January 23, 1998  
Dear State Health Official:  
This letter highlights new and existing opportunities for outreach to uninsured 
children. We share a mutual interest in and commitment to enrolling uninsured 
children in both Medicaid and the new State Children's Health Insurance Program 
(CHIP). An estimated 3 million children are eligible for Medicaid, but remain 
uninsured. Millions more will be eligible for CHIP because of historic, bipartisan 
legislation passed by the Administration and Congress. Successfully enrolling these 
eligible but uninsured children is critical to both the success of these programs and 
the health of these children; as such, outreach is a high priority for the President, 
First Lady, and Department of Health and Human Services.  
In this letter, we describe examples of and options for successful outreach and 
enrollment and Federal funding available for these activities. Most of these provisions 
are currently options within Medicaid or reflect preliminary guidance for CHIP. Two of 
these provisions -- expanding the entities that can determine presumptive eligibility 
and expanding access to a special fund for outreach -- are proposals in the 
President's fiscal year 1999 Budget that would provide nearly $200 million a year in 
additional Federal dollars to States that choose to take advantage of these initiatives. 
If passed, they would be effective on October 1, 1998.  
I. Funding for Outreach  
States have several options for receiving Federal matching funds to find and enroll 
uninsured children in Medicaid and/or CHIP. Medicaid will match States' expenditures 
associated with outreach to Medicaid-eligible children. Similarly, CHIP funds may be 
used to pay for outreach to CHIP-eligible children (up to the 10 percent limit, 
described below). Because of the importance of outreach, the President's fiscal year 
1999 Budget contains proposed legislation that, if enacted, would provide a higher 
matching rate for outreach activities for all children, regardless of their eligibility. 
This section describes these options.  
Federal Matching of Outreach under Medicaid  
There have been questions about what types of outreach activities Medicaid will fund. 
The Federal government matches State Medicaid expenditures for outreach activities 
that bring potential eligibles into the Medicaid system to determine if they qualify for 
Medicaid benefits. These activities include: informing families about Medicaid through 
brochures or other promotional material; assisting families in completing Medicaid 
applications; and providing the necessary forms and packaging for Medicaid eligibility 
determinations. These activities are considered allowable Medicaid administrative 
activities for the purpose of Federal matching. Since the Medicaid program is an 
open-ended entitlement program, there is no limit on the amount of allowable 
Medicaid outreach expenditures States may claim for Federal matching.  
Federal Matching of Outreach under CHIP   Title XXI places a strong emphasis on outreach. State child health plans cannot be 
approved without a description of how States will educate families, assist them in 
enrolling children in the appropriate program, and coordinate health insurance 
programs across the State. There are several ways that CHIP outreach expenditures 
may be matched.  
Non-Medicaid CHIP Option Outreach activities related to a non-Medicaid CHIP 
program only would be matched from the State's CHIP allotment. States may spend 
up to 10 percent of their total CHIP expenditures (Federal and State) on non-benefit 
activities, including: outreach conducted to identify and enroll eligible children in 
CHIP; administration costs; health services initiatives; and other child health 
assistance. These expenditures are matched at the enhanced CHIP matching rate 
and count against both the 10 percent limit and the allotment.  
Medicaid CHIP Option Outreach activities related strictly to a Medicaid expansion 
under CHIP can be matched either from the State's CHIP allotment or under regular 
Medicaid, at the State's option. If a State elects to claim Federal matching for its 
outreach expenditures from the CHIP allotment, such Federal payments will count 
against the State's 10 percent limit and allotment and will be matched at the 
enhanced CHIP matching rate. Once the State reaches its 10 percent limit and/or its 
CHIP allotment, it may then claim Federal matching for any additional Medicaid 
outreach expenditures under the Medicaid program. States may claim Federal 
matching for outreach expenditures under the Medicaid program only if such 
expenditures are for CHIP-related Medicaid expansion groups. Alternatively, a State 
may elect to claim Federal matching for outreach expenditures for CHIP-related 
Medicaid expansion groups under the Medicaid program at the regular Medicaid 
administrative matching rate. If claimed in this way, Federal payments for these 
expenditures would not count against the 10 percent limit or the CHIP allotment.  
Joint Medicaid-CHIP Option Joint outreach efforts for Medicaid and CHIP may 
similarly be matched by either Medicaid or CHIP. Detailed guidance on these options 
was provided in a December 8, 1997 letter to State Health Officials on financial 
issues.  
Enhanced Matching for Children's Outreach Efforts [Proposed Legislation]  
In the welfare reform bill that created the Temporary Assistance for Needy Families 
(TANF) program, a $500 million Medicaid fund was established to help States ensure 
that children and parents losing welfare know about their continued eligibility for 
Medicaid. These funds, which are allotted to States, provide an enhanced Federal 
matching rate for outreach and administrative costs related to this narrow group of 
Medicaid-eligible people. Certain outreach activities are eligible to receive a 90 
percent matching rate from the fund. (See the May 14, 1997 Federal Register notice 
for details.) Few States, however, have taken advantage of this fund so far, in part, 
due to the difficulty of targeting outreach only to a subset of Medicaid-eligible 
