, the largest  number of States 
reported progress for performance goals related to increasing access to 
care and increasing the  use of preventative care.    
Despite improvements  made by  CMS to the Annual Report template, 
States  progress remains difficult to assess.   Although the Centers for                    
Medicare &  Medicaid Services (CMS) made improvements to  the 
Annual Report template, issues remain that make assessing States 
progress difficult.  Concerns about using the U.S. Census Bureau 
(Census) data to measure States progress in reducing the number of 
uninsured low-income children continue.  States and CMS cited small 
State sample sizes as a limitation. Also, States  use of nondirectional 
performance goals as well as goals and measures  missing from Annual 
Reports limit the usefulness of the Annual Reports in assessing States 
progress in meeting performance goals.  
RECOMMENDATIONS 
CMS should continue efforts to address States  Census data 
concerns.  Small State sample sizes appear to limit the usefulness of  
State-level estimates of the percentage of uninsured children.   
Therefore, we suggest that CMS continue departmental efforts to 
collaborate with Census to address these concerns. 
CMS should provide to States guidance on developing directional  
performance goals with a target.  CMS should provide States with 
guidance and technical assistance regarding the development of specific, 
reasonable, and targeted goals.   
CMS should ensure that States report on all goals and measures.  
CMS should ensure that States include all of their goals in their Annual 
Reports.  CMS should also work with States to ensure that each goal in 
the Annual Reports includes a report of progress.   
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E X E C U T I V E   S U M M A R Y
   
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
CMS indicated general support for our findings and recommendations.  
However, CMS took issue with the presentation of the second finding 
and had a few comments related to the recommendations and their 
implementation. 
With respect to the second finding, CMS suggested that we highlight 
State changes in the percentage of uninsured low-income children.  
Because none of the State changes were statistically significant, we 
opted not to  highlight them in the findings.  However, we do present 
State-level data in Appendix A.  
In regard to our first recommendation that CMS should continue efforts 
to address States Census data concerns, it pointed out that it has 
limited ability to effect a change at Census.  We recognize that the 
issues with Census data are not unique to CMS and that a Federal 
solution is required.  However, we believe that CMS can have impact 
regarding this issue by continuing to contribute to departmental efforts 
to collaborate with Census to address data concerns. 
Finally, CMS expressed concern with our suggestion that States update 
their State plans to reflect their current goals.  Based on CMSs 
comments, we now suggest that CMS create a comprehensive list of 
States current performance goals. 
 
 
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  T A B L E   O F   C O N T E N T S  
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
  
 
 
I N T RO DUC T IO N  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1 
  
 
 
F I N D IN G S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  10 
  
  The national percentage of uninsured decreased. . . . . . . . . . . . . .  10 
  
State-level percentages did not change  . . . . . . . . . . . . . . . . . . . . .  11 
  
  States are making progress in meeting performance goals. . . . . .  11 
  
  States progress remains difficult to assess . . . . . . . . . . . . . . . . . .  13 
  
 
 
R E C O MMEN D A T ION S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  16 
  
Agency Comments and Office of Inspector General Response . . .  17
   
 
 
APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  19 
  
A: 	Percentage of Uninsured Low-income Children Nationally 
              
and by State  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  19 
  
  B:	  States Progress in Meeting Goals  . . . . . . . . . . . . . . . . . . . . . .  21 
  
  C:	  States Goals by Specificity. . . . . . . . . . . . . . . . . . . . . . . . . . . .  23 
  
D:	  Agency Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  25 
  
 
A C K NO WL E D G M E N T S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  30 
  
   
   
  I N T R O D U C T I O N
OBJECTIVES 
1.  To assess States progress in reducing the number of uninsured 
   
low-income children. 

2.  To assess States progress in meeting performance goals related to 
the State Childrens Health Insurance Program (SCHIP). 
BACKGROUND 
Section 703 of the Medicare, Medicaid, and SCHIP Balanced Budget 
Refinement Act (BBRA) of 1999 requires that every 3 years the Office of 
Inspector General (OIG) (1) evaluate whether States are enrolling 
Medicaid eligible children in SCHIP and (2) assess States progress in 
reducing the number of  uninsured low-income children, including their 
progress in meeting the  strategic objectives and performance goals 
included in State plans.1  This study addresses the second mandate.  
OIG is addressing the first mandate in a separate study. 
SCHIP 
The Balanced Budget Act of 1997 created SCHIP to provide health 
insurance coverage to uninsured low-income children.2  The programs  
overall goal is to expand coverage  to uninsured children in households 
with incomes greater than States Medicaid eligibility but below              
200 percent of the Federal poverty level.3  States have the option of     
(1) instituting a separate childrens health insurance program,                        
(2) expanding Medicaid eligibility, or  (3) instituting both a separate 
SCHIP and a Medicaid expansion, known as a combination program.4  
SCHIP funding is allocated per State using the Annual Social and 
Economic Supplement of the U.S. Census Bureaus Current Population 
Surveys (hereinafter referred to as Census) estimation of the number of 
uninsured low-income children per State.5  
 
1 Public Law 106-113 and 42 U.S.C.  1397hh(d)(1). 

2 Public Law 105-133 and 42 U.S.C.  1397aa et seq. 

3 Sections 2101(a) and 2110(b) of the Social Security Act, 42 U.S.C.  1397aa and 

1397jj(b). 
4 Section 2101(a) of the Social Security Act, 42 U.S.C.  1397aa(a), and                            
42 CFR  457.70(a). 
5 Section 2104(b)(2)(B) of the Social Security Act, 42 U.S.C. 1397dd(b)(2)(B), and              
42 CFR  457.608(e). 
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To encourage States to implement SCHIP, the Federal match for State  
SCHIP expenditures is greater than the Medicaid match.6 In fiscal year 
(FY) 2007, the average Federal match for Medicaid is 59 percent, while 
the average for SCHIP is 71 percent.7  
SCHIP funds are due for reauthorization on September 30, 2007. In        
FY 2006, Federal spending for SCHIP reached $5.5 billion with over   
6.6 million children enrolled.8 The FY 2008 proposed Administration 
budget increases SCHIP spending to nearly $30 billion over the next          
5 years.9    
SCHIP State Plan 
To receive SCHIP funding, a State  must submit, and the Centers for 
Medicare & Medicaid Services (CMS) must approve, a State  plan that 
describes the purpose, nature, and scope of its SCHIP program.10 States 
are required to amend their original State plans with any changes and 
submit these for approval from CMS.11  
SCHIP Annual Report 
States must annually assess the operation of their SCHIP State plans in 
their Annual Reports.12 Among other things, States must report their 
progress in reducing the number of  uninsured low-income children and 
meeting State-specific performance  goals (hereinafter referred to as 
goals) in the Annual Reports.13 States must also report their progress  
on a core set of national performance measures developed by CMS. 
 
