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Maintaining Coverage for Children: Retention Strategies


Legislative Authority

Since the inceptions of Medicaid (in 1965) and SCHIP (in 1997), states have had the flexibility to adopt administrative and outreach practices that can improve retention rates. Specific administrative strategies allowed, and, in some instances, required, under Medicaid and SCHIP include: guaranteeing a full year of coverage (12-month continuous eligibility), simplified renewal procedures (such as no renewal interview), and coordinating coverage between Medicaid and SCHIP. 1

When conducting Medicaid renewals, federal law also specifically requires states to base the review "to the maximum extent possible" on information already known to the Medicaid agency. This means that a state should use information it has collected from other programs, such as food stamps, to assess ongoing Medicaid eligibility to ensure families are not required to submit information already available to a state. 2

The implementation of SCHIP, and the consequent interest in improving child health coverage rates, led to an increase in states efforts to put some of these practices into play. For example, a decade ago, most states required families to renew Medicaid more than once a year, sometimes as often as every few months. As of January 2008, 45 states and Washington, D.C. allow renewal annually, and 16 states guarantee a full year of coverage regardless of changes in family circumstances. 3 (See Facts and Statistics for a look at each state program.)

Another important federal development was the discussion of retention strategies during the 2007 debate on reauthorization of the SCHIP program. While the program was ultimately extended with few changes, there was wide support for improving retention and data collection efforts. Specifically, SCHIP legislation included financing incentives to encourage states to increase child health enrollment rates, including by strengthening retention efforts. SCHIP reauthorization, which will occur again in 2009, offers an opportunity for Congress to implement similar measures. (See SCHIP reauthorization.)

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Strategies

Footnotes


1. Centers for Medicare and Medicaid Services, "Continuing the Progress: Enrolling and Retaining Families and Children in Health Care Coverage," (August 2001). Back

2. Centers for Medicare and Medicaid Services, Letter from Health Care Financing Administration to State Medicaid Directors, (April 7, 2000). Back

3. D. Cohen Ross, A. Horn, & C. Marks, "Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2008," Kaiser Commission on Medicaid and the Uninsured, (January 2008). Back




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Legislative Authority

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