- The Kaiser Commission on Medicaid and the Uninsured. Making it simple: Medicaid for children and CHIP income eligibility guidelines and enrollment procedures. Menlo Park (CA): Kaiser Family Foundation; Oct 2000.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This report examines the eligibility guidelines and enrollment processes of SCHIP and Medicaid programs, with focus on streamlining and simplification efforts. Some important findings include:
- Of the 32 States that have separate SCHIP programs, 28 use a joint Medicaid/SCHIP application.
- Most States (42 and Washington, DC) have dropped an asset test for children in Medicaid and SCHIP.
- Only 8 States have adopted presumptive eligibility for Medicaid, only 10 States allow for self-declaration of income in both programs, and only 13 States have adopted 12-month continuous eligibility in both programs.
This report offers strategies and suggestions for streamlining these processes.
- Perry M, et al. Marketing Medicaid and CHIP: a study of state advertising campaigns Washington (DC): The Kaiser Commission on Medicaid and the Uninsured; Oct 2000.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This study is the first nationwide analysis of States' advertising campaigns for children's health coverage programs. To conduct this study, officials from 48 States (including Washington, DC), who are responsible for SCHIP and Medicaid outreach were interviewed in June and July 2000. In addition, 37 print ads, 24 television ads, and 15 radio ads from 38 States were reviewed and analyzed. The purpose of these efforts is to create a baseline of information about States' marketing efforts for children's health coverage programs and to identify common approaches and messages States are using, as well as innovative approaches and ideas. This report also contains suggestions, based on interviews with State officials and past survey and focus group research, for strengthening these campaigns and for increasing SCHIP and Medicaid enrollment.
- Robert Wood Johnson Foundation. Key findings of a national public opinion survey of families with children who qualify for SCHIP and Medicaid. Princeton (NJ): The Foundation; Aug 2000.
This study is based on a survey of 829 low-income parents. Participants included parents who either have children already enrolled in Medicaid or SCHIP or have children who were eligible for coverage through either program but were unenrolled. According to this study, three out of five parents whose children may qualify for SCHIP or Medicaid do not know they are eligible, resulting in an estimated seven million unnecessarily uninsured children. While States have used SCHIP funding to expand coverage to families with moderate incomes, this survey shows that 71 percent of parents in two-income households and 69 percent of parents with an annual household income of more than $25,000 believe their children are ineligible for the program. The study also found that four out of five parents would enroll their children if they knew they were eligible for coverage.
- Edmunds M, Teitelbaum M, Gleason C. All over the map. A progress report on the State Children's Health Insurance Program (CHIP). Washington (DC): Children's Defense Fund; Jul 2000.
This report on children's health found dramatic differences in the way States enroll children and varying degrees of success in reducing the numbers of uninsured children. The Children's Defense Fund (CDF) estimates that nearly 12 million children are uninsured with 7 million of them eligible for SCHIP and Medicaid, but not enrolled. According to the report: one in three Hispanic children is uninsured, one in five Black children is uninsured, and nine out of ten uninsured children live with parents who work. CDF ranked States based on monthly rates of progress in enrolling children in SCHIP and Medicaid. The report covers the period from October 1997 through September 30, 1999.
- Patterson J. Conducting children's health insurance outreach in African American communities. Washington (DC): Center on Budget and Policy Priorities; Jun 2000.
This report can be found at: http://www.cbpp.org/6-26-00health.htm.
In 1998 nearly 20 percent of black children in the United States were uninsured and 68 percent lived in families with income below 200 percent of the Federal Poverty Level. This report examines a number of Medicaid and SCHIP outreach programs tailored to be sensitive to the cultures and dynamics of the black community, and describes specific recruitment and enrollment strategies that have been employed to reach members of this community.
- Ellis ER, Smith VK. Medicaid enrollment in 21 States: June 1997-June 1999. Menlo Park (CA): Kaiser Family Foundation; Apr 2000.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This study analyzes Medicaid enrollment data between 1997 and 1999 to identify key trends occurring across 21 State Medicaid programs. Study findings show that aggregate Medicaid enrollment declined in these States by 1.3 percent during that time period, with enrollment patterns differing considerably across States. However, the implementation of SCHIP has had a positive impact on Medicaid enrollment. In these 21 States, Medicaid enrollment increased from December 1998 to June 1999. Seventy-two percent of the increase was in regular Medicaid and 28 percent was enrollment in Medicaid-expansion SCHIP programs.
- Cox L, Ross DC. Making it simple: Medicaid for children and CHIP income eligibility guidelines and enrollment procedures. Findings from a 50-State survey. Washington (DC): Center on Budget and Policy Priorities; Apr 2000.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This report examines the extent to which States have implemented key strategies for simplifying enrollment procedures, reducing verification documentation, and streamlining the redetermination process. The report also examines how well States have coordinated these enrollment strategies in their Medicaid and SCHIP programs. Authors of the report recommend additional steps States can take to coordinate their Medicaid and SCHIP application, enrollment and redetermination procedures.
