# Presentation: 684246

## 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

## 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 

- 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

- THE CHALLENGE

## 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

- 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

- WHAT ARE THE PROBLEMS WITH CURRENT ENROLLMENT SYSTEMS?

## 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

- 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

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

## 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

- 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

- PRESUMPTIVE ELIGIBILITY FOR CHILDREN

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

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

## 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

- 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

- ADDITIONAL CONSIDERATIONS UNDER CHIP

## 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

- 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

- MONITORING ENROLLMENT TRENDS UNDER CHIP AND MEDICAID