children.  
The President's fiscal year 1999 Budget includes a legislative proposal that, if 
enacted, would expand the use of this fund. States would be able to receive a 90  percent matching rate for outreach activities for all uninsured children, not just those 
who would have been eligible for welfare. The Federal funds to cover the extra 
matching (above Medicaid's regular matching amount) would come from this fund. In 
addition, the proposal would remove the sunset on the fund in 2000 and add another 
$25 million to assist States with increased outreach activities.  
II. Expanding Sites for Enrolling Children  
In the wake of welfare reform, families often misunderstand their children's 
continued eligibility for Medicaid. They also may be unsure about differences 
between Medicaid and CHIP. Thus, it has become more important than ever that 
States have and pursue options to conduct educational activities and enrollment of 
children in a wider array of community settings.  
Allowing Immediate Medicaid Coverage Through Schools, Head Start, and 
Child Care Centers [Proposed Legislation]  
The Balanced Budget Act (BBA) of 1997 gave States a new option in Medicaid to 
grant "presumptive eligibility" to children. Certain children may receive immediate 
health care coverage without having to wait for a full Medicaid eligibility 
determination. Under this option, a "qualified entity"and/or its employees may 
presume that a child is temporarily eligible for Medicaid if, using preliminary 
information, family income does not exceed the State's applicable income eligibility 
level. The child's parent or guardian has until the end of the following month to 
submit a full Medicaid application for the child. Until a final eligibility determination 
on that application is made by the State, the child is covered for Medicaid services. 
Although the CHIP statute does not expressly provide for presumptive eligibility, 
States also could use this option in their eligibility for a CHIP separate State 
program.  
The BBA defines "qualified entities" as providers of health care items and services 
under the Medicaid State plan (including IHS, Tribal and urban Indian health care 
providers that participate in a Medicaid State plan) and entities that determine 
eligibility for Head Start, WIC and child care subsidies under the Child Care and 
Development Block Grant. It also requires that certain costs associated with 
presumptive eligibility be subtracted from the State's child health allotment ( see the 
December 8, 1997 letter on financial issues).  
The President's fiscal year 1999 Budget proposes to make this presumptive eligibility 
option more flexible and attractive to States. First, it would broaden the definition of 
"qualified entities" to include sites such as schools, child care resource and referral 
centers, child support enforcement agencies and CHIP eligibility workers. Second, it 
would eliminate the requirement that States subtract the costs of presumptive 
eligibility from their CHIP allotments. Instead, these costs would be matched as a 
regular Medicaid State plan option. Both of these changes would give States greater 
incentives and flexibility for using this important authority.  
"Outstationing" Eligibility Workers in Communities   Outstationing eligibility workers is a promising outreach strategy for enrolling 
Medicaid and CHIP-eligible children. "Outstationing" means locating eligibility 
workers in places other than welfare offices to assist with the initial processing of 
applications. (The final Medicaid eligibility determination must be made by the 
appropriate State agency.) Current Medicaid law requires States to outstation 
eligibility workers in Federally qualified health centers and disproportionate share 
hospitals. States also can receive Federal matching for outstationing eligibility 
workers in other locations.  
We encourage States to consider outstationing eligibility workers at sites that are 
frequented by families with children such as schools, child care centers, churches, 
Head Start centers, WIC offices, community centers, Job Corps sites, GED programs, 
local Tribal organizations and Social Security offices.  
Using Mail-In Applications  
One option that allows States to ease the enrollment process is the use of mail-in 
applications. Mail-in applications, especially for Medicaid, can significantly reduce the 
barriers to enrollment that may occur with requiring in-person applications. 
Transportation costs are eliminated, the stigma of going to a social services office is 
removed, parents will not have to miss work, and community groups like PTAs and 
church organizations can assist in distributing applications and information regarding 
Medicaid and CHIP. Many, but not all, States use this option in Medicaid today. We 
encourage all States to adopt this option.  
III. Simplifying Enrollment  
A key to successfully enrolling children at a wide range of sites is a simple application 
and enrollment process.  
Simplifying the Medicaid Application and Eligibility Process  
One barrier to enrollment in Medicaid is the complexity of the application. Some 
States have applications over 20 pages long, posing an often insurmountable 
challenge for families. We encourage States to develop strategies to simplify these 
processes by: preparing a simplified Medicaid application for the eligibility groups 
that include most children; using a "less restrictive" eligibility methodology that 
drops the Medicaid assets test for children; shortening the Medicaid application form 
generally; and allowing mail-in applications. Also, there are few verification 
requirements under Federal law that are mandatory. While it is important to 
maintain program integrity by verifying income, excessive requirements can deter 
families from completing the application process.  
Medicaid administrative funds can be used to redesign the Medicaid application form. 
Attached are some examples of shortened and simplified Medicaid applications used 
in some States ( see attachment A).   Using a Single Application for Medicaid and CHIP  
