About half of the 7.9 million uninsured children are eligible for CHIP or Medicaid, but state bureaucratic barriers prevent them from enrolling. These barriers include mandatory asset tests, required in-person interviews, long waiting periods and excessive paperwork.
When CHIP was reauthorized in February 2009, the Act included incentives for states to improve their enrollment processes. Twenty-six states adopted new measures to make it easier for children to get coverage and to keep it. 2.6 million children gained coverage in 2009, with CHIP now serving more than 7 million children. Twenty-two states now have continuous eligibility, 25 have online applications, 48 have done away with asset tests, and 47 eliminated mandatory in-person interviews.
In addition to incentivizing states through performance bonuses, CHIPRA also gave grants to states, community-based organizations, health centers and faith-based organizations to conduct enrollment and outreach activities. With $40 million in grant money awarded in September 2009, and an additional $50 million to be paid out within the next few years, governments and organizations across the nation are making great strides in ensuring that children eligible for health coverage can get it and keep it. As more states work to realize the promise of health reform, many of these initial efforts can serve as promising practices for giving children the coverage they deserve.
- Even in the face of economic downturn, many states have been working to increase their children’s health coverage. Following the passage of CHIPRA, 31 states and DC now cover children at or above 250% FPL.
- ICHIA: Covering all kids
The ICHIA provision in CHIPRA gives states the ability to cover eligible children and pregnant women who legally immigrated to the United States. Previously, only children who were citizens or had been in the United States for at lest five years could be covered. In Wisconsin, the provision was almost immediately implemented. The state used express line eligibility to begin covering kids as quickly as possible.
- With the assistance of federal matching funds, Rhode Island was also able to expand coverage to immigrant children. Other states have taken this once step further: Illinois and Washington will cover any child, regardless of immigration status.
Simplified Enrollment System
- In Iowa, the governor expanded coverage to 300% FPL and implemented 12-month continuous eligibility, simplified income verification, presumptive eligibility and paperless renewal. The state took special measures to address the inconsistent income often experienced by agricultural families. Iowa pledged expansion even without a guarantee of federal funds, demonstrating the state’s commitment to quality health care for all children.
- Since March 2010, Ohio has used 12-month continuous eligibility, presumptive eligibility and express lane eligibility. The announcement of these new policies coincided with the annual conference of Ohio Covering Kids and Families, which works to educate individuals statewide about enrolling kids and maintaining their coverage. The implementation of these important enrollment approaches makes the state eligible for CHIPRA grants, which will fund initiatives to help further expand enrollment numbers. At the time the new measures were implemented, 77,000 Ohio children were eligible, but not enrolled.
- California: Express Lane Eligibility and School Means
The first group to take on express lane eligibility, The Children’s Partnership enrolled children in Medicaid and CHIP by linking health coverage to free lunch programs. Children eligible for free lunch were made automatically eligible for California’s Medicaid and Happy Families programs. The organization is now working directly with 100 public schools in eight California districts to pilot a larger express lane eligibility program and build support from parents and educators.
- Louisiana: Express Lane Eligibility and SNAP
In February 2010, Louisiana enrolled over 10,000 children in Medicaid – overnight. Using eligibility data from the state’s Supplemental Nutrition Assistant Program (food stamps), families received Medicaid cards for their children in the mail, which become activated upon use. The state is looking to include other programs that would lead to automatic Medicaid enrollment, and will automatically re-enroll any SNAP child in health coverage.
- New Mexico: Enrollment Kiosks
In order to help facilitate enrollment for children who may not otherwise have access to enrollment offices, the state has designed standalone kiosks at community centers and schools which will allow for electronic enrollment in CHIP and Medicaid. The efforts are targeted at rural children, and Native Americans and Hispanics in particular. Many of the planned 12 kiosks will be placed on reservations in order to reach particular populations. The electronic process may assist in the enrollment of eligible citizen children whose parents may be undocumented and thus hesitant to visit a government office. With implementation scheduled to take place in the next year, the kiosks are being funded through a $1 million CHIPRA outreach grant.
- Texas: 100% Campaign
In 2007, the Children’s Defense Fund in Texas began a partnership with the Houston Independent School District to connect children with health coverage through their school enrollment forms. Parents are given information about health coverage options and those who are uninsured, but not eligible for Medicaid or CHIP, are connected with other affordable options. Parents are also provided with renewal instructions, as well as guidance to enhance preventative care and avoid emergency room visits. In two years, the 100% Campaign was able to reach out to 32,000 Houston children. It is estimated that 44,000 children in the Houston school district were without insurance.
Following the success of the 100% Campaign, CDF Texas’s “Every Child, A Healthy Child” campaign has partnered with 19 school districts in Harris County to educate families and enroll eligible children in CHIP and Medicaid. As of 2008, the program helped enroll 33,000 children in the county in CHIP. An additional 15 districts throughout the Rio Grande Valley are served through similar means.