Medicaid and CHIP – Performing Under Pressure

By Martha Heberlein and Tricia Brooks

For those of you who have been anxiously awaiting (and you can count us, too!) the release of the annual survey on Medicaid and CHIP, today is your lucky day.  In partnership with the Kaiser Commission on Medicaid and the Uninsured, we released “Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost Sharing Policies in Medicaid and CHIP” at a briefing today.

Probably not surprising to those who follow such things, but we found that eligibility held steady in nearly all states, with only two states reducing eligibility. And the two that did – they did so for low-income adults relying on limited exceptions to the stability protections (otherwise known as maintenance of effort provisions of the Affordable Care Act). It’s very likely that without the stability protections, more states would have made cutbacks and far more children and families would be left without an affordable coverage option during these turbulent economic times.

A far more surprising finding was the fact that 29 states went beyond holding steady and improved coverage through targeted expansions and simplifications. Most of these changes centered around the greater use of technology to boost government efficiency and make it easier for people to enroll in coverage; actions that have a dual benefit of helping eligible children and families while also stretching scarce state administrative resources.

But perhaps the most striking finding is how quickly a large number of diverse states across the country are leaping at the opportunity to make sweeping changes to their decades-old eligibility systems. More than half of the states have already sought the enhanced federal funding to develop the latest technology that will both transform families’ experience of applying for health care coverage and make government work better. And, with just three exceptions, the rest of the states are planning to move in that direction in 2012.

And all this in spite of the fact that in 2011, state budgets remained stressed due to dampened revenue growth and the mid-year expiration of the temporary increase in the federal matching rate. So while strained state budgets have taken a toll on administrative resources, states have sharpened their use of technology and streamlined their procedures to create more efficient programs, while also simplifying the steps for families to enroll in and renew coverage. These actions, in addition to the massive systems upgrades they’ve undertaken, have not only helped states deal with current pressures, but are also laying the groundwork for the coverage expansions and new enrollment requirements that will take effect in 2014.

And let’s not forget that amid these ongoing pressures, the stability protections in the Affordable Care Act were central to the preservation of health care coverage last year. So even with a weak economic recovery that has been slow to add new jobs with access to employer-based insurance, Medicaid and CHIP continued to be key sources of coverage for children, and, in some cases, for their uninsured parents. A bit of good news to start the year!

[A parting note to those who like us, want to dig in on the nitty-gritty details – there are several new areas that we report on this year (such as the use of out-stationed state eligibility workers and enhanced functionality with online accounts) all of which can be found in the full report. Enjoy!]