6 Section 2105(a) of the Social Security Act, 42 U.S.C.  1397ee(a). 

7 70 Federal Register 71586, November 30, 2005.
  
8 Kaiser Family  Foundation, Total SCHIP Expenditures, FY 2006. Available online at 

http://www.statehealthfacts.org/cgibin/healthfacts.cgi?action=compare&category=categor
 
y=Medicaid+%26+SCHIP&topic=Total+SCHIP+Spending%2C+FY2006. Accessed on 

April 10, 2007. 
 
CMS, FY 2006 Number of Children Ever Enrolled Year  SCHIP by Program Type. 

Available online at http://www.cms.gov/NationalSCHIPPolicy/downloads/FY2006
  
StateTotalTable.pdf. Accessed on June 7, 2007. 

9 Office of Management and Budget, Budget of the United States Government, Fiscal 

Year 2008, February 5, 2007.   Available online at http://www.whitehouse.gov/
  
omb/budget/fy2008/hhs.html. Accessed on May 8, 2007. 

10 Section 2101(b) of the Social Security Act, 42 U.S.C.  1397aa(b), and 42 CFR  457.50. 

11 Section 2107(b) of the Social Security Act, 42 U.S.C.  1397ff(b),  and 
                         
42 CFR  457.60 (2001). 

12 42 CFR  457.750(a) (2001). 

13 Section 2108(a) of the Social Security Act, 42 U.S.C.  1397hh(a), and 
                           
42 CFR  457.750(b)(1) (2001). 

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CMS annually refines the Annual Report template and recently created 
a Web-based template system that enables States to submit their 
Annual Reports to CMS via the Internet.14  
Reporting progress in reducing the number of uninsured low-income 
children.  CMS inputs Census data in each States Annual Report to  
assist States in reporting its progress in reducing the number of 
uninsured.  Census data are the main source of data on the uninsured 
and have the largest sample size of  any national survey with data on 
the uninsured.   
CMS enters 3-year averages of the number and  percentage of uninsured  
low-income children into each States Annual Report.  In the                   
2006 Annual Reports, CMS included five overlapping 3-year averages 
between 1996 and 2005, along with the percentage changes between 
19961998 and 20032005.   
According to Census, 3-year averages should be used to estimate the 
number and percentage of uninsured low-income children at the State 
level to improve precision.15  However, Census notes that small State 
sample sizes can limit the usefulness of these State level estimates.     
States may substitute an alternative source of data for Census data to 
measure and report progress in reducing the number of uninsured     
low-income children. If States elect to use an alternate data source, 
States must explain their methodology and reasons for using the 
alternative source.16  
Reporting on State-specific performance goals.  The Annual Report 
template instructs States to report  on the goals specified in their State 
plans. States must categorize their goals into one of five strategic 
objectives developed by CMS.17  The strategic objectives are:                  
(1) reducing the number of uninsured low-income children, (2) SCHIP 
 
14 Department of Health and Human Services, FY 2007 HHS Annual Plan, Strategic 
Goal 3. Available online at http://www.hhs.gov/budget/07plan/sGoal3.html#prog3e. 
Accessed on May 8, 2007. 
15 Source and Accuracy of Estimates for Income, Poverty, and Health Insurance 
Coverage in the United States:  2005. Available online at:  
http://www.census.gov/prod/2002pubs/p60-219sa.pdf. Accessed on May 17, 2007.   
16 42 CFR  457.750(c)(1)(ii) (2001). 
17 CMS, 2006 SCHIP State Annual Reports, section IIC.  Available online at 
http://www.cms.hhs.gov/NationalSCHIPPolicy/SCHIPER/itemdetail.asp?filterType=none 
&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=CMS1199208&intNumP 
erPage=10. Accessed on July 16, 2007. 
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I N T R O D U C T I O N   
enrollment, (3) Medicaid enrollment, (4) increasing access to care, and    
(5) increasing the use of preventative care. 
CMS requires States to  report their  progress in meeting each goal.18 To  
measure progress, CMS directs States to identify their data source(s), 
population, methodology, and baseline measurement.19  The             
2006 Annual Report template prompts States to report progress on each 
goal for the current year and the previous 2 years to track progress over 
time.  Prior  versions of the template prompted States to report progress  
for the current year only.  
Reporting on CMS national performance measures.  The Annual Report 
template instructs States to report information  on a core set of national 
performance measures developed by CMS.  The measures are well-child 
visits, use of appropriate medications for children with asthma, and  
childrens access to primary care practitioners.20 CMS contracted with 
an evaluation agency to analyze the data reported in the States       
2003 SCHIP Annual Reports and to provide States with guidance to  
improve the completeness and quality of their reporting on these 
national performance measures.   The evaluation agency issued two 
reports in 2005 that summarize States reporting on these measures.21  
Previously  Mandated OIG Studies  
In accordance with the  BBRA mandate  to assess States progress, OIG 
has issued two prior reports related to States progress in reducing the  
number of uninsured low-income children and meeting goals.22 In      
2001, OIG could not assess States progress in meeting goals because of 
 
18 Section 2108(b)(1) of the Social Security Act, 42 U.S.C.  1397hh(b)(1), and                                
42 CFR  457.750(b)(1) (2001). 

19 CMS, SCHIP State Annual Report Template.  Available online at
  
http://www.cms.hhs.gov/ NationalSCHIPPolicy/ 06_SCHIPAnnual Reports.asp# Top Of 
 
Page. Accessed on May 8, 2007.
  
20 42 CFR  457.750(b)(1) and CMS, 2006 SCHIP State Annual Reports, section IIA.  

Available online at http://www.cms.hhs.gov/NationalSCHIPPolicy/SCHIPER/itemdetail. 

asp?filterType=none&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=CM
 
S1199208&intNumPerPage=10.  Accessed on July 16, 2007. 