Schwalberg R, Mathis SA, Hill I. New opportunities, new approaches: serving children with special health care needs under SCHIP. Volume 1. Baltimore (MD): The National Policy Center for Children with Special Health Care Needs; Jun 2000.
This study examines five States' SCHIP programs in detail in order to examine alternative models of serving children with special health care needs (CSHCN) under SCHIP to assess their ability to meet children's needs. According to the research, most States are learning that ongoing, sustained outreach is needed to assure that the families of potentially eligible children are aware of the SCHIP program. These outreach campaigns, however, do not specifically target families of CSHCN; States may be reluctant to advertise SCHIP as a program for children with disabilities for fear of encouraging adverse selection or crowd-out. Whatever the reason, States have found that in the SCHIP programs, the proportion of children identified as having special needs rarely comes close to their original estimates, and none even approach the 15-20 percent estimated in national studies.
Families USA. Promising ideas in children's health insurance: presumptive eligibility for children. Washington (DC): Families USA; May 2000.
Presumptive eligibility is a way for States to enable health care providers and other organizations that serve low-income children to give temporary Medicaid or SCHIP eligibility to children and improve outreach, access to care and enrollment in these programs. As of February 2000, only five States had implemented presumptive eligibility for children in their Medicaid programs. Three additional States have authorized presumptive eligibility for Medicaid but have not implemented it and only three States have adopted presumptive eligibility in separate SCHIP programs. This issue brief is designed to answer questions about presumptive eligibility that may stand in the way of more States adopting this approach.
This article may be ordered through the Families USA Web site at: http://www.familiesusa.org/.
Sieben I, Rosenberg TJ, Bazile Y. The role of WIC centers and small businesses in enrolling uninsured children in Medicaid and Child Health Plus. New York: Medical and Health Research Association of New York City, Inc.; Mar 2000.
This report can be found at: http://www.cmwf.org/.
The authors designed, conducted, and evaluated two innovative models for enrolling uninsured children into Medicaid or CHP (Child Health Plus). One model targeted low-income families applying for or receiving Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritional services. Parents at these centers were given intensive one-on-one enrollment assistance and follow-up after applications had been filed. The second model was aimed at owners and employees of small supermarkets, grocery stores, and pharmacies that sell WIC-approved foods. This model sought to educate low-income workers in small businesses that do not provide health insurance coverage about the availability of Medicaid and CHP, and to conduct enrollment at the vendor sites. According to this study, community-based enrollment in sites such as WIC centers is effective in increasing health insurance coverage for low-income children. Small businesses can be effective venues for outreach and education about Medicaid and CHP, but are less effective as sites for actual enrollment.
Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and Child Health Plus. New York: Children's Defense Fund; Mar 2000.
This report can be found at: http://www.cdfny.org/.
In December 1998, the Children's Defense Fund-New York (CDF-NY) began to pilot-test the Student Health Outreach Project (SHOUT). SHOUT placed student volunteers in community organizations to educate families about the availability of Medicaid and Child Health Plus (CHP) for their uninsured children and to assist families with the application forms. By the project's close in May 1999, SHOUT had successfully enrolled nearly 200 children and adults in Medicaid or Child Health Plus. SHOUT's high enrollment success and application approval rates reveal that with proper training and oversight, it is possible to effectively use volunteers in the enrollment process.
Mann C, Cox L, Ross DC. Making the link: strategies for coordinating publicly funded health care coverage for children. Rockville (MD): Agency for Health Care Research and Quality; Feb 2000. AHRQ Pub. No. 00-0014.
This report describes strategies States can use to coordinate SCHIP coverage with existing Medicaid coverage. The authors use examples of strategies already used in various States.
This report can be ordered from the AHRQ Publication Clearinghouse at: http://www.ahrq.gov/news/pubsix.htm
Perry M, Kannel S, Valdez RB, et al. Medicaid and children: overcoming barriers to enrollment: findings from a national survey. Menlo Park (CA): Kaiser Commission on Medicaid and the Uninsured; Jan 2000.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This report summarizes the findings of a national survey focused on gaining a better understanding of barriers to Medicaid enrollment. The survey also aimed to gather participants' feedback on various methods of facilitating enrollment in Medicaid. The study is comprised of a nationwide telephone survey of 1,335 low-income parents. Two groups of parents participated in the survey: 1) parents of children currently enrolled in Medicaid and 2) parents of children who are uninsured but appear to be eligible for Medicaid. The main findings from the report are:
- The majority of children who are currently uninsured but eligible for Medicaid come from two-parent, working families with little welfare participation.
- Eligible but uninsured children have less access to health care services.
- The vast majority of low-income parents value the Medicaid program.
- A complex and burdensome enrollment process is the greatest barrier to enrollment.
Horner D, Lazarus W, Morrow B. Express lane eligibility: how to enroll large groups of eligible children into Medicaid and CHIP. Menlo Park (CA): The Children's Partnership for the Kaiser Commission on Medicaid and the Uninsured; Dec 1999.
