See our full blog series on evidence-based policies available to policymakers to prevent more eligible children from losing health coverage.

As Say Ahhh! readers know, in May, we released a comprehensive report showing that child enrollment dropped by nearly 1 million children in 38 states in 2018 and have continued to track the growing enrollment decline in Medicaid and CHIP.  Data recently released by the U.S Census Bureau underscores the need to for policymakers to focus on this alarming trend for children’s health coverage.

In addition to discussing various factors contributing to the decline in our report, we summarized a number of strategies and steps that states can take to reverse the negative enrollment trend. In this blog series, we are taking a closer look at the policies and actions that are proven to promote enrollment and retention. This third installment focuses on ways to boost outreach and consumer assistance.

Targeted Outreach – Public education of coverage options has always been important to reaching eligible, uninsured children and families. Over time, research has shown that families may be either unaware of these essential programs or think they or their children don’t qualify. The most effective (and cost-effective) outreach is to identify and target outreach to children and families who are uninsured but likely eligible. And with tens of thousands of children recently losing Medicaid and joining the ranks of the uninsured, there is an opportunity to focus outreach to this group as well. States know who these children are and can take a variety of steps to update mailing addresses or otherwise reach families by phone, with e-communications or through community-based outreach partners.

• Community-Based Outreach – Efforts to reach and enroll eligible children is often most effective when done in collaboration with community-based organizations that serve children and families like schools and community resource centers. Health care providers also play a critical role since they are able to pinpoint insurance status and often have the resources to provide direct enrollment assistance.
• Outreach Coordinators – Dedicating state staff to supporting and training community-based organizations is an effective way to extend the outreach and assistance capacity of the state. Site visits, trainings, community meetings, and listening sessions help to keep partners knowledgeable and engaged.
• Print Materials — To support outreach, states should produce print materials to promote coverage options and how to apply. Materials can be distributed through community organizations that serve families. Many states have found that working through the schools and using earned media to promote back-to-school enrollment is highly effective in reaching eligible, uninsured children. 

Consumer Assistance – Providing direct assistance to families in completing the application or renewal process helps families overcome challenges when forms and processes are difficult to maneuver or they face language, cultural, or literacy barriers. One size doesn’t fit all, so operating high functioning call centers and providing in-person assistance at government offices and community locations are all important. States are obligated to provide in-person and telephone assistance and should ensure there are adequate resources and appropriate training for all assisters. State leaders should also set an example of promoting coverage and ensuring that eligibility workers embrace a working culture that seeks to help not hinder or discourage families from enrolling and renewal eligibility.

• Call Centers – States are required by law to provide assistance over the phone but too often call centers are understaffed and inadequately trained. Families report long waits on hold (which are difficult for working parents), dropped calls, and the inability of operators to trouble shoot and resolve problems. State agencies should adopt long-standing and proven best practices in call center operations that successful businesses have perfected. Monitoring the quality of calls, having special teams of experienced workers for problem escalation and resolution, extending call center hours beyond normal business hours when most parents work, and tracking call volume to ensure adequate staffing are all key elements of effective call center management.
• Local or County Eligibility Offices – Many states have centralized the processing of applications and renewals and have cut back staff in local or county offices. We often hear stories of families being told to call the 800-line or just drop off documents without talking to someone who is trained to provide culturally and linguistically competent assistance.
• Outstationed Eligibility Workers – By law, states are required to provide opportunities for families to apply at places other than government offices. Given the trend to centralize eligibility and cutback local office staffing, it’s more important than ever that there be options for individuals to seek assistance from eligibility workers or trained partners stationed in the community at places like hospitals or local public health departments.
• Community-Based Assistance –Fostering a strong network of community-based partners can greatly extend the capacity of states to maximize enrollment and retention. It’s important for states to support partners by providing them with outreach materials, training, and access to eligibility experts who can troubleshoot problems. Building system portals for community assisters to submit applications and renewals and check the status of coverage makes their work easier and gives states a way to monitor their effectiveness.

Like other blogs in this series, this is not an exhaustive list but it is among the top strategies I found effective as a former CHIP director. Stay tune for the last two installments in this series when we’ll dive into how states can foster enrollment and retention by maximizing the use of technology and enhancing state procedures and processes.