Eighty-six phone calls! That’s how many calls it took new parents Ari Friedman and Tara Mendola of Philadelphia, Pennsylvania to finally obtain Children’s Health Insurance Program (CHIP) coverage for their son. (And we all know new parents have nothing better to do than sit on hold!) Ari and Tara are both graduate students who were covered under student plans but could not find affordable private insurance for their newborn, Erik. He was eligible for CHIP coverage but the bureaucratic barriers to enrollment stymied their efforts to get him CHIP coverage until he was eight months old.
Their story is published in this month’s Health Affairs “Narrative Matters” section (no subscription necessary). The couple tells the all too familiar tale of lost paperwork, a lack of coordination between agencies, unanswered phone calls, being put on hold and cutoff, and encountering other frustrating obstacles as they tried to sign up their son for coverage for which he was eligible. While others may have become discouraged and stopped trying, Ari and Tara continued battling the bureaucracy until, through sheer perseverance and outside help (including assistance from CCF colleague George Hoover at Pennsylvania Partnerships for Children), they were finally able to sign Erik up for CHIP coverage eight months after starting the process.
Their story ends on a hopeful note. Here’s what they have to say:
“Fortunately for parents who find themselves in our position, the system is poised for change. Under provisions of the Affordable Care Act, beginning in 2014 CHIP, Medicaid, and the new health insurance exchanges will be able to request application data directly from other government institutions, such as the Internal Revenue Service and Social Security Administration. These three groups will be required by law to share with each other the information needed for eligibility determinations. Assuming that the process unfolds as it should, this electronic transfer of information, coupled with the law’s virtual elimination of paper income verification, should eliminate what turned out to produce the greatest delay in our application process: the repeated loss of our application forms with the Medicaid system.”
In a perfect world, the passage of the new law would automatically usher in the reforms needed to protect families from enduring the same anguish as the Freidman/Mendola family but we all know it takes teamwork, culture change and strong leadership to accomplish such a large shift in how things work (or don’t work in this case). We’re on the right path, thanks to the Affordable Care Act, but now we need state and local government to really make the new law’s vision of coordinated, seamless access to coverage work for everyone.
[Read Tricia Brook’s Tech Tuesday blog series to learn more about how the Affordable Care Act is designed to make enrollment easier and more consumer friendly.]