This report can be found at: http://www.kff.org/about/kcmu.cfm.
This report reviews the potential for increasing enrollment in Medicaid and SCHIP through "Express Lane Eligibility"-the accelerated enrollment of low-income uninsured children already participating in other income-comparable publicly funded programs, such as the Supplemental Nutrition Program for Women, Infants, and Children (WIC) or school lunch. The report discusses the potential impact on Medicaid and SCHIP enrollment, analyzes different models, discusses key challenges of implementation, and suggests steps States and localities can take to initiate the implementation of Express Lane Eligibility.
Kenney GM, Haley JM, Ullman F. Most uninsured children are in families served by government programs. Washington (DC): The Urban Institute; Dec 1999.
This report analyzed data from the 1997 National Survey of America's Families and includes State-specific information for 13 States. Findings suggest that three-quarters of low-income children and 60 percent of all children without health insurance live in families that participate in the National School Lunch Program, the Food Stamp program, the Supplemental Nutrition Program for Women, Infants and Children (WIC), and the Unemployment Compensation Program. The National School Lunch Program appears to be a particularly effective vehicle for identifying uninsured children who are eligible for Medicaid or SCHIP coverage.
Dunbar JL, Sloane HI, Mueller CD. Implementation of SCHIP: outreach, enrollment and provider participation in rural areas. Bethesda (MD): The Project Hope Walsh Center for Rural Health Analysis; Nov 1999.
This report can be found at: http://www.projhope.org/.
Previous research found that children in rural areas are more likely to be uninsured than their urban counterparts. Many uninsured children are not enrolled in public insurance programs for which they are eligible and this problem may be exacerbated in rural areas. However, no research to date evaluates progress in enrolling and providing services to children living in rural areas. This study responds to these concerns by qualitatively assessing outreach, enrollment, and provider issues in rural areas of Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia.
Schwalberg R, Hill I, Bellamy H, et al. Making child health coverage a reality: case studies of Medicaid and CHIP outreach and enrollment strategies. Menlo Park (CA): The Kaiser Commission on Medicaid and the Uninsured; Sept 1999.
This study describes four States' strategies for reaching out to and enrolling children in Medicaid and SCHIP in order to highlight the particular issues and challenges States face as they design outreach and enrollment programs. The authors conclude that ultimately, the goal of fully enrolling eligible populations into programs like Medicaid and SCHIP may never be reached until the systems and structures that support them are completely de-linked from those that support public welfare programs. As policymakers work to cover children in low-income working families, it is apparent that further steps are needed to ensure that families are aware of the availability of publicly-sponsored health coverage and can take advantage of it without enduring onerous enrollment processes.
Selden T, Banthin J, Cohen J. Waiting in the wings: eligibility and enrollment in the State Children's Health Insurance Program. Health Aff 1999 Mar/Apr; 18(2):126-33.
This study found that 2.6 million uninsured children are eligible for coverage under SCHIP. If these children were added to the 4.7 million uninsured children who were eligible for but not enrolled in Medicaid in 1996, then these public health insurance programs would cover nearly two-thirds of all uninsured children in the United States. With $24 billion set aside over 5 years, SCHIP is the largest single expansion of health insurance coverage for U.S. children in more than 30 years. The challenge is to get children enrolled via aggressive outreach programs, conclude the researchers. The authors simulated SCHIP eligibility and enrollment based on an analysis of data on 6,903 children from the 1996 Medical Expenditure Panel Survey.
Covering Kids. Outreach ideas from Covering Kids proposals. Columbia (SC): Southern Institute on Children and Families; 2000.
A list of outreach ideas can be found on the Covering Kids Web site. From school-based outreach to employer-based outreach to nonconventional locations for posting outreach materials, groups that have used these strategies explain their programs. Outreach ideas are taken from Covering Kids grant proposals, as well as information that grantees have shared from their experiences in the field. Information on other projects will be provided as it becomes available. This is an excellent resource for those considering different outreach alternatives.
More information can be found on the Covering Kids Web site at: http://www.coveringkids.org/.
Bellamy H, Mathis SA, Botsko C, et al. Strategies for tracking and monitoring SCHIP outreach and enrollment activities: the experience of four States. Washington (DC): Health Systems Research, Inc.; Nov 2000.
This report details efforts to assist the Maryland Department of Health and Mental Hygiene (DHMH) with evaluating the effectiveness of its SCHIP outreach and enrollment activities, and developing a system to track and monitor these activities. The authors interviewed representatives in four States?Alabama, Colorado, Georgia, and New Jersey?to explore State SCHIP outreach tracking mechanisms that are based on the SCHIP application. These States highlighted the advantages and disadvantages of a variety of tracking mechanisms, and offered recommendations to Maryland regarding elements the DHMH should incorporate into any tracking and monitoring system.
Hill I. Charting new courses for children's health insurance. Policy & Practice: American Public Human Services Association 2000 Dec; 58(4).
Please see entry under "Benefit Design."
Outreach/Enrollment