21 Improving Performance Measures in the State Childrens Health Insurance Program, 

Mathematica Policy Research, Inc., July 18,  2005, and Beyond Coverage:  SCHIP Makes 

Strides Toward Providing a Usual Source of Care to Low-Income Children, Mathematica 

Policy Research, Inc., December 23, 2005. 

22 State Childrens Health Insurance Program:  Assessment of State Evaluations 
Reports, OEI-05-00-00240, February 2001.   

SCHIP: States Progress in Reducing the Number of  Uninsured Children,          
         
OEI-05-03-00280, August 2004. 
 
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States conceptually and technically weak evaluative measures. In 
2004, OIG found that CMS did not ensure that States reported on their 
progress in reducing the number of  uninsured children in the Annual 
Reports and instead accepted enrollment data as a proxy for this 
information.    
The BBRA also requires the Government Accountability Office (GAO) to 
monitor OIG evaluations of SCHIP.23 GAO responded favorably to the 
findings and recommendations of OIGs two reports with a 
recommendation in response to OIGs 2001 evaluation.24  The  BBRA 
mandate requires only that OIG assess States that administer SCHIP 
separately from their Medicaid programs.  To better inform Congress,  
GAO recommended that OIG include States that administer Medicaid 
expansion programs and Medicaid-SCHIP combination programs.25   
OIG agreed  with the recommendation and expanded subsequent 
reviews to include all SCHIP program types. 
METHODOLOGY 
Scope 
To determine States progress in reducing the percentage of uninsured         
low-income children, we included all 50 States and the District of 
Columbia. In keeping with GAOs recommendation that we use our 
authority to  expand the scope of the  evaluations to include other SCHIP 
options, such as the Medicaid-expansion and combination programs, as 
a way to provide Congress a more comprehensive and meaningful 
review of State progress.  We  expanded our review even further to  
include all States, regardless of whether they had a SCHIP program.   
Thus, Tennessee is included in our review even though it did not have  
an SCHIP program in FY 2006. All States, regardless of whether they 
have a SCHIP program, face multiple factors affecting the number of 
uninsured low-income children. 
 
23 42 U.S.C.  1397hh(d)(3). 
24 Childrens Health Insurance:  Inspector General Reviews Should Be Expanded  To 
Further Inform the Congress, GAO-02-512, March 29, 2002. 
Childrens Health Insurance:  Recent HHS-OIG  Reviews Inform  the Congress on  
Improper Enrollment and Reductions in Low-Income, Uninsured Children,               
GAO-06-457R, March 9, 2006. 

25 Childrens Health Insurance:  Inspector General Reviews Should Be Expanded  To 

Further Inform the Congress, GAO-02-512, p. 19.  March 29, 2002. 

 
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To determine States progress in meeting and reporting on their goals, 
we included all States that had SCHIP programs in 2006.  This decision 
reflects GAOs recommendation to include States with all program 
types. This includes 49 States and the District of Columbia. We did not 
include Tennessee because it started its program in January 2007.  
Therefore Tennessee was not required to submit a 2006 Annual Report. 
We assessed States progress in reducing the percentage of uninsured      
low-income children. We did not determine whether any change in the  
percentage of uninsured low-income children was attributable to 
SCHIP.  Many factors, including those outside the control of a State, 
contribute to whether a State experiences a change in the percentage of 
uninsured low-income children.   
We focused only on States goals and did not assess national 
performance measures required by CMS because of previous  
evaluations of these measures. 
Data Collection 
As part of the evaluation, we reviewed current SCHIP State plans, 
State plan amendments, the 2006 Annual Report template, States  
2006 Annual Reports, and Census data.  We also reviewed CMSs 
oversight documents, including the Annual Reports Requirement 
checklist, the Regional Office Monitoring handbook, and the Guide to 
Quality Measures Compendium.  We also held discussions with CMS 
officials about their review of goals in the State plans and Annual 
Reports and their guidance to States regarding the development and 
measurement of their goals. 
Data Analysis 
Assessing States progress in reducing the number of uninsured              
low-income children.  We independently obtained national and              
State-level Census data on the number of uninsured low-income 
children.26  We calculated four 3-year  averages from 2000 to 2005   
(2000-2002, 2001-2003, 2002-2004, and 2003-2005).   
To assess change, we compared the first 3-year average, 20002002 
(hereinafter referred to as 2002) and the last 3-year average, 20032005 
(hereinafter referred to as 2005) to assess progress in reducing the 
 
26 We define the percentage of  uninsured low-income children as the number of  
uninsured children among the population of low-income children, not among the 
population of  all children as Census defines it. 
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number of uninsured low-income children. We assessed whether  
changes were statistically significant at the 90-percent confidence 
level.27  
Our analysis starts with 2000 Census data. We started with             
2000 rather than the beginning of SCHIP in 1997 because starting in 
the 2000 Census survey a verification question that improved 
estimates of the uninsured was included.28 It asks individuals that 
responded no to all questions about specific types of health insurance 
coverage to  verify whether they were actually uninsured.29 Accordingly, 
estimates based on the revised Census data are not directly comparable 
with estimates from earlier years. 
We analyzed whether States made progress in reducing the number of  
uninsured low-income children by determining the percentage change in 
the number of uninsured low-income children out of the total population  
of low-income children. 
Assessing States progress in meeting goals. We reviewed whether  
States made progress in meeting their goals in FY 2006 as compared 
with FY 2005 as reported in their 2006 Annual Reports. We identified a 
total of 555 goals listed in either State plans or Annual Reports.  
However, only 368 goals were in the Annual Reports, and 20 of these 
were marked discontinued. Therefore, our analysis included                      
348 continuing goals listed in States Annual Reports. 
We measured progress in relation to each goals specificity. We 
categorized goals into three types.  We defined directional goals with a 
target as goals that had a defined benchmark (i.e., increase SCHIP 
enrollment  by 5 percent). We defined directional goals without a 
target as goals that stated a general direction (i.e., increase access to  
primary care physicians). Lastly, we defined nondirectional goals as 
goals that lacked direction and a finite target (i.e., immunizations). 
These goals were typically not quantifiable. 
 
