Medicaid and SCHIP Outreach: Opportunities and Challenges for South Carolina in 2006 and Beyond

1
Medicaid and SCHIP Outreach Opportunities and
Challenges forSouth Carolina in 2006 and Beyond

• Pat Redmond
• Senior Project Associate
• www.cbpp.org

2
The Outreach Context

• Overview of Todays Presentation
• South Carolinas application and renewal
  procedures what works and whats next?
  
• Attention to groups that may have been missed
• Building a long term systems approach to
  outreach and renewal what works and whats
  next? Current examples.
  
• New barrier from change in federal law
  citizenship documentation.
  

3
South Carolinas Procedures

• Family-friendly procedures
• No interview at application or renewal for
  children or parents
  
• No asset test for children or parents
• 12 month continuous eligibility for children

4
South Carolinas Procedures

• What more could be done?
• On-line application
• Presumptive eligibility for children
• Third party verification of income
• Simplify renewal

5
On-line Application

• Fourteen states now allow families to apply
  online for Medicaid.
  
• This strategy gives families the opportunity to
  apply when it is most convenient for them and
  in some cases get quick feedback about
  potential eligibility.

6
Presumptive Eligibility

• Most states provide this option to pregnant
  women nine states provide this option to
  children applying for Medicaid.
  
• Under this option, certain qualified entities
  can make a preliminary, or presumptive
  determination that a child is eligible for
  Medicaid based on the familys declaration that
  their income is below that states eligibility
  guidelines for Medicaid.
• Range of qualified entities includes Medicaid
  providers, WIC programs, Head Start programs, and
  agencies that determine eligibility for
  subsidized child care.

7
Third Party Verification of Income

• States are not required to obtain proof of income
  from families. States can use their own data
  base searches to verify income. No need to ask
  for income information that the state has
  available from another program.
• Nine states permit this in Medicaid. This process
  can be done in a way that does not compromise
  program integrity.
  
• Tremendous aid to families burdened by paperwork
  requirements, especially now that families will
  be facing new requirements to document
  citizenship. This is one way South Carolina
  could offset the citizenship documentation burden.

8
Simplification of Renewal

• States can simplify the renewal process and
  minimize paperwork for families by
  
• pre-populating so there is less to complete
• reducing verification
• reduce steps beneficiaries must take. Federal
  law allows Medicaid renewal without requiring
  action from the beneficiary if information is
  available to determine ongoing eligibility.
  State need not require a separate renewal form
  could get information from another program (food
  stamps) or over the telephone.

9
Groups That May Have Been Missed

• Immigrants Until 1990, about three-quarters of
  all immigrants lived in just six states. That
  pattern is changing. SC is considered a new
  growth state for immigrants. The immigrant
  population expanded considerably during the
  1990s.
• What has been done in South Carolina to reach out
  to immigrant populations?

10
Groups that May Have Been Missed

• Each year, approximately 250,000 children are
  discharged from foster care. The majority are
  reunited with their families.
  
• While in state custody, children are generally
  enrolled in Medicaid.
  
• Several state-level studies have found that many
  of children risk becoming uninsured when they
  return home.

11
Children in Foster Care

• Children returning home from foster care are
  likely to still be eligible.
  
• Children in this situation are also likely to
  need ongoing, perhaps immediate medical care.
  
• There are steps states can take to facilitate
  coverage at this time.

12
Children in Foster Care

• States can ease this transition and reduce the
  chance that children will go without health care
  by
  
• Conducting ex parte reviews of the childs
  eligibility.
  
• Providing a grace period of eligibility for
  children discharged from foster care, by
  pending the childs case for some period of
  time.

13
Systems Outreach Approaches

• Use applications as gateways to other benefit
  programs. Technical assistance on program
  integration is available from CBPP.
  
• Incorporate application and renewal assistance
  into as many community based sites as possible.

14
Systems Outreach Approaches

• Some Examples
• Wilmington Health Access for Teens in North
  Carolina
  
• Metro Hospital in Cleveland, Ohio
• Family Resource Counselor Program in Rhode Island

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Systems Outreach Approaches

• Wilmington Health Access for Teens
• W.H.A.T. logs 12,000 patient visits annually,
  all of which are youth between 11 and 24. Clinic
  staff approach insurance as a life skill with
  teens, and work with them to deal with privacy
  issues. 80 to 90 percent of the patients are
  insured 60 percent are enrolled in Medicaid.

16
Systems Outreach Approaches

• Metro Hospital in Cleveland, Ohio integrated
  insurance application and renewal assistance into
  its nurse on call hotline. This is funded by a
  contract with the county.
• All TV, radio and print advertising points people
  to the hotline number.

17
Systems Outreach Approaches

• The Family Resource Counselor program, managed by
  the Rhode Island Health Center Association,
  provides application assistance for Medicaid, the
  states expansion program, RIte Care, and other
  crucial benefits such as WIC, food stamps and
  child care subsidy. An approximately 53,000
  investment in this program brought the hospital
  316,237 in reimbursement.

18
New Barrier Citizenship Documentation

• The budget legislation signed by the President in
  February requires that beginning July 1, 2006,
  all citizens applying for Medicaid have to
  submit
• passports or naturalization papers or birth
  certificates AND other proof of identity (such as
  a drivers license) to prove that they are
  citizens.

19
New Barrier Citizenship Documentation

• The new requirement is unnecessary. The HHS
  Office of Inspector General found no substantial
  evidence that immigrants are obtaining Medicaid
  by falsely claiming citizenship.
• State Medicaid directors have stated that the
  requirement will substantially increase
  administrative burdens.

20
New Barrier Citizenship Documentation

• Current beneficiaries are subject to the same
  requirementprove citizenshipthe first time that
  their eligibility is renewed after July 1, 2006.
  
• In the first six to twelve months after July 1,
  states will have to check citizenship documents
  for more than 50 million beneficiaries. No one
  is exempt.
• More than one-tenth of U.S. born adults with
  children who have incomes below 25,000 annually
  reported that they do not have a birth
  certificate for at least one child.

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New Barrier Citizenship Documentation

• Many issues are unclear, including whether birth
  certificates must be raised seal or not. If
  the person must order a birth certificate from
  the state, there is often a difference in cost.
• South Carolina DHHS website has a link to Vital
  Records. Birth certificates cost 12 to more
  than 40 based on type of service requested.

22
New Barrier Citizenship Documentation

• Outreach messages and materials need to describe
  the new requirement and clarify that non-citizen
  immigrants do not need to submit a U.S. passport
  or birth certificate to qualify.
• Has South Carolina begun to plan outreach efforts
  to notify beneficiaries and new applicants about
  the requirement?

23
New Barrier Citizenship Documentation

• We cannot eliminate the barrier, but we can work
  to minimize the impact.
  
• CBPP will be providing technical assistance to
  states and community organizations on this
  issue.
  
• Share what is happening with us how you
  approach and resolve problems.

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Next Step

• Group Activity focused on South Carolinas
  challenges. Take a look at spectrum of
  outreach activities in handout.