We encourage States to use one application for both Medicaid and CHIP. The 
advantages of a single application form include a reduction in paperwork for the 
State and a simplified process for families potentially eligible for Medicaid or CHIP. 
Attachment B includes a model joint application form and its instructions. We also 
encourage States to use single applications for health and non-health programs like 
TANF.  
Eligibility Screening and Enrollment for Medicaid and CHIP  
CHIP requires States to ensure that only targeted low-income children are furnished 
child health assistance and that children found eligible for Medicaid through 
screening are enrolled in Medicaid. At a minimum, State screening processes should 
assure that all children who are potentially eligible for Medicaid under the poverty-
level-related groups are identified. The State may initially use a gross income test 
that compares total family income to the applicable Medicaid standard. The initial 
gross income test would immediately identify children whose family income is low 
enough that Medicaid eligibility would be almost certain. A second test would be 
needed, however, to detect those children whose gross family income exceeds the 
Medicaid standard but who are Medicaid-eligible when income disregards are applied. 
Without this second test, the State would not be meeting its responsibility to ensure 
that children eligible for Medicaid are identified and enrolled in Medicaid. (Some 
States have used this technique with simplified Medicaid applications.) Screening is 
not required for States that elect to expand Medicaid under CHIP, because the child's 
eligibility for regular Medicaid will be determined as part of the State's eligibility 
determination process.  
The statute clearly says that States must include in their State child health plans a 
description of procedures to ensure that children found to be eligible for Medicaid 
must be enrolled in Medicaid; a simple referral procedure to Medicaid will not meet 
this requirement. The Department of Health and Human Services (DHHS) will be 
providing guidance on options to meet this requirement in the near future. Some 
examples include:  
  Single State agency for eligibility determination: States can use the 
Medicaid State agency to make eligibility determinations for non-Medicaid 
CHIP expansions as well as Medicaid CHIP expansions.  
  Joint application for both CHIP and Medicaid: States can use a joint 
CHIP and Medicaid application. As noted earlier, DHHS has developed a model 
application form for CHIP and Medicaid (see attachment B). States could use 
interagency agreements to send applications to the appropriate place for 
processing.  
  Presumptive eligibility: If the President's fiscal year 1999 Budget proposal 
is enacted, States will have the option of allowing their CHIP eligibility 
workers to make presumptive Medicaid eligibility determinations as well as 
CHIP eligibility determinations. (The final Medicaid eligibility determination 
must be made by the appropriate State agency.)  
Granting 12-Month Continuous Eligibility   Another way to increase the number of children with health insurance is to grant 
children eligibility for Medicaid for a longer period of time. Many families fall in and 
out of income eligibility due to job changes or fluctuations in paychecks. The BBA 
provides States the option to provide individuals under age 19 with up to 12 months 
of continuous eligibility after they are determined eligible for Medicaid, even if there 
is a change in the family's income, assets, or size. Under this option, Medicaid 
eligibility is granted for a period of up to one year regardless of changes in 
circumstances. States that use their CHIP funds for separate State programs can 
also provide continuous eligibility, since they have the flexibility to determine how 
frequently follow-up screening (redetermination) will be conducted.  
IV. Other Outreach Strategies  
In addition to expanding sites for enrollment and simplifying the process, States 
have used a number of valuable approaches to help them locate children and 
facilitate their enrollment in Medicaid and other health programs. This has been 
especially true for children who are members of special populations, such as children 
with special health care needs, homeless children and migrant children. State 
strategies to reduce barriers to enrollment range from advertising on billboards to 
linking health with other types of public programs like Head Start. Promising 
examples of State outreach activities are described in attachment C.  
Summary  
Every successful outreach model requires cooperation among diverse entities. 
Potential partners for outreach programs include school districts, community-based 
organizations, local health and human service providers, Head Start programs and 
child care centers. In addition, collaboration between the Federal and State 
governments, private businesses, foundations and advocacy groups could also 
produce creative and effective outreach initiatives.  
We believe that the new children's health insurance program provides a unique 
opportunity to ensure that the millions of eligible children are enrolled in public or 
private health insurance plans and receive essential health care services. We hope 
you will join us in meeting this challenge.  
Sincerely,  
Nancy-Ann Min DeParle  
Administrator  
Health Care Financing Administration  
Claude Earl Fox, M.D., M.P.H.  
Acting Administrator  
Health Resources and Service Administration  
Attachments   cc: HHS Regional Directors  
HCFA Regional Offices  
PHS Regional Offices  
TANF State Agencies  
Title IV-D Agencies  
Child Care Directors  
Child Welfare Directors  
Ms. Lee Partridge, American Public Welfare Association  
Ms. Jennifer Baxendell, National Governors' Association  
Ms. Joy Wilson, National Conference of State Legislatures  
Ms. Cheryl Beversdorf, Association of State and Territorial Health Officials  
Ms. Mary Beth Senkewicz, National Association of Insurance Commissioners  
 
