The State Children's Health Insurance Program (SCHIP), created as Title XXI of the Social Security Act by the Balanced Budget Act of 1997, offers an unprecedented opportunity to provide health insurance to nearly 4 million uninsured children in the United States. With support from both federal grants and individual state contributions, each state has the flexibility of offering health insurance through a Medicaid expansion, a separate state program, or a combination of both approaches. The challenges for each state are to effectively identify and enroll eligible low-income children and to assure that newly enrolled children receive quality comprehensive health care. States must include in their program an evaluation component that accurately assesses progress in reducing the number of uninsured low-income children and assuring their access to quality health services. The SCHIP Evaluation Tool is a document developed by the American Academy of Pediatrics (AAP) to assist states in this effort.

This tool provides 30 indicators that measure the impact of Title XXI on three closely linked dimensions of quality assessment of health care: access, process, and outcomes. These three domains comprise a logical sequence from making health insurance available to achieving improved health status. In adapting these indicators, we encourage states to address populations of children who have special health care needs or who have experienced barriers to access, eg, children with chronic illness, adolescents, minority populations, and families experiencing language barriers. We expect that all states can provide periodic evaluations that report comparisons with baseline and among subgroups of enrollees by age, gender, race/ethnicity, household income, and health plan. We recognize, finally, that certain outcomes may be influenced by circumstances beyond health insurance and health care, such as living conditions, education, and nutrition. Additional comparisons with other groups of children, eg, children with commercial insurance or Medicaid, may prove useful to disentangle the impact of such factors.