Describe the Title XXI Outreach and Enrollment Regulations

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Title XXI Outreach and Enrollment Regulations: Legislation and HCFA Suggested Approaches

In addition, the President’s fiscal year 1999 budget includes proposed legislation for enhanced matching for children’s outreach efforts that would allow a 90 percent matching rate for outreach activities for all uninsured children, not just those who would have been eligible for welfare (as covered currently by the welfare reform bill’s Medicaid Fund). Originally, matching funds were provided only for outreach activities to Medicaid eligible children.

In the January 23, 1998, letter to State officials (this letter and other HCFA guidance can be found at http://cms.hhs.gov/schip/), the Health Care Financing Administration (HCFA) makes the following two suggestions for expanding enrollment of children into SCHIP:

Allowing Immediate Coverage by Means of Presumptive Eligibility. The presumptive eligibility option allows a qualified entity or its employees to presume temporary eligibility for Medicaid if the child’s family income does not exceed the State’s applicable income eligibility level. States could also use this option in eligibility determination for a SCHIP separate State program.

Outstationing Eligibility Workers in Communities. Outstationing involves locating eligibility workers in places other than welfare offices to assist with the initial processing of applications. States can receive Federal matching funds for outstationing eligibility workers. HCFA is encouraging States to consider outstationing eligibility workers at sites such as schools, child care centers, churches, Head Start centers, Job Corps sites, and GED programs.

According to HCFA, the key to successfully enrolling children at a wide range of sites is a simple application and enrollment process. Suggested methods for simplifying enrollment include the following:

Generally shortening and reducing the complexity of the application form.

Utilizing less restrictive eligibility methodology.

Reducing the “excessive” verification requirements.

Utilizing a single application for Medicaid and SCHIP.

Granting 12-month continuous eligibility.

The HCFA January 23, 1998, letter to State officials (this letter and other HCFA guidance can be found at http://cms.hhs.gov/schip/), also provides examples of simplified Medicaid application forms, a model joint application for SCHIP/Medicaid, a list of States that have simplified the Medicaid application process, and a discussion of specific outreach strategies currently being practiced or considered that States may use to increase enrollment of eligible children into Medicaid.