STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID AND CHIP PROGRAMS

1
STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID
AND CHIP PROGRAMS

• Overview of Presentation
• The challenge Maximizing enrollment of both
  already-eligible children into Medicaid and other
  uninsured children into CHIP
• Problems surrounding the enrollment process
• Options and strategies available for streamlining
  childrens enrollment
• What did we learn from the Medicaid expansions
  for pregnant women?
• Additional considerations under CHIP

2
THE CHALLENGE

• Over 11 million uninsured children
• Of these, 4.7 million already eligible for
  Medicaid, but not enrolled
• An additional 3 to 5 million could be eligible
  for coverage under CHIP
• Maximizing enrollment will take aggressive and
  creative efforts in both outreach and eligibility
  simplification

3
WHAT ARE THE PROBLEMS WITH CURRENT ENROLLMENT
SYSTEMS?

• Historically, leading reasons for denials of
  eligibility are NOT too much income, or too many
  resources. Rather, noncompliance with
  procedures. In other words, families could not
  complete the process.
• Specific barriers include
• Long applications
• Multi-program applications
• Extensive verification of assets and resources
• Location of eligibility workers in county social
  services offices
• Welfare stigma
• Long waits for determinations and receipt of cards

4
STRATEGIES AND AVAILABLE OPTIONS FOR REDUCING
ADMINISTRATIVE BARRIERS AND FACILITATING
ENROLLMENT

• Shorten and simplify forms
• Eliminate assets tests
• Permit mail-in applications
• Expand use of outstationed workers
• New 12-month continuous eligibility for kids
• Make income eligibility thresholds consistent for
  all ages
• Expedited eligibility determinations
• Eliminate automatic closures by the computer

5
PRESUMPTIVE ELIGIBILITY FOR CHILDREN

• Establishes short-term temporary eligibility
  based on declaration of family income
• Provides immediate coverage of all covered
  services, and guarantees payment to providers who
  render these services
• Brings enrollment process into community-based
  settings. Broad range of sites permitted to make
  presumptive determinations (including doctors
  offices, clinics, LHDs, CHCs, school-based health
  centers, hospitals, as well as WIC clinics, Head
  Start programs, groups that determine eligibility
  for subsidized child care, etc.)
• Must establish systems for ensuring that families
  submit formal application for Medicaid

6
WHAT WORKED LAST TIME?

• States that simultaneously implemented
  presumptive eligibility and dropped assets tests
  experienced most rapid growth in enrollment of
  pregnant women.
• Source General Accounting Office, 1991

7
ADDITIONAL CONSIDERATIONS UNDER CHIP

• Requirement to screen for Medicaid eligibility
  prior to enrollment into CHIP program
• Suggests need for/importance of working to
  coordinate the two systems
• Available strategies include single application
  form, uniform eligibility rules
• Administrative matching funds available under
  Medicaid for outreach and enrollment initiatives
• Under CHIP, 10 cap on use of funds for these
  purposes
• Additional funds available through welfare reform
  can supplement and enhance CHIP outreach efforts

8
MONITORING ENROLLMENT TRENDS UNDER CHIP AND
MEDICAID

• Use routine administrative data to monitor
  applications and
• case closures. Specifically
• Number of applications received
• Rates of approval and denial
• Reasons for denial
• Presumptive eligibility cases and successful (and
  failed) conversions to full Medicaid eligibility
• Number of closures
• Reasons for closure
• Reapplication rates and outcomes after closures