 
(Attachment A)  
EXAMPLES OF SIMPLE MEDICAID APPLICATION FORMS  
 
1) List of States that have simplified the Medicaid Application Process:  
2) Delaware's Application (For more information call (302) 577-4901)  
3) Georgia's Application (For more information call (404) 656-4479)  
4) South Carolina's Application (For more information call (803) 253-6100)  
(1) States That Have Simplified the Medicaid Application Process  
 
The following States have taken steps to simplify their Medicaid application 
processes, by allowing mail-in applications, shortening the Medicaid application form, 
or eliminating the assets test for children or by using a combination of these 
techniques.  
Mail-In Applications (24) Short Application (29) ** No Assets Test (36)  
*** 
Alabama    Alabama    Alabama 
Alaska *   Alaska    Alaska 
Connecticu    Arkansas   Arizona 
Delaware   Colorado   Connecticut 
District of Columbia  Georgia    Delaware 
Hawaii *   Hawaii    District of Columbia 
Illinois *   Illinois   Florida 
Maine *    Indiana    Georgia 
Massachusetts   Iowa    Illinois 
Michigan (local decision) Kentucky   Indiana 
Minnesota   Michigan   Kansas 
Mississippi   Mississippi   Kentucky  Missouri   Missouri   Louisiana 
New Mexico *   New Hampshire   Maine 
North Dakota *   New Mexico   Maryland 
Ohio    New York   Massachusetts 
Oklahoma   Ohio    Michigan 
Oregon    Oklahoma   Mississippi 
Pennsylvania   Oregon    Missouri 
Utah *    South Carolina   Nebraska 
Vermont    South Dakota   New Hampshire 
Virginia   Tennessee   New Jersey 
Washington   Texas    New Mexico 
Wyoming *   Utah    New York 
    Vermont    North Carolina 
    Virginia   Ohio 
    Washington   Oklahoma 
    West Virginia   Pennsylvania 
    Wyoming    South Carolina 
        South Dakota 
        Tennessee 
        Vermont 
        Virginia 
        Washington 
        West Virginia 
        Wisconsin 
 
