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Programs share lessons learned in improving coverage for children
A pilot Express Lane Eligibility program implemented in the 2003-04 school year allowed families to apply for California's Medi-Cal and Healthy Families programs at the same time as the National School Lunch Program, which has similar income eligibility requirements.
The California HealthCare Foundation (CHCF) says that since 56% of the state's uninsured children already participate in the school lunch program, the approach seemed to offer a straightforward way to identify large numbers of children and enroll them in public insurance programs. The three-year pilot included seven school districts in six California counties.
Some 15% of all applicants forwarded to the counties for processing were eventually enrolled into full-scope Medi-Cal. But there have been some disappointments, CHCF says. Thus, while in the program's first year, 42% of free lunch-eligible children consented to forwarding their information to Medi-Cal for processing, that number dropped to less than 15% in the second year. CHCF says the biggest problem was that many of the applications forwarded to social service agencies for processing were from people who were already enrolled in Medi-Cal.
According to an evaluation, the pilot taught the importance of working toward