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Historical Barriers to Health Program Enrollment

One of the critical challenges facing States in implementation of the SCHIP program is to maximize enrollment of uninsured children into SCHIP and enrollment of eligible children into Medicaid. Ian Hill, Senior Research Associate at the Urban Institute, presented historical barriers to health program enrollment at the User Liaison Program (ULP) SCHIP Workshop in September 1998, as summarized below.

As of September 1998 there were over 11 million uninsured children in the United States, and of these, 4.7 million are already eligible for Medicaid but not enrolled. National estimates have indicated that an additional 3 to 5 million could be eligible for coverage under SCHIP. States’ past experiences and current health services research indicate that maximizing enrollment into the available health insurance programs will require aggressive and creative efforts in both outreach and eligibility simplification.

Historically, a significant number of eligible families have failed to gain entry into State health programs due to the complexity of the eligibility process. The reason for denial of eligibility for many families is not means related (e.g., too much income or too many resources). Rather, the reason is more frequently related to noncompliance with enrollment procedures, such as failure to provide the required number of pay stubs.

Specific eligibility process issues which have historically been barriers to enrollment are:

• Lengthy applications.

• Complex multi-program applications.

• Extensive assets and resources verification requirements.

• Location of eligibility workers solely in county social services offices.

• Long waiting periods for eligibility determination and receipt of the insurance cards.

• Programs perceived to be associated with the "welfare" stigma.

Collectively, these eligibility process barriers have resulted in many applicants not completing the enrollment process. In enrolling eligible children into SCHIP, utilization of enrollment and eligibility simplification strategies will assist States in reaching targeted enrollment rates.

Related Questions

Give me details

• What Are the Effects of Copayments and Premium Cost-Sharing on Access and Utilization in State Expansion Programs?

• Implications of Past State Experiences for Effect of Cost-Sharing on SCHIP Access and Utilization

Show me some lessons learned

• Overview of the Various Approaches Available for Facilitating Enrollment in SCHIP

Tell me some known or potential problems

• Title XXI Cost-Sharing Regulations for Medicaid Expansion Programs

• Title XXI Cost-Sharing Regulations for Non-Medicaid Expansion Programs

• What Are the Implications of Instituting Copayments and Premium Cost-Sharing?

Who presented this material?

• Ian Hill, a Senior Research Associate at the Urban Institute, presented historical barriers to health program enrollment at the September User Liaison Program (ULP) SCHIP Workshop in September 1998.