* After the mail-in application is received, the Medicaid agency will conduct a 
telephone interview.  
** Applications are the same length or shorter than the HCFA model application  
*** AR, CA, HI & UT count assets in determining Medicaid eligibility for some 
children.  
Source: Center on Budget and Policy Priorities, August 1997  
 
(Attachment B)  
MODEL JOINT APPLICATION FOR CHIP/MEDICAID FOR CHILDREN  
 
Purpose: The attached model joint application can be used for both the Children's 
Health Insurance Program (CHIP) and children's Medicaid eligibility (under the 
children's poverty level related groups). States could allow individuals to use this 
form to apply for both programs and the information on this form would be sufficient 
for determining which program a child is eligible for. It includes only that information 
which is required in all circumstances and is provided as a base form which a State 
can adapt to meet its own needs. As presented, the form is suitable for completion 
by an intake worker. Modifications would be required to make the form suitable for 
direct completion by the applicant.  
Screening: This application will meet the statutory requirement in Title XXI that 
States identify children who are eligible for Medicaid.  
NOTE: In situations where the State has contracted out the CHIP program eligibility 
(i.e., determinations will be made by non-State employees), this form can be  modified to be used as a pure screening form (or a combination of an application for 
CHIP and screening form) by removing all references to Medicaid. The statement 
about the use of the Social Security number [33] would be required. Inclusion of the 
rights and responsibilities section (without reference to Medicaid), however, would be 
at State option. Non-State employees cannot make a determination of Medicaid 
eligibility. If the form is so modified, in order to permit the information on the form 
to be submitted for use in making a Medicaid determination, the non-State 
employees could have a separate page for those whom the screen indicates are 
Medicaid-eligible. On that page, the individual should consent to submission of the 
information as part of a Medicaid application, and accept the rights and 
responsibilities outlined on this draft (including a statement under penalty of perjury 
that the information provided on the "attached screening form" or "attached CHIP 
application" is correct). After this page is completed, the form could be forwarded to 
the State for a Medicaid eligibility determination.  
Mandatory Information About Medicaid: If a State uses a joint CHIP/Medicaid 
application and denies the Medicaid application, then the State must thoroughly 
inform the individual about the availability of Medicaid and his or her right to apply 
for Medicaid on a basis other than as a poverty-level child. This includes an 
explanation of the Medicaid program and the various eligibility groups, the 
advantages of Medicaid over CHIP and information about how and where to apply for 
Medicaid.  
Federal Verification Requirements: Under Federal law, there are no verification 
requirements pertaining to eligibility for the children's poverty-level-related groups 
under Medicaid other than those related to alien status of non-citizens, and the 
posteligibility requirements of 1137 pertaining to use of the individual's social 
security number and an income and eligibility verification system. Eligibility of a 
citizen child may be established on the basis of a declaration under penalty of 
perjury. States are permitted to require further verification as a condition of 
eligibility.  
Additional Simplification of Medicaid Eligibility Determination: If the total 
gross income of the family is at or below the applicable Medicaid income standard, 
the questions in the shaded areas need not be answered. The individual is obviously 
income eligible for Medicaid without further information.  
Explanation of Certain Fields: There are some questions on the application that 
may not elicit all the information needed to make a determination. Under certain 
circumstances, additional information will be required. For example:  
If the answer to the question about citizenship [18] is no, actual status will need to 
be determined, official documents submitted, etc.  
If the child has insurance [22] and is Medicaid-eligible, information about the 
insurance company and policy number will be needed; and   If the child had medical bills in the last 3 months [32] and is Medicaid-eligible, 
eligibility information for the last three months will be needed to establish retroactive 
eligibility, in addition to information about the bills.  
In addition, the question concerning employment by a public agency in the State 
[25] is only needed for CHIP eligibility and is not needed for Medicaid. This field does 
not ask directly about the availability and nature of health insurance on the 
assumption that the eligibility worker would have access to a list of public agencies 
which offer State health insurance of the type which precludes CHIP eligibility. If this 
is not the case in your State, this field would need to be expanded.  
Examples of State Modifications:  
A State may wish to include voter registration; or  
A State may want to use this as an application for Medicaid for the adults which 
would require additional information about the adults and stock affidavits concerning 
assignment of rights and pursuit of support.  
A State will need to add a question concerning each individual's resources (assets) if:  
  the State applies a resource test for the poverty level children; or  
  the State has not chosen to cover children born before 10/1/83 under the 
poverty level group AND the State applies a resource test for the optional 
group of categorically needy children ("Ribicoff children").  
 