27 Census analyzes its data at the 90-percent confidence level. U.S. Census Bureau, 
Source and Accuracy of Estimates for Income, Poverty, and Health Insurance  Coverage  
in the United States: 2005. Available online at: 
http://www.census.gov/prod/2002pubs/p60-219sa.pdf. Accessed on May 17, 2007. 
28 U.S. Census Bureau, The March CPS Health Insurance Verification Question and Its 
Effect on Estimates of the Uninsured. Available online at 
http://www.census.gov/hhes/www/hlthins/verif.html. Accessed on April 12, 2007.  
29 U.S. Census Bureau, Current Population Reports, Health Insurance Coverage: 2000, 
September 2001. 
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Based on the States report of progress, we coded goals as met, 
making progress, or not making progress. See Table 1 for the 
criteria we  used to assess States progress in meeting their goals. 
 
Table 1: Criteria to Assess States Progress in Meeting Their Goals 
  Progress 
Type of Goal   Met   Making Progress  Not Making Progress 
 
Directional Goal With a  State reached the target.  State was at least half of  State was below  the 
Target  the way to achieving the  halfway mark to 
  target.  achieving the target. 
Directional Goal  Trend of the data   State maintained status  Trend of the data moved 
Without a Target    matched the goal   from previous year.  in opposition to the goal 
direction.  direction. 
Nondirectional G oal  Task was completed.  State attempted the  State did not attempt the 
task.  task. 
  Source: OIG Analysis of States 2006 Annual Reports, 2007. 
We also analyzed States progress in meeting goals by the strategic 
objective categories developed by CMS. 
Assessing States reporting of goals.   We conducted two levels  of review to  
assess States reporting of goals. First, we assessed whether each goal 
listed in a State plan was in the Annual Report. For each goal listed in 
a State plan but not in the Annual Report, we determined whether the 
goal was outdated. We considered any goal with a completion date 
earlier than 2006 to be outdated. 
Second, for the 368 goals included in the Annual Report, we assessed 
whether a State reported on its progress anywhere in the Annual 
Report. If a State did not include a report of progress, we analyzed the  
reasons that a State provided for not  reporting. We coded the reasons 
the State provided as one of three categories: (1) the State discontinued  
the goal, (2) the State indicated a lack of sufficient data to analyze the 
goal, or (3) the State did not provide a reason for not reporting progress. 
Limitations 
Census may undercount Medicaid recipients which may affect estimates 
of the number of uninsured low-income children. In 2005, Census 
estimated 21.3 million Medicaid recipients, while CMS data indicated 
28.2 million recipients.30   The  Urban Institute developed the Transfer  
Income Model which adjusts for this  undercounting. However, Urban 
Institute officials stated that Medicaid recipients may be incorrectly  
 
30 U.S. Census Bureau, Current Population Survey, CENSUS, 2005, and Centers for 
Medicare & Medicaid Services, 2005 CMS Statistics, 2005. 
OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   8   
   
I N T R O D U C T I O N   
reporting that they have employer-based or private insurance instead of 
Medicaid.  This error would affect the underestimation of Medicaid  
recipients but may not  affect the estimate of the number of uninsured. 
We determined that Census data was adequate for our study because 
we are assessing change in the uninsured population, rather than 
assessing change in the number of Medicaid recipients.  We 
acknowledge that Census data may overestimate the number of 
uninsured as a by-product of the underestimate of Medicaid recipients. 
We did not independently verify the  information reported by States  
regarding their goals. 
Standards    
This study was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and 
Efficiency and the Executive Council on Integrity and Efficiency. 
 
 
 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   9   
   
F I N D I N G S  
  F I N D I N G S  
Nationally  the percentage of uninsured     Nationally the percentage of uninsured   
low-income children decreased between  low-income children had a statistically 
significant decrease between 2002 and 
2002 and 2005 
2005. In 2005, 18.5 percent of low-income 
children were uninsured nationally, down from 20 percent in 2002.   
See Graph 1 for national estimates of the percentage of uninsured              
low-income children annually from 2000 to 2005 and 3-year averages 
between 2002 and 2005. 
Graph 1:  National Percentage of Uninsured Low -Income Children From 2000 to 2005 
 
25.0% 
23.0% 
n 
e
dr
hil
C
e 
om 21.0% 
c
n
w-I
o
L
d 
e
ur 19.0% 
s
n
ni
U
nt 
e
c
Per 17.0% 
15.0% 
2000  2001  2002  2003  2004  2005 
Year 
Annual Estimates  3-Year Average 
Source: OIG Analysis of Census data, 2007.  
 
The national percentage of uninsured low-income children decreased 
during the same time that both SCHIP and Medicaid enrollment of  
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   10   
   
FF II NN DD II NN GG SS  
children increased. SCHIP enrollment increased by 15 percent31 and 
Medicaid increased  enrollment by 18 percent,32 between 2002 and 2005. 
 
However, no State had a statistically significant  Although the national 
change in the percentage of uninsured  percentage of uninsured 
low-income children 
low-income children 
decreased, no State 
experienced a statistically significant change in the percentage of  
uninsured low-income children between 2002 and 2005. 
While each States sample showed  changes in the percentage of 
uninsured low-income children, none  of the changes were significant 
when projected to the entire State at the 90-percent confidence level.   
Because of small State sample sizes, statistical tests are limited in 
accurately detecting modest changes at the State-level. See Appendix A  
for the percentage of uninsured low-income children by State in 2002 
and 2005. 
Many factors contribute to whether a State experiences a change in the 
percentage of uninsured low-income  children. For instance, SCHIP and 
Medicaid enrollment, State and national economic climates, shifts in 
low-income populations, and private insurance rates all contribute to 
changes in a States percentage of uninsured low-income children. 
 
In 2006, 37 States met or made progress in  Thirty-seven States met or made  
meeting at least half of their performance goals  progress in meeting at least half 
of their goals. Almost half of 
these 37 States met or  made  
progress in meeting between 50 percent and 74 percent of their goals. 
In general, States varied on the number of goals they had,  ranging from     
1 to 25 goals. In total, States had an average of seven goals. 
 
31 CMS, "SCHIP Enrollment Reports: FY 2002 and 2005 Annual Enrollment Reports." 
Available online at: http://www.cms.hhs.gov/NationalSCHIPPolicy/SCHIPER /list.asp#  
TopOfPage. Accessed on June 25, 2007. 
32 CMS, "Fiscal Year 2002 National MSIS Tables." Available online at: 
http://www.cms.hhs.gov/MedicaidDataSourcesGenInfo/Downloads/MSISTables2002.pdf. 
Accessed on June 25, 2007. CMS, "2005 CMS Statistics." Available online at: 
http://www.cms.hhs.gov/CapMarketUpdates/Downloads/2005CMSStats.pdf. Accessed on 
June 25, 2007. 
OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   11    
   
F I N D I N G
  S  
Only six States met or made progress  toward all of their goals.  One of 
these States had only one goal and another State had three goals.  The 
remaining four States had four to six goals each.      
Four States did not meet or make progress on any of their goals.  Of 
these States, two States  had only one goal each and the other two States  
had three goals each.  See Table 2 for a breakout of States by the 
percentage of goals that were classified as met or making progress. 
 
