Strategies
1. In function and appearance, create “one” child health coverage system. Though a state may designate SCHIP and Medicaid as separate programs, they can operate on-the-ground as part of a single, unified child health coverage system. Optimally, program distinctions should be invisible to families. There is no reason families should be obliged to understand and navigate the differences between Medicaid and SCHIP, or to figure out for which program their children will qualify. Key components of a unified child health coverage system include:
- A single program name, which can facilitate unified outreach activities and contribute to the sense that the state operates a single, unified child health coverage system.
- Issuance of identical (or similar) enrollment cards to avoid the appearance that some families can access better care.
- Use of the same income and asset counting rules, verification requirements, and renewal procedures—such as establishing 12 months continuous eligibility—for both programs.
- A single agency to determine eligibility for both programs based on a unified application process (e.g., a single application or renewal form with the same verification requirements for SCHIP and Medicaid-eligible children). States that do not use the same agency or that use contractors to determine SCHIP eligibility, can co-locate eligibility workers or rely on electronic means to transfer information.
- Elimination of age-based eligibility rules (sometimes called "staircase" eligibility") so that siblings can qualify for the same program.
- Access to the same service providers for children in both programs.
2. Promote smooth transitions between the two child health programs. Since low- and moderate-income families frequently experience changes in circumstances that cause them to lose eligibility for Medicaid or SCHIP, it is vital to ensure that children can move seamlessly between the two programs. To promote smooth transitions, states can take action to ensure that:
- Children are automatically transferred between programs, with no interruption of coverage, if their family income or circumstances change. Each agency should be required to act on these transfers to ensure that no children are unnecessarily lost.
- Initial premiums for SCHIP are collected after eligibility has been determined (instead of with the application) to eliminate the need for returning premiums to families whose children turn out to be eligible for Medicaid, as well as to avoid deterring families whose children turn out to be Medicaid-eligible from seeking applying for coverage in the first place.
- Grace periods for collecting premiums are provided when a child moves from Medicaid to SCHIP to ensure uninterrupted coverage and access to care.
3. Coordinate the renewal process as well. While 92 percent of states with a separate SCHIP program use a joint SCHIP/Medicaid application, only 48 percent use a joint renewal form. 1 Efforts at coordination can and should extend to renewal procedures since eligible children continue to be “disenrolled” from public health insurance. See Maintaining Coverage for Children: Retention Strategies for more information.
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 State Experiences
Footnotes
1. D. Cohen Ross, A. Horn and C. Marks, “Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,” Kaiser Commission on Medicaid and the Uninsured (January 2008).
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