 
 
CHILDRENS HEALTH INSURANCE PROGRAM / MEDICAID  
JOINT APPLICATION FORM  
   
                       
I. Person Applying for the                     
Child or Children  
                    Name       LAST   Home Phone [2]   Work 
Phone [3]  
[ 1] FIRST MIDDLE  
   
   
                       
Home Address   Apt. #  City [6]   State [7]   Zip [8]   County [9]  
[5]  
[4]Street  
       
   
                       
Mailing Address   Apt. #  City [12]   State [13]   Zip [14]   County 
[11]   [15]  
( if different from above) [10] 
Street  
   
   
   
   
   
II. Family Members Living in the Home  
(Attach extra sheet if needed)  
                       
Children (under 19) living  Date of  Social Security  Mothers Name  Fathe in the home   Birth  Citizen   Number   [20]   [
[17]  
NAMES [16]   (Yes or No)  [19]  
[18]  
                       
                       
                       
                       
                       
                       
           
Adults living in the home   Social Security  If employed by a public agency in the State,
Number  
NAMES [23]   [25]  
[24]  
           
           
           
                       
           
Joint Application Page 2  
   
III. Income and Child Care Payments  
   
List all the Income Received by Family Members Listed Above  
(Attach Extra Sheet if Needed)  
           
Name of person(s) working   Who provides the money? [27]   How Often?  
or receiving money* [26]   Employer, program or person   [28]  
Weekly, twice a 
month, monthly  
           
1.          
           
2.          
            3.          
   
*Be sure to include all sources of gross income (before taxes) such as wages, dividends & interest, TAN
pension, disability, child support, alimony, cash gifts, & other unearned income.  
   
List the payments made for child care  
(or care for an adult who cannot care for himself) so that someone in your household can work. [30]  
               
Name of person(s) who works   Name of Person  Under Age 2?   How Often?  
Care For  
               
        Yes      
  No    
   
   
   
IV. Medicaid Questions  
       
Is any child   Do any of the children have 
from the last 3 months?  
: [31] Pregnant: Yes     No   In an Institution: Yes   No     [32] Yes   No    
   
Social Security Number (SSN)  
[33]  
You must give us your SSN in order to receive Medicaid. This is required by section 
1137(a)(1) of the Social Security Act and the Medicaid regulations of 42 CFR 
435.910. The Medicaid agency will use the SSN to verify you Income, eligibility, and 
the amount of medical assistance payments we will make on your behalf. It is 
possible that we will also use the SSN to determine another persons right to 
Medicaid or to comply with Federal law requiring that we release information from 
Medicaid records. The information may be matched with the records in other 
agencies, such as the Social Security Administration or the Internal Revenue Service. 
These matches may be done by computer or on an individual basis.  
   
Rights and Responsibilities  
[34]  
I agree to the release of personal and financial information     I understand that this application is an
from this application form and supporting documents to the  kind of childrens health benefits unde
agencies that run these programs so that they can evaluate it  full Medicaid application. I understand
and verify eligibility. I understand that the agencies that run  eligible for this kind of childrens healt
the programs will determine confidentiality of this information  Medicaid, I may be eligible for Medicai
according to the federal laws, 42CFR 431.300-431.307.1, and  other basis and have a right to comple
any applicable federal and state laws and regulations.   application.  
Officials from the programs that I, or members of my  I have the right to appeal any decision
household, have applied for may verify all information on this  Medicaid program. Information on the
form.   obtained from the local Medicaid agen
I understand that I must immediately tell the Medicaid agency  I understand that anyone who knowin
about any changes in information on this form.   the truth or arranges for someone to k
misrepresent the truth is committing a
punished under federal law, state law,
I understand that I may be asked to provide additional 
that I may also be liable for repaying i
information.  
benefits received and my be subject to
I understand my eligibility will not be affected by my race, 
I certify under penalty of perjury that 
color, national origin, age, disability, or sex, except where this  is restricted by law.   application form is the truth as best I 
   