Table 2: Number of States by the Percentage and Number of Goals 
  Classified as Met or Making Progress  
  Percentage of Goals Classified   Average Number of Goals 
as Met or Making Progress  Number of States  per State by Quartile 
  100%  6  4 
 75% and < 100%   14  8 
 
 50% and < 75%  17  8 
   25% and < 50%  8  8 
   1% and < 25%   1  7 
0%  4  2 
 
Total  50 
Source:  OIG Analysis of States 2006 Annual Reports, 2007.  
 
See Appendix B for each States progress towards meeting its goals. 
States made progress in meeting goals in all strategic objective categories  
Of the States that reported progress, the largest  number of States 
reported progress for goals related to increasing access to care and 
increasing the use of preventative care.  Thirty-one States  met or made  
progress in meeting at least half their goals related to increasing access  
to care.  Of these 31 States, 19 met all goals related to increasing access  
to care.  In addition, 28 States met or made progress in meeting half the 
goals related to increasing the use of preventative care, with 18 States 
meeting all of their goals related to increasing the use of preventative 
care.    
States with goals related to SCHIP enrollment also experienced 
progress.  Twenty-five States met or made progress in meeting at least 
half of their goals related to SCHIP enrollment.  Of these 25 States,           
18 States met all of their goals related to SCHIP enrollment.  
States made less progress meeting goals related to reducing the number  
of uninsured low-income children.   While 24 States met or made 
progress in meeting at least half their goals related to reducing the 
number of uninsured low-income children, 17 States did not meet half of 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   12   
   
F I N D I N G S  
their goals. Of these 17 States, 16 did not meet any goals related to 
reducing the number of  uninsured low-income children. 
Seven States met or made progress in meeting at least half their goals 
that did not fit into any strategic objective.   These goals concerned  
either enrollee satisfaction with the States SCHIP program  or SCHIP 
outreach.   
See Table 3 for the number of goals in each strategic objective category  
for each State and the percentage of these goals that were classified as 
met or making progress.  
Table 3: Number of States by the Percentage of Goals Classified as Met or Making 
Progress by  Strategic Objective Category  
States Average  
Number of States  Number of Goals  Number of States by the 
That Reported  at   Per Strategic  Percent That Made Progress 
Strategic Objective  Least One Goal   Objective  or Met Goals 
049  50100 
    Percent  Percent 
Increasing access to care  41  2  10  31 
Increasing use of preventative care   35  3  7  28 
SCHIP enrollment  33  2  8  25 
Reducing the number of uninsured      41  2  17  24 
low-income children 
Medicaid enrollment  20  1  9  11 
Other  10  1  3  7 
Source:  OIG Analysis of States 2006 Annual Reports, 2007. 
 
OIGs previous SCHIP 
Despite improvements made by  CMS to the 
reviews reported significant 
Annual Report template, States progress 
difficulties using the Annual 
remains difficult to assess   
Reports to assess States 
progress in reducing the 
uninsured and meeting  goals.  In 2001, OIG could not assess States 
progress in meeting goals because of States conceptually and 
technically weak evaluative measures.  OIG recommended that CMS 
develop a framework for the Annual Reports and provide guidance to 
States in conducting useful evaluations of their  program. 33  Since then,  
CMS created the Annual Report template and annually reevaluates this 
template.  Also, CMS developed a compendium of quality measures to 
provide States with various approaches to measuring data for CMSs 
national performance measures.    
 
33 State Childrens Health Insurance Program:  Assessment of State Evaluations 
Reports, OEI-05-00-00240, p. 15.  February 2001. 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   13   
   
FF II NN DD II NN GG
  SS  
In 2004, OIG found that CMS did not ensure that States report their 
progress in reducing the number of  uninsured low-income children and 
instead accepted enrollment data as a proxy in  their Annual Reports.34   
Since then, CMS automatically enters Census data on the number and 
percentage of uninsured low-income children into States Annual 
Reports.  
Although CMS has improved the Annual Report template and started 
measuring rates of uninsured, issues that make it difficult to measure 
States progress remain. There continue to be concerns about using 
Census data to measure States progress in reducing the number of 
uninsured low-income children. Also, States use of nondirectional goals 
as well as goals and measures missing from Annual Reports limit the 
usefulness of the Annual Reports in  assessing States progress in 
meeting goals. 
Concerns with using Census data for State-level assessments persist 
States continue to report concerns with the use of Census data to 
measure their progress in reducing the uninsured in their Annual 
Reports. In 2002, 11 States reported limitations to Census data.35 In 
2006, 20 States reported limitations.  Despite the increased sample size 
of the Census survey in 2002, the most common limitation cited by 
States in their 2006 Annual Reports was small State sample sizes. 
States also cited the undercounting of Medicaid recipients and the use  
of income thresholds that may differ from States specific SCHIP 
eligibility criteria as limitations to Census data.   
CMS staff also expressed concern with Census data. CMS staff shared 
State concerns regarding the small State sample sizes and the 
undercounting of Medicaid recipients. CMS staff also expressed concern 
that Census data includes non-U.S. citizens, who would not be eligible 
for SCHIP. 
Despite 20 States reporting concerns with Census data in 2006, only          
6 of these States used an alternative data source to report their progress 
in reducing  the uninsured. In total, 10 States used alternative data 
sources to report their progress in reducing the number of uninsured                
low-income children in 2006. Nine of these States used State surveys 
 
34 SCHIP: States Progress in Reducing the Number of Uninsured Children, 
                
OEI-05-03-00280, p. 12. August 2004. 

