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 children’s 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