Strategy 1: Establish a Core Set of Enrollment and Renewal Standards

• Screen and Enroll. For children who apply for coverage under a separate SCHIP program, federal law requires that states first screen children for Medicaid eligibility and enroll eligible children. States must also assist families in applying for SCHIP if their child applies for Medicaid and is not eligible. The requirement helps boost enrollment by assuring that families are able to enroll their children, even if they applied to the wrong program.
  

See: 42 CFR 457.350 (PDF)

• Coordination. Federal law requires states with separate SCHIP-funded programs to coordinate their enrollment and renewal procedures with Medicaid. This coordination helps prevent children from “falling through the cracks” in states with two child health coverage programs.

See: 42 CFR 457.80 (PDF)

• Ex Parte. When conducting a Medicaid renewal process, federal law requires states to base their 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 limit the amount of information a family has to submit, increasing the ease of renewal.
  

See: Letter from Health Care Financing Administration to State Medicaid Directors, April 7, 2000 (PDF)

• Delinking. The federal welfare law enacted in 1996 eliminated the AFDC cash assistance program and created the TANF block grant. In order to assure that welfare changes did not cause children and their parents to lose coverage under Medicaid, the welfare law "delinked" Medicaid eligibility from eligibility for cash assistance and established a new family coverage category under section 1931 of the federal Medicaid law (Title XIX). Eligibility is based on family income, not receipt of welfare. Delinking means that families who do not apply for welfare, or who become ineligible for welfare, should always be separately evaluated for Medicaid eligibility. Medicaid regulations (42 CFR 435.906) also require states to provide families the opportunity to apply for Medicaid without delay. As a result, a state should implement outreach and enrollment strategies to ensure that eligible families not receiving, or leaving, cash assistance receive Medicaid coverage.
  

See: Supporting Families in Transition, A Guide to Expanding Health Coverage in the Post-Welfare Reform World, Health Care Financing Administration-now Centers for Medicaid and Medicaid Services (PDF)

• No procedural differences between Medicaid and SCHIP policies. States with a separate SCHIP program should not have separate policies for Medicaid and SCHIP. Abolishing procedural and policy differences at application and renewal between Medicaid and SCHIP makes the process for obtaining children’s health coverage less confusing for families and facilitates a smooth transfer of children from one program to another, preventing lost applications and gaps in coverage. This includes ensuring Medicaid and SCHIP have the same application, renewal form, eligibility rules, and verification processes.
  

• No assets test for children. States can establish asset (resource) requirements, but they need not do so. Most states, but not all, currently have no asset limit for their children’s coverage in either Medicaid or, if applicable, in their separate SCHIP programs. Few low- and moderate-income families have any assets of note. Eliminating the test ensures that families (who have little or no flexibility to leave work for an interview) are not unnecessarily burdened by the intensive paperwork requirements associated with documenting assets during the enrollment or renewal process.

• No face-to-face interviews. Requiring families to come into an office to enroll or renew coverage creates an unnecessary burden on families and increases the likelihood of parents not seeking out or retaining coverage. A family still has the option of coming to the office to seek assistance but eliminating the interview requirement significantly simplifies the application and renewal processes for families.

• Coordinated Medicaid and SCHIP enrollment and renewal processes. States should ensure that their Medicaid and SCHIP programs are relatively seamless for families. This includes having joint applications and renewal forms and automatic bridges between programs to ensure children only have to apply through one-door and remain enrolled even if their circumstances change.

• 12-months “continuous eligibility”. To promote continuity of coverage and care, states have the option under Medicaid and SCHIP to enroll children for periods of up to 12 months. The continuous eligibility period allows a child to remain enrolled regardless of changes in income, which tend to be relatively inconsequential. Most importantly, it ensures a family need not submit unnecessary paperwork to retain coverage and guarantees a set period of coverage. This in turn ensures continuity of care and that children do not lose coverage due to small fluctuations in income. Continuous eligibility also limits costly "churning" and makes it easier to attract managed care plans to participate. If continuous eligibility is not possible in a state, another option is implementing a 12-month renewal period—in which a family renews yearly but if their income or circumstances change they must report that to the state.

• No unnecessary documentation requirements. Families usually have to submit numerous pieces of documentation, such a payroll statements, at enrollment and renewal. States can, however, rely solely on electronic databases and audits and they can require families to provide documentation of income or other eligibility requirements only if the state cannot verify the information through other means (e.g., checking existing state databases). The only components of their eligibility that families must document under federal law are citizenship and immigration status. The other components also must be verified, but verification can be done by a state agency.

• Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles, Kaiser Commission on Medicaid and the Uninsured and Center on Budget and Policy Priorities, January 2008.
  Or see Facts and Statistics, Program Facts which provides data from the report on where states stand on implementing enrollment and renewal simplifications.
  
  
• Opening Doorways to Health Care for Children, Kaiser Commission on Medicaid and the Uninsured and The Children’s Partnership, May 2006
  
  
• Continuing the Progress: Enrolling and Retaining Low-Income Families and Children in Health Care Coverage, Centers for Medicare and Medicaid Services, August 2001

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