          
Signature [35]  
Date  
Date Received by Agency [36]  
 
(Attachment C)  
DISCUSSION OF PROMISING OUTREACH STRATEGIES  
 
Significant barriers exist to providing health care coverage for uninsured children and 
enrolling them in Medicaid. States and local communities are implementing a variety 
of approaches to reducing these barriers. Many States are simplifying the 
complicated application forms and enrollment processes, as well as allocating more 
resources to developing innovative outreach activities. The Department of Health and 
Human Services (DHHS) is prepared to assist States and local communities by 
facilitating the exchange of information regarding successful outreach endeavors and 
information related to enrollment simplification. The following are examples of 
promising outreach strategies currently practiced or being considered in various 
places.  
  Implement an 800 hotline number for enrollment information in each State, 
to provide information (in appropriate languages) on child health insurance 
programs, referrals, and telephone assistance in completing application 
forms. To the extent possible, publicize a single number; several 800 
numbers may lead to confusion. Most States already have an effective toll-
free hotline through their Title V Maternal and Child Health offices that could 
be serve as a base for disseminating information relating to Medicaid and 
CHIP.  
  Streamline the eligibility process, have simplified application forms in 
appropriate languages, and allow application by mail. Ask only for necessary 
information. Allow for enrollment on certain evenings and Saturdays at 
convenient sites. Allow appropriate entities, especially in remote areas, to 
determine eligibility presumptively.  
  Use billboards in bus and subway stations and radio stations to publicize the 
programs, including information that uninsured children of low-income 
working parents may also qualify for Medicaid or CHIP. Place posters (that 
have been field-tested in that community ) at locations frequented by target 
families -- e.g., thrift shops, discount stores, fast-food restaurants, 
laundromats, and ethnic festivals.  
  Encourage prenatal care and child health through unified State-wide public 
service outreach campaigns which are advertised with an identifiable logo and 
reader-friendly materials that appeal to lower-income families.     Distribute information about child health insurance programs through child 
care centers, Head Start programs, schools, child support enforcement 
agencies, community action programs, refugee resettlement programs, TANF 
offices, family preservation and support programs, Special Education and 
Social Security offices -- with materials in simple, appropriate languages. 
Also, verbally ask the children in the above settings (as they take the 
literature home) to tell their families that they may be eligible for health care.  
  Provide enrollment opportunities at local sites where children receive health 
care; school-based health centers are a particularly good vehicle for 
identifying and enrolling children in insurance programs.  
  Station eligibility workers in hospitals to assure prompt enrollment of 
newborns, in health centers, and at locations where immunizations are 
provided.  
  Coordinate with other programs, such as TANF, child support enforcement 
agencies, family support councils, local Tribes, WIC, food stamps, Title V, free 
or reduced-price lunch programs, Head Start, Special Education and Social 
Security offices.  
  Establish a State-wide computer program, wherein applications for any one 
public assistance program will (with the client's permission) be automatically 
"cross-referred".  
  Develop outreach strategies with local community-based organizations, and 
have them assist in outreach efforts, including at events such as community 
fairs. Word-of-mouth can be the best outreach tool in communities where 
there is mistrust of the system. Provide speakers and program information to 
community, school and religious programs.  
  Use trained, trusted persons within the local community to do eligibility 
outreach and to provide assistance to their neighbors in completing 
application forms.  
  De-stigmatize Medicaid to the extent possible. Some States have addressed 
this issue by renaming the program with names such as "Dr. Dynasaur", or 
"KIDMED" or "Child Health Plus." Encourage eligibility workers to treat clients 
with courtesy and respect. Ensure that the card issued to the family is free of 
any perceived "welfare stigma." Have posters reflect a positive image of 
Medicaid and those who use Medicaid.  
  Enlist the support of businesses and foundations to provide incentives (e.g., 
gift certificates, coupons for free meals or merchandise, movie passes) for 
families who apply for and/or use services.