Department of Health and Human Services
 

OFFICE OF 

INSPECTOR GENERAL 

ASSESSING STATES’ PROGRESS 


IN MEETING STATE CHILDREN’S 


HEALTH INSURANCE PROGRAM 


GOALS 


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. 
 

 

 

 

 

 

 

Δ EXECUTIVE SUMMARY 

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 Children’s 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. 

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EXECUTIVE SUMMARY 

However, no State had a statistically significant change in the 

percentage of uninsured low-income children. While each State’s 

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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EXECUTIVE SUMMARY 
 

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 CMS’s 

comments, we now suggest that CMS create a comprehensive list of 

States’ current performance goals. 

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Δ TABLE OF CONTENTS 

EXECUTIVE SUMMARY ..................................... i 
 

INTRODUCTION ........................................... 1 
 

FINDINGS ................................................ 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 
 

RECOMMENDATIONS ..................................... 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 
 

ACKNOWLEDGMENTS .................................... 30 
 
 

 

 

 

 

 

 

Δ INTRODUCTION 

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 Children’s 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 program’s 

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 children’s 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 Bureau’s Current Population 

Survey’s (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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INTROD U C T I O N 

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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INTRODUCTION 

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 State’s 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 State’s Annual Report. In the 

2006 Annual Reports, CMS included five overlapping 3-year averages 

between 1996 and 2005, along with the percentage changes between 

1996–1998 and 2003–2005. 

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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INTRODUCTION 

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 

children’s 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 Children’s 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 Children’s 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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INTRODUCTION 

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 OIG’s two reports with a 

recommendation in response to OIG’s 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 GAO’s 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 “Children’s Health Insurance: Inspector General Reviews Should Be Expanded To 

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

“Children’s 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 “Children’s 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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INTRODUCTION 

To determine States’ progress in meeting and reporting on their goals, 

we included all States that had SCHIP programs in 2006. This decision 

reflects GAO’s 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 CMS’s 

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, 2000–2002 

(hereinafter referred to as 2002) and the last 3-year average, 2003–2005 

(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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INTROD U C T I O N 

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 goal’s 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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INTROD U C T I O N 

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 

Target 

State reached the target. State was at least half of 

the way to achieving the 

target. 

State was below the 

halfway mark to 

achieving the target. 

Directional Goal 

Without a Target 

Trend of the data 

matched the goal 

direction. 

State maintained status 

from previous year. 

Trend of the data moved 

in opposition to the goal 

direction. 

Nondirectional Goal Task was completed. State attempted the 

task. 

State did not attempt the 

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. 

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INTRODUCTION 

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 President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

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FINDINGS 

 

 

-

Δ 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 between 2002 and 

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 Percent Uninsured Low-Income Children 

25.0% 

23.0% 

21.0% 

19.0% 

17.0% 

15.0% 

Annual Estimates 3-Year Average 

2000 2001 2002 2003 2004 2005 

Year 

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 

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F I NDING S 

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 

change in the percentage of uninsured 

low-income children 

Although the national 

percentage of uninsured 

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 State’s 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 State’s percentage of uninsured low-income children. 

Thirty-seven States met or made 

progress in meeting at least half 

In 2006, 37 States met or made progress in 

meeting at least half of their performance goals 

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. 

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FINDING 
 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. 

See Appendix B for each State’s 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 

Table 2: Number of States by the Percentage and Number of Goals 

Classified as Met or Making Progress 

Percentage of Goals Classified 

as Met or Making Progress Number of States 

Average Number of Goals 

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. 

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FINDINGS 

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 State’s 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 

Strategic Objective 

Number of States 

That Reported at 

Least One Goal 

States’ Average 

Number of Goals 

Per Strategic 

Objective 

Number of States by the 

Percent That Made Progress 

or Met Goals 

0–49 

Percent 

50–100 

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 

low-income children 

41 2 17 24 

Medicaid enrollment 20 1 9 11 

Other 10 1 3 7 

Source: OIG Analysis of States’ 2006 Annual Reports, 2007. 

Despite improvements made by CMS to the 

Annual Report template, States’ progress 

remains difficult to assess 

OIG’s previous SCHIP 

reviews reported significant 

difficulties using the Annual 

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 CMS’s 

national performance measures. 

33 “State Children’s Health Insurance Program: Assessment of State Evaluations 

Reports,” OEI-05-00-00240, p. 15. February 2001. 

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F I NDING 
 S 

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. 

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F I NDING 
 S 

and one State used the Center for Disease Control’s 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 

State’s 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 State’s 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. 

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Δ RECOMMENDATIONS 

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 State’s 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 

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RECOMMENDATIONS 

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. 

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RECOMMENDATIONS 

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 CMS’s comments, we now suggest that CMS 

create a comprehensive list of States’ current performance goals. 

For the full text of CMS’s comments, see Appendix D. 

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-

 

 

APPENDIX ~ A 

PERCENTAGE OF UNINSURED LOW-INCOME CHILDREN 

NATIONALLY AND BY STATE 

Table 4: Percentage of Uninsured Low Income in 2005 and 2002 

State 

Current 

Program 

Type* 

2005 2002 Difference Between 2005 and 2002 

Percentage 

Difference† 

Confidence Intervals 

 (2005–2002) Lower 

90 Percent 

Upper 

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% 

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-

 

 

 

APPENDIX~A 

Table 4: Percent of Uninsured Low Income Children in 2005 and 2002 (Continued) 

State 

Current 

Program 

Type* 

2005 2002 Difference Between 2005 and 2002 

Percentage 

Difference† 

Confidence Intervals 

(2005–2002) Lower 

90 Percent 

Upper 

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 Bureau’s 

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. 

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Δ APPENDIX~C APPENDIX~B 

STATES’ PROGRESS IN MEETING GOALS 

Table 5: Number of Goals by States’ Progress 

Progress of Goal 

State Met 

Making 

Progress 

Not Making 

Progress 

Progress 

Unreported/ 

Data Does Not 

Measure Goal 

Total 

Number of 

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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APPENDIX~B 

Table 5: Number of Goals by States’ Progress (Continued) 

Progress of Goal 

State Met 

Making 

Progress 

Not Making 

Progress 

Progress 

Unreported/ Data 

Does Not 

Measure Goal 

Total 

Number of 

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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APPENDIX~C 

 

 

Δ APPENDIX~D APPENDIX~C 

STATE GOALS BY SPECIFICITY 

Table 6: Number of Goals by Specificity per State 

Type of Goal 

State Total 

Number 

of Goals 

Directional 

Without Target 

Directional 

With Target 

Nondirectional 

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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APPENDIX~C 

Table 6: Number of Goals by Specificity per State (Continued) 

Type of Goal 

State Total 

Number 

of Goals 

Directional 

Without Target 

Directional With 

Target 

Nondirectional 

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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Δ APPENDIX ~ D 
 

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APPENDIX ~ D 
 

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APPENDIX ~ D 
 

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APPENDIX ~ D 
 

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APPENDIX ~ D 
 

ΔAPPENDIX ~ A ACKNOWLEDGEMENTS ACKNOWLEDGMENTS 

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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