One of the many lessons learned about advancing children’s health coverage is how critical retention in Medicaid and CHIP is to our coverage goals. Dr. Benjamin Sommers drove this point home in a study that concluded that one-third of all eligible, uninsured children in 2006 had actually been enrolled in Medicaid or CHIP in the prior year. A recent update of Dr. Sommer’s study in Health Affairs shows that we have made progress on this front with this key statistic dropping to 25% in a little over two years.

Over the years the importance of customer retention, a long-standing best practice in the business world, has gained equal footing with outreach and streamlining enrollment as effective strategies to reduce barriers to coverage. Dr. Sommer’s report is good news for states that have made retention a priority and is a contributing factor in our continuing success in reducing the number of uninsured children. 

While the drop-out rate improved, there was some evidence in the study that take-up or new enrollment may have slipped. Dr. Benjamin Sommers points out that this change in trend coincided with new federal rules imposing complex paperwork requirements on states and applicants to document citizenship. The negative impact of the citizenship verification requirement on eligible, citizen children has been well documented.

I’m optimistic that if Dr. Sommers updates his report in another three years we’ll see improvement in both areas. More than one-third of states have had impressive results with a new data exchange with the Social Security Administration (SSA) to verify citizenship rather than requiring paperwork from individuals. Many more states are testing or planning to develop the SSA electronic interface as a means of documenting citizenship.

Additionally, states continue to innovate and replicate effective enrollment and retention strategies through major initiatives such as the Robert Wood Johnson funded Maximizing Enrollment for Kids and the State Health Access Grant Program.

Dr. Sommers research shows how policy and procedural decisions can make a difference, both positive and negative.  Taking stock of what is working in Medicaid and CHIP to promote enrollment and retention is essential to the expansion of coverage as we implement the Affordable Care Act efficiently, cost-effectively and with optimal results.