By Leigh Cobb, Advocates for Children and Youth
and Suzanne Schlattman, Maryland Citizen’s Health Initiative Education Fund
Maryland has just received its second Children’s Health Insurance Program Reauthorization Act (CHIPRA) performance bonus from CMS. This recognizes its efforts to identify and enroll eligible children in Medicaid and the Children’s Health Insurance Program (CHIP). Maryland enrolled an additional 41,000 children in FY 2011 alone, and since 2007 we have seen a 34% overall increase in enrollment. Our bonus of $28.3 million represents the highest amount awarded by CMS this year.
Streamlined eligibility and enrollment have long been a priority for Maryland advocates. However, at the time CHIPRA passed, Maryland met 3 only of 5 required bonus criteria: it had eliminated the asset test, adopted a single, simplified application form for Medicaid and CHIP, and eliminated the in-person interview requirement. The state had begun to recognize that many children continued to fall through the cracks and lose coverage as a result of our renewal process. To address this, Maryland streamlined and automated the renewal process in 2009. Still, Maryland had to take one more step to become eligible for a CHIPRA performance bonus.
In 2008, Maryland had passed the Kids First Act creating a national model. Under the legislation, the state tax forms included a question to determine if dependent children had health care coverage. A combined Medicaid/CHIP application was then sent to all families with incomes under 300% of the federal poverty level who indicated lack of coverage for their children. The State then recognized the need to create even more targeted outreach. In 2010, with substantial support from the advocacy community, the legislation was modified to facilitate better coordination between the Comptroller’s Office and the Department of Health and Mental Hygiene (DHMH). At the same time, it added a separate opt-in provision to the tax form. These steps led to the realization of true “express lane eligibility” and allowed the State to apply for and receive its first CHIPRA bonus. The State also piloted another express lane eligibility effort that uses Free and Reduced Meals (FARMS) program applications in Baltimore City.
The substantive expansion in enrollment in 2011, made Maryland eligible for this year’s Tier 2 bonus–because it increased enrollment more than 10 percent above the target level needed to earn a bonus. Commenting on the latest performance bonus and the lessons learned from child enrollment efforts, DHMH Secretary Dr. Joshua Sharfstein said, “We have a great foundation for further progress with the Health Benefit Exchange”.
This second performance bonus will support Maryland’s ongoing efforts to make sure that all eligible children get enrolled in Medicaid and CHIP, and can then access the full range of health services they need.
