I don’t know about you, but I’m feeling quite crunched by the holiday calendar this year. The usual holiday stress has emerged, so to keep things in perspective I, like my colleagues, am reflecting on all those things we have to be grateful for this year.
One of those things is the Children’s Health Insurance Program Reauthorization Act (CHIPRA), which, among many other good tidings for families, gave states incentives to streamline their eligibility and enrollment systems to get more children enrolled in health coverage. Since almost 70% of uninsured children are already eligible for Medicaid or CHIP, but are not enrolled, incentivizing states is the name of the game with respect to reducing the number of uninsured children.
Say Ahh! readers know that one of CCF’s annual holiday traditions—usually somewhere between Christmas and New Year’s Eve—is CMS’s announcement of CHIPRA performance bonus awards. In 2012, $306 million went to 23 states. This innovative CHIPRA provision has proved to be a catalyst for states on the path of simplifying and streamlining their enrollment system for children. Sadly, unless Congress intervenes, 2013 will be the last year for these awards, since the provision expired this past September.
A growing number of states have received performance bonuses (Section 104 of P.L. 111-3) by making significant progress reaching eligible-but-unenrolled children in Medicaid. The funds help states by offsetting the added costs of insuring the lowest-income children and encouraging them to adopt improvements in their children’s health coverage programs. Since the first year of awards in 2009, 26 states have received more than $800 million. To qualify for awards, states must adopt “5 of 8” enrollment simplification measures that (for the most part) have a track record of helping enroll children and keeping them covered as long as they are eligible— typically improvements that cut unnecessary red tape in state enrollment systems.
The incentives have worked as intended: more children are covered. In 2012, as our recent report showed, the number of uninsured children declined to 5.3 million – in large part due to the success of Medicaid and CHIP. The performance bonuses, in concert with other features of CHIPRA and a national commitment to reducing the number of uninsured children, have translated to unprecedented progress covering kids.
As you may be aware, the Affordable Care Act built on the CHIPRA provision, making 4 of the 8 performance bonus qualification measures a requirement for all states (eliminating in-person interviews, eliminating asset tests, administrative renewals, joint application and renewal forms). But don’t let that fool you into thinking the ACA will take care of enrollment red tape! Students of children’s coverage know that adopting the policy is merely the first step; reaching eligible children requires sustained attention and persistence. And despite success, we are not done – 5.3 million uninsured children is still 5.3 million too many!
So, what’s a great gift idea for states swamped with ACA implementation? While it would take some retooling of the qualifying ‘5 of 8’ measures, extending CHIPRA’s performance bonuses would help states that have made covering children a priority and encourage other states to do the same. Most importantly, we need to maintain the national momentum for reducing the number of uninsured children.
