Retaining Eligible Children and Families in SCHIP and Medicaid

2. Retaining Eligible Children and Families in SCHIP and Medicaid A Review of Research Prepared by Lake Snell Perry & Associates

3. Agenda • Overview of the project • Factors that affect retention • Ways to improve retention • Communication strategies • Q & A

4. Description of the Project LSPA reviewed existing research and interviewed experts to inform states, grantees and others about the challenge of retention in SCHIP and Medicaid

5. Methodology • 51 studies were collected and reviewed • 24 in-depth telephone interviews were conducted • 16 with leading experts • 8 with Medicaid/SCHIP directors

6. What We Learned about the Field • Retention is a new topic • Most studies are about retention in SCHIP, not in Medicaid • Most of the research focuses on retaining children, not adults • Most of the studies are state-specific

7. Studies and Experts Agree on the Factors That Affect Retention

8. Procedural Barriers Studies show a large drop in enrollment during renewal periods due to: • Complex renewal forms • Too much documentation • Frequent renewal • Face-to-face interviews • Administrative errors • Language barriers

9. Cost-Sharing • Families sometimes have difficulty paying SCHIP premiums • The inflexibility of the payment rules may be a bigger problem • Overall impact of cost-sharing – does it lead to disenrollment or do families prefer paying?

10. Awareness Gaps Families have gaps in their knowledge about SCHIP and Medicaid. Many are unaware: • That they need to renew regularly • Of income eligibility levels • That their premium amount for SCHIP is adjustable

11. Life Circumstances • Busy and fluctuating personal and economic lives • Families move in and out of employment frequently • Lives are “less predictable” • They “forgot” or “did not get around to it”

12. Valuing Health Coverage • Most studies argue that low income families place a high value on health coverage, particularly for their children • Others suggest that coverage is not always seen as “necessary”

13. Perceptions of the Programs • Stigma may not be a big factor in retention • SCHIP and Medicaid often get high satisfaction rates • Some negative attitudes about the programs, particularly Medicaid

14. Delinking Problems • Children may be wrongly losing Medicaid coverage when their parents lose public assistance • According to one state study, 51 percent of children lose Medicaid coverage each year after leaving cash assistance

15. Health Status • Families with more health needs are more likely to stay enrolled • At least one study did not find that children with more health needs stay enrolled • Bottom line – more research is needed

16. Race, Gender and Income • This is a new area of study • One study showed that lower-income families were more likely to lose SCHIP coverage than higher income families • A few studies found that African-American children were less likely to remain enrolled • One study found that boys were slightly less likely than girls to lose coverage

17. Vital Role of Third Parties • Many experts say that community-based organizations, schools, employers, doctor offices, health plans and others can play a vital role in retention • Caseworkers also play a vital role

18. Studies and Experts Identify Many Ways to Improve Retention

19. Simplify the Renewal Process • Consider passive renewal • Require annual renewal as opposed to quarterly or every 6 months • Limit face-to-face interviews • Allow for self-declaration of income • Use pre-filled renewal forms

20. Simplify the Renewal Process • Use shorter, simpler renewal forms • Send renewal forms in self-addressed, stamped envelopes • Allow renewal forms to be accepted at numerous sites • Enable families to renew off-cycle when it may be more convenient

21. Reach Out to At-Risk Families • Contact families due for renewal to encourage them to renew • Follow up with families that do not return their renewal forms • Improve communication notices reminding families it is time to renew • Keep addresses up to date

22. Reach Out to At-Risk Families • Increase reminder notices prior to the renewal deadline • Create toll-free renewal information lines in different languages • Provide reminder notices in multiple languages • Train caseworkers to better assist families to complete the renewal process

23. Offer Renewal Assistance • Provide renewal assistance to first-timers • Use “community-based application assistors” to help with renewal • Reach out to community-based partners to help with renewal • Pay community-based organizations for each renewal they assist

24. Relax Premium Payment Rules (SCHIP) • Help families who miss payments stay enrolled • Create a universal premium amount to avoid confusion • Allow for automatic paycheck deductions • Shift to an annual payment with a reasonable cost

25. Coordinate Program Databases • Coordinate the databases of SCHIP and Medicaid to track movement between programs • Reduce the number of renewals a family must complete by coordinating among food stamps and TANF

26. Other Ideas • Measure the effectiveness of renewal strategies • Evaluate reasons for disenrollment to determine the real causes for loss of coverage

27. Other Ideas • Get enrolled families to use their coverage so they will value it more • Complete the delinking of TANF and food stamp procedures from Medicaid

28. Communication Strategies: What States Are Doing

29. What Some States Are Doing • Mailing postcards in advance of renewal • Redesigning the renewal notice to include a renewal checklist • Creating a two-sided renewal form – one side English, the other Spanish • Using bright colored paper for renewal notices (“if it is blue, it is time to renew”)

30. What Some States Are Doing • Mailing SCHIP newsletter with retention messages to enrolled families • Developing a renewal mailing that is different from other packets (i.e. bright yellow stickers on renewal mailings) • Creating a refrigerator magnet urging families to renew that includes the renewal date

31. What Some States Are Doing • Using the SCHIP logo (instead of the Department of Health Logo) on program mailings • Creating a training video for outreach workers that includes renewal tips • Using premium payment coupons that include printed reminders about renewal

32. Available Resources