35 Ibid, p. 13. 

OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   14   
   
FFF III NNN DDD III NNN GGG
  SSS  
and one State used the Center for Disease Controls Behavioral Risk 
Factor survey. 
It is more difficult to assess progress of States with nondirectional goals 
Across all States, one-third of goals were nondirectional and not 
quantifiable. Ten States had a majority of nondirectional goals.  
Thirty-three States had at least one  nondirectional goal. See           
Appendix C for a complete list of States goals by their level of 
specificity. 
Nondirectional goals do  not provide a desired direction of  change nor are  
they quantifiable. Given these characteristics, it is hard to ascertain 
what constitutes progress for nondirectional goals. For instance, if a 
States nondirectional goal was monitor utilization of specialty care 
the State would have met the goal if  it mentioned a monitoring system. 
In contrast,  directional goals with targets have clear criteria by which to 
assess progress. For instance, if a States goal is increase well-child 
visits annually by 5 percent it is clear that only a 5-percent increase 
constitutes  meeting the goal. 
Because of the nature  of the State-Federal SCHIP partnership, States 
have the discretion to develop goals that are nondirectional and not 
quantifiable. CMS does  not dictate or provide written guidance 
concerning the content,  quality, or specificity of States goals. 
States failed to report on all goals listed in their State plan 
Only seven  States reported on all goals from their State plans in their  
2006 Annual Reports as required. Twenty-nine States included at least 
half of the goals from their State plan. Three States did not report on 
any goals from their State plans. 
Twenty-eight percent of all goals from States plans that were not 
included in the 2006 Annual Reports were outdated. Thus, States 
failure to report on 72 percent of goals from their State plans was not 
due to the goals being outdated. In addition, 32 States included in their 
Annual Reports new goals that were not listed in their State plans. 
States did not provide reports of progress for all goals in the Annual 
Reports 
Not all goals included in States Annual Reports included information  
on States progress as required. Fourteen States did not report any 
information for at least one goal in their Annual Reports. Of these      
14 States, 11 reported that data were not available for these goals. 
OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   15   
   
  R E C O M M E N D A T I O N S  
The national percentage of uninsured low-income children experienced 
a statistically significant decrease between 2002 and 2005.  In addition, 
37 States met or made progress in meeting at least half of their goals.  
However, measuring States progress remains difficult because of  
Census data concerns and nondirectional goals, as well as goals and 
measures missing from Annual Reports.  Therefore, we recommend the 
following: 
CMS should continue efforts to address States Census data concerns   
States continue to report limitations to using Census data for               
State-level estimations of the change in the number and percentage of 
uninsured low-income children.  These State-level estimates are 
important because they are used  not only to assess States progress in 
reducing the number of  uninsured, but they are also used when 
allocating SCHIP funding. 
The most commonly cited limitation was small State sample sizes.  Our 
analysis also revealed that, because of small State sample sizes, 
statistical tests may not be able to accurately detect modest changes in 
a States percentage of uninsured low-income children.  Therefore, we  
suggest that CMS continue departmental efforts to collaborate with 
Census officials to address these concerns.  Possible solutions include 
increasing State sample sizes or pursuing alternative methodologies,  
such as small-area estimations.   
In addition to small State sample sizes, CMS and States reported the 
undercounting of Medicaid recipients by the Census, the concern that 
Census data include non-U.S. citizens, and the use of income thresholds 
that may differ from States specific  SCHIP eligibility criteria.  We 
suggest that CMS explore the appropriateness of using adjusted Census 
estimates in the Annual Reports.  Microsimulation models have been 
developed that adjust Census estimates to address these limitations.   
We also suggest that CMS work with States that reported limitations to 
Census data but did not utilize an alternative data source to  identify 
alternative data sources or methodologies for reporting the percentage 
change in uninsured low-income children.   
CMS should provide to States guidance on developing directional 
performance goals with a target  
One-third of States 2006 goals were nondirectional.  These goals did not 
provide a desired direction of change nor were they quantifiable.  Given 
these characteristics, it is hard to ascertain what constitutes progress 
for nondirectional goals.  To address this, CMS should provide States 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   16   
   
 R E C O M M E N D A T I O N S  
with guidance and technical assistance regarding the development of 
specific, reasonable, and targeted goals. 
CMS should ensure that States report on all goals and measures 
The Annual Report is the tool by which CMS assesses States progress 
in meeting their performance goals.  CMS has been successful in 
ensuring that all States submit their Annual Reports.  However, in 
their Annual Reports, States failed to report on all goals listed in their 
State plans and not all goals included in the Annual Reports had 
information on States progress.   
To ensure that Annual Reports reflect progress  on goals States 
committed to achieving for the current year, we suggest that CMS 
create and maintain a comprehensive list of States current goals.  This 
list should begin with goals listed in States plans and be updated with 
goals that were added or discontinued in previous Annual Reports, and 
updated annually thereafter. 
States can choose to discontinue a goal from their State plan or Annual 
Report.  We suggest that CMS change the Annual Report template to 
require that States provide an explanation when a goal is marked 
discontinued.  
Fourteen States did not report any information for at least one goal in 
their Annual Reports.  This was largely a result of States reporting that 
data were not available.  To help ensure that States annually report 
progress on  all goals, we suggest that CMS work with States that have 
difficulty reporting on all of their goals.  CMS has already provided a 
compendium of measures which outlines various approaches to 
measuring different goals.  CMS could use this compendium to work 
with States to select meaningful measures.  CMS could also facilitate 
interaction between States that are having difficulty measuring 
progress and States that have been successful in measuring progress. 
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
CMS indicated general support for our findings and recommendations.  
However, CMS took issue with the presentation of the second finding 
and had a few comments related to the recommendations and their 
implementation.   
With respect to the second finding, CMS suggested that we highlight 
State changes in the percentage of uninsured low-income children.  
  OEI-05-07-00330   ASSESSING  STATES   PROGRESS IN  MEETING SCHIP  G OALS   17   
   
R E C O M M E N D A T I O N S  
Because none of the State changes were statistically significant, we 
opted not to  highlight them in the findings.  However, we do present 
State-level data in Appendix A. 
In regard to our first recommendation that CMS should continue efforts 
to address States Census data concerns, CMS pointed out that it has 
limited ability to effect a change at Census. It also stated that a 
solution across Federal agencies is  needed.  On the other hand, CMS 
indicated a willingness to continue to work with the Census to convey 
States concerns.  We  recognize that the issues with Census data are not 
unique to CMS and that a Federal solution is required.  However, we  
believe that CMS can have impact regarding this issue by continuing to 
contribute to departmental efforts to collaborate with Census to address 
data concerns. 
Finally, CMS expressed concern with our suggestion that States update 
their State plans to reflect their current goals.  CMS indicated that 
State plans only need to be updated for reasons outlined in                    
42 CFR  457.60, which does not include changes to performance goals.  
However, to assess States progress using the Annual Report, it is 
necessary to know what goals States have committed to assess.  We  
used the goals listed in the State plans because the mandate directs us 
to, and because CMS does not maintain a comprehensive list of States 
current goals.  Based on  CMSs comments, we now suggest that CMS 
create a comprehensive list of States current performance goals. 
For the full text of CMSs comments, see Appendix D. 
 
