Reaching Eligible But Uninsured Children
Where States Stand
As a result of CHIP's creation in 1997, states across the country moved to take advantage of the opportunity to cover more uninsured children. Every state expanded eligibility levels, but equally important, to reach more eligible children, they conducted outreach and made their enrollment and renewal procedures for CHIP and Medicaid more family-friendly. (See Facts and Statistics.)
As a result, the rate at which eligible but uninsured children participate in Medicaid is far above the pre-CHIP levels and participation rates in CHIP have been rising steadily as well. In 1999 the Medicaid participation rate was 73 percent compared to 82 percent in 2002. CHIP's rate of 48 percent in 1999 jumped to 68 percent by 2002. 1
The extent in which states are covering coverage eligible but uninsured children varies by state, with participation rates ranging from 53 percent in Nevada to 92 percent in Vermont. 2 Particularly telling is that if all states brought the participation rates up to the levels already achieved in some states (e.g., 90-92 percent), the number of uninsured children in America could be cut by about half (4.1-4.6 million). 3
The experiences to date in states show that "if you build it right" states can make a significant impact on enrollment. This is exemplified by Washington State's experiences with 12-month continuous eligibility and other simplifications for its Medicaid program. In 2003, Washington moved from 12-months of continuous eligibility to a 6-month renewal period. As a result the state witnessed a large drop in children enrolled in the program. On the reverse, when Washington reinstated the policy in 2005 and once again made the program easier for children to remain enrolled, the enrollment numbers rose. 4
Other states have had success in keeping children enrolled in their programs through retention strategies. For example, after implementing a number of retention strategies, including ex parte renewals (described later), Louisiana's procedural closures at renewal dropped to less than one percent. (See Louisiana Close-Up.)
Unfortunately, some notable federal barriers also remain for states in increasing enrollment for uninsured but eligible children. These include federal policies that make it harder for states to reach these lower income eligible children or concerns on coverage costs. For example, states must meet a new federal mandate to document citizenship status in Medicaid and CHIP. 5 Thousands of eligible children have lost or experienced delayed coverage as a result. 6
The CHIP law enacted in 2009 has created additional opportunities for states to reach eligible but uninsured children. Measures include streamlining the citizenship documentation requirement and allowing states to use other public program findings to enroll children in Medicaid and CHIP. These new tools are accompanied by a performance bonus system that provides states with additional federal financial help when they significantly increase their enrollment of already-eligible uninsured children in Medicaid and adopt measures to streamline enrollment and renewal in both Medicaid and CHIP. (See information on the Chip Law.)
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About Eligible but Uninsured Children
Footnotes
1. 1997, 1999, 2002 National Survey America's Families by L. Dubay, Urban Institute.
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2. Analysis of March 2005 Current Population Survey using July 2004 state eligibility rules by L. Dubay, Urban Institute.
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3. Calculations by the Center for Children and Families based on 2005 CPS using July 2004 eligibility rules.
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4. Washington State Department of Social and Health Services, 2005, updated 2006.
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5. See A. Grady, "
Medicaid Citizenship Documentation," Congressional Research Services (May 16, 2007); P. Shin, B. Finnegan, L. Hughes, & S. Rosenbaum, "
An Initial Assessment of the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients," The George Washington University School of Public Health (May 7, 2007); and National Academy for State Health Policy, "
Reauthorizing SCHIP: Principles, Issues and Ideas from State Directors," (April 2007).
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6. See D. Cohen Ross, "
New Medicaid Citizenship Documentation Requirement is Taking a Toll: States Report Enrollment Is Down and Administrative Costs Are Up," Center on Budget and Policy Priorities (March 13, 2007); and Virginia Health Care Foundation, "
Unintended Consequences: The Impact of New Medicaid Citizenship Documentation Requirements on Virginia's Children," (May 24, 2007).
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Summary