STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID AND CHIP PROGRAMS - PowerPoint PPT Presentation

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STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID AND CHIP PROGRAMS

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Overview of Presentation: The challenge: Maximizing enrollment of both already-eligible children into Medicaid and other uninsured children into CHIP – PowerPoint PPT presentation

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Title: STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID AND CHIP PROGRAMS


1
STREAMLINING ENROLLMENT OF CHILDREN INTO MEDICAID
AND CHIP PROGRAMS
  • Overview of Presentation
  • The challenge Maximizing enrollment of both
    already-eligible children into Medicaid and other
    uninsured children into CHIP
  • Problems surrounding the enrollment process
  • Options and strategies available for streamlining
    childrens enrollment
  • What did we learn from the Medicaid expansions
    for pregnant women?
  • Additional considerations under CHIP

2
THE CHALLENGE
  • Over 11 million uninsured children
  • Of these, 4.7 million already eligible for
    Medicaid, but not enrolled
  • An additional 3 to 5 million could be eligible
    for coverage under CHIP
  • Maximizing enrollment will take aggressive and
    creative efforts in both outreach and eligibility
    simplification

3
WHAT ARE THE PROBLEMS WITH CURRENT ENROLLMENT
SYSTEMS?
  • Historically, leading reasons for denials of
    eligibility are NOT too much income, or too many
    resources. Rather, noncompliance with
    procedures. In other words, families could not
    complete the process.
  • Specific barriers include
  • Long applications
  • Multi-program applications
  • Extensive verification of assets and resources
  • Location of eligibility workers in county social
    services offices
  • Welfare stigma
  • Long waits for determinations and receipt of cards

4
STRATEGIES AND AVAILABLE OPTIONS FOR REDUCING
ADMINISTRATIVE BARRIERS AND FACILITATING
ENROLLMENT
  • Shorten and simplify forms
  • Eliminate assets tests
  • Permit mail-in applications
  • Expand use of outstationed workers
  • New 12-month continuous eligibility for kids
  • Make income eligibility thresholds consistent for
    all ages
  • Expedited eligibility determinations
  • Eliminate automatic closures by the computer

5
PRESUMPTIVE ELIGIBILITY FOR CHILDREN
  • Establishes short-term temporary eligibility
    based on declaration of family income
  • Provides immediate coverage of all covered
    services, and guarantees payment to providers who
    render these services
  • Brings enrollment process into community-based
    settings. Broad range of sites permitted to make
    presumptive determinations (including doctors
    offices, clinics, LHDs, CHCs, school-based health
    centers, hospitals, as well as WIC clinics, Head
    Start programs, groups that determine eligibility
    for subsidized child care, etc.)
  • Must establish systems for ensuring that families
    submit formal application for Medicaid

6
WHAT WORKED LAST TIME?
  • States that simultaneously implemented
    presumptive eligibility and dropped assets tests
    experienced most rapid growth in enrollment of
    pregnant women.
  • Source General Accounting Office, 1991

7
ADDITIONAL CONSIDERATIONS UNDER CHIP
  • Requirement to screen for Medicaid eligibility
    prior to enrollment into CHIP program
  • Suggests need for/importance of working to
    coordinate the two systems
  • Available strategies include single application
    form, uniform eligibility rules
  • Administrative matching funds available under
    Medicaid for outreach and enrollment initiatives
  • Under CHIP, 10 cap on use of funds for these
    purposes
  • Additional funds available through welfare reform
    can supplement and enhance CHIP outreach efforts

8
MONITORING ENROLLMENT TRENDS UNDER CHIP AND
MEDICAID
  • Use routine administrative data to monitor
    applications and
  • case closures. Specifically
  • Number of applications received
  • Rates of approval and denial
  • Reasons for denial
  • Presumptive eligibility cases and successful (and
    failed) conversions to full Medicaid eligibility
  • Number of closures
  • Reasons for closure
  • Reapplication rates and outcomes after closures
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