 
 
 
 
 
 
 
 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   18   
   
A P P E N D I X   ~   A  

PERCENTAGE OF UNINSURED LOW-INCOME CHILDREN 
NATIONALLY  AND BY STATE  
Table 4: Percentage of Uninsured Low -Income in 2005 and 2002  
Current   
     
Program  2005 
State  2002  Difference Between 2005 and 2002 
Type*  
  Percentage 
       Difference   Confidence Intervals 
  Lower   Upper 
     (20052002) 
  90 Percent  90 Percent 
United States  N/A  18.5%  20.0%  -1.5%  -2.6%  -0.5% 
Alabama  Separate  9.7%  15.9%  -6.1%  -12.3%  0.0% 
Alaska  Expansion  14.7%  19.7%  -5.0%  -12.9%  3.0% 
Arizona  Separate  24.6%  26.4%  -1.8%  -10.9%  7.3% 
Arkansas  Combination  10.9%  15.7%  -4.8%  -11.0%  1.4% 
California  Combination  19.9%  22.9%  -3.0%  -6.7%  0.7% 
Colorado  Separate  27.7%  27.5%  0.2%  -10.6%  10.9% 
Connecticut  Separate  17.4%  16.0%  1.3%  -8.2%  10.8% 
Delaware  Combination  19.1%  14.0%  5.1%  -4.8%  15.0% 
District of Columbia  Expansion  11.3%  11.5%  -0.2%  -8.1%  7.7% 
Florida  Combination  25.7%  25.6%  0.1%  -5.7%  5.8% 
Georgia  Separate  19.7%  19.5%  0.2%  -7.1%  7.6% 
Hawaii  Expansion  8.7%  12.4%  -3.7%  -9.7%  2.3% 
Idaho  Combination  16.7%  21.2%  -4.5%  -12.2%  3.1% 
Illinois  Combination  18.7%  19.8%  -1.1%  -6.8%  4.5% 
Indiana  Combination  14.8%  19.5%  -4.7%  -11.7%  2.3% 
Iowa  Combination  14.0%  12.8%  1.2%  -6.3%  8.7% 
Kansas  Separate  13.1%  16.7%  -3.7%  -11.2%  3.9% 
Kentucky  Combination  15.0%  16.1%  -1.0%  -8.2%  6.1% 
Louisiana  Expansion  15.3%  19.5%  -4.2%  -11.5%  3.1% 
Maine  Combination  10.1%  11.5%  -1.4%  -8.3%  5.4% 
Maryland  Combination  17.5%  18.6%  -1.1%  -10.4%  8.2% 
Massachusetts  Combination  11.6%  8.7%  2.9%  -3.2%  9.0% 
Michigan  Combination  9.1%  12.6%  -3.5%  -8.0%  1.0% 
Minnesota  Expansion  14.7%  13.2%  1.4%  -7.0%  9.8% 
Mississippi  Separate  17.1%  14.1%  3.0%  -4.0%  9.9% 
Missouri  Expansion  13.4%  9.5%  3.9%  -2.6%  10.3% 
Montana  Separate  22.9%  19.8%  3.1%  -6.8%  12.9% 
 
  OEI-05-07-00330   ASSESSING  STATES   PROGRESS IN  MEETING SCHIP  G OALS   19   
   
A P P E N D I X ~ A  

 
 
Table 4: Percent of Uninsured Low -Income Children in 2005 and 2002 (Continued)  
Current 
State  Program  2005  2002  Difference Between 2005 and 2002 
Type*  
Percentage 
         Difference  Confidence Intervals 
Lower   Upper 
        (20052002) 
  90 Percent  90 Percent 
Nebraska  Expansion  12.6%  11.6%  0.9%  -6.5%  8.4% 
Nevada  Separate  25.6%  28.8%  -3.2%  -13.1%  6.7% 
New  Hampshire  Combination  10.6%  13.2%  -2.6%  -11.9%  6.7% 
New  Jersey   Combination  22.7%  21.2%  1.6%  -7.0%  10.1% 
New  Mexico  Expansion  22.4%  21.8%  0.6%  -8.1%  9.3% 
New  York  Separate  12.6%  14.6%  -2.0%  -5.6%  1.6% 
North Carolina  Combination  18.7%  18.5%  0.2%  -5.9%  6.4% 
North Dakota  Combination  18.2%  14.5%  3.6%  -5.4%  12.7% 
Ohio  Expansion  14.7%  16.3%  -1.6%  -7.1%  3.9% 
Oklahoma  Expansion  21.2%  22.6%  -1.4%  -9.9%  7.2% 
Oregon  Separate  17.2%  19.7%  -2.5%  -11.1%  6.1% 
Pennsylvania  Separate  16.6%  16.6%  0.1%  -5.4%  5.5% 
Rhode Island  Combination  10.8%  9.2%  1.5%  -5.6%  8.7% 
South Carolina  Expansion  14.3%  12.5%  1.8%  -4.9%  8.6% 
South Dakota  Combination  12.3%  13.6%  -1.3%  -8.4%  5.8% 
Tennessee  N/A  16.5%  10.4%  6.1%  -0.6%  12.9% 
Texas  Separate  28.6%  33.8%  -5.2%  -10.5%  0.1% 
Utah  Separate  18.1%  17.8%  0.2%  -7.6%  8.0% 
Vermont  Separate  7.3%  6.8%  0.5%  -5.2%  6.2% 
Virginia  Combination  15.7%  18.8%  -3.1%  -11.3%  5.1% 
Washington  Separate  12.7%  15.7%  -3.0%  -10.1%  4.1% 
West Virginia  Separate  10.7%  14.2%  -3.5%  -9.8%  2.8% 
Wisconsin  Combination  12.4%  8.7%  3.7%  -2.3%  9.7% 
Wyoming  Separate  14.6%  22.9%  -8.3%  -19.5%  3.0% 
Source:  Office of  Inspector General (OIG) Analysis of Annual Social and Economic Supplement of the U.S. Census Bureaus 
Current Population  Survey (Census) data, 2007. 
 
* Combined = Combined Medicaid and SCHIP program, Expansion = Medicaid Expansion program, Separate= Separate SCHIP  
program
 Figures  have been rounded to the nearest tenth. 
 Statistically significant at  the 90-percent confidence level. 
  OEI-05-07-00330   ASSESSING  STATES  PROGRESS IN  MEETING SCHIP  GOALS   20   
   
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STATES PROGRESS IN MEETING GOALS 

 
Table 5: Number of Goals by States Progress   
Progress of Goal   
   
Progress 
Unreported/  Total 
Making  Not Making  Data Does Not  Number of 
State  Met   Progress  Progress  Measure Goal  Goals 
Alabama  6  3  2  1  12 
Alaska  2  2  0  0  4 
Arizona  1  5  0  0  6 
Arkansas  1  2  0  2  5 
California  5  1  0  6  12 
Colorado  0  0  3  0  3 
Connecticut  2  1  4  3  10 
Delaware  0  0  1  0  1 
District of Columbia  4  0  0  0  4 
Florida  1  0  5  1  7 
Georgia  6  1  1  0  8 
Hawaii  2  3  2  2  9 
Idaho  1  3  3  0  7 
Illinois  2  0  0  6  8 
Indiana  1  3  0  2  6 
Iowa  7  1  1  0  9 
Kansas  0  2  1  1  4 
Kentucky   2  2  1  2  7 
Louisiana  1  0  2  0  3 
Maine  4  0  1  0  5 
Maryland  0  2  1  2  5 
Massachusetts  5  0  1  1  7 
Michigan  7  0  1  3  11 
Minnesota  3  0  0  1  4 
Mississippi  7  1  1  1  10 
Missouri  0  0  3  0  3 
Montana  4  1  0  1  6 
Nebraska  5  5  1  1  12 
Nevada  1  1  4  1  7 
New Hampshire  2  1  1  1  5 
New Jersey   12  6  3  4  25 
New Mexico  1  0  2  1  4 
New York  2  1  0  0  3 
North Carolina  4  0  1  1  6 
North Dakota  2  4  4  5  15 
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A P P E N D I X ~ B  

Table 5: Number  of Goals by States Progress (Continued)  
  Progress of Goal   
   
  Progress 
Unreported/ Data  Total 
  Making  Not Making  Does Not  Number of 
State  Met   Progress  Progress  Measure Goal  Goals 
Ohio     2  3  0  0  5 
Oklahoma  1  1  0  1  3 
Oregon    2  1  0  5  8 
Pennsylvania  7  2  1  0  10 
 
Rhode Island  1  0  0  0  1 
South Carolina    5  0  0  2  7 
South Dakota  5  1  3  0  9 
Texas     4  1  1  0  6 
Utah  1  5  1  1  8 
 
Vermont  0  0  0  1  1 
Virginia    3  2  3  0  8 
Washington  1  3  0  1  5 
West Virginia    3  2  0  1  6 
Wisconsin  0  6  3  0  9 
 
Wyoming  5  3  1  0  9 
Source:  OIG Analysis of  States 2006 Annual Reports, 2007. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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A P P E N D I X ~ C  
   A AP PP PE EN ND DI IX X~ ~C D  
STATE GOALS BY SPECIFICITY 

 
Table 6: Number of Goals by Specificity per State 
   
   
Type of Goal 
State  Total   Directional  Directional  Nondirectional 
Number  Without Target   With Target  
of Goals 
Alabama  12  5  3  4 
Alaska  4  1  0  3 
Arizona  6  0  6  0 
Arkansas  5  1  0  4 
California  12  8  0  4 
Colorado  3  3  0  0 
Connecticut  10  6  0  4 
Delaware  1  1  0  0 
District of Columbia  4  0  0  4 
Florida  7  7  0  0 
Georgia  8  3  1  4 
Hawaii  9  4  0  5 
Idaho  7  0  7  0 
Illinois  8  4  2  2 
Indiana  6  0  6  0 
Iowa  9  3  6  0 
Kansas  4  0  3  1 
Kentucky  7  2  5  0 
Louisiana  3  1  2  0 
Maine  5  3  0  2 
Maryland  5  4  0  1 
Massachusetts  7  2  2  3 
Michigan  11  0  1  10 
Minnesota  4  1  0  3 
Mississippi  10  0  5  5 
Missouri  3  3  0  0 
Montana  6  3  3  0 
Nebraska  12  1  0  11 
Nevada  7  4  1  2 
New Hampshire  5  5  0  0 
New Jersey   25  6  15  4 
New Mexico  4  4  0  0 
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A P P E N D I X ~ C  

 
Table 6: Number of Goals by Specificity per State (Continued)  
   
Type of Goal 
State  Total   Directional  Directional With   Nondirectional  
Number  Without Target   Target  
of Goals 
New  York  3  1  1  1 
North Carolina  6  5  0  1 
North Dakota  15  3  11  1 
Ohio  5  2  3  0 
Oklahoma  3  1  1  1 
Oregon  8  4  0  4 
Pennsylvania  10  2  0  8 
Rhode Island  1  1  0  0 
South Carolina  7  5  1  1 
South Dakota  9  7  0  2 
Texas  6  0  0  6 
Utah  8  0  5  3 
Vermont  1  0  1  0 
Virginia  8  6  2  0 
Washington  5  4  0  1 
West Virginia  6  0  1  5 
Wisconsin  9  7  0  2 
Wyoming  9  0  6  3 
Total  348  133  100  115 
Source:  OIG Analysis of States 2006 Annual Reports, 2007.  
 
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  AA CC KK NN OO WW LL EE DD GG ME ME NE NT ST S  
This report was prepared under the  direction of Ann Maxwell, Regional 
Inspector General for Evaluation and Inspections in the Chicago 
regional office, and Thomas Komaniecki, Deputy Regional Inspector 
General. 
Anne Bracken led this study and Tamara Perry served as the lead 
analyst. Other principal Office of Evaluation and Inspections staff from 
the Chicago regional office who contributed to this report include Beth 
McDowell; central office staff who contributed include Kevin Farber and 
Alan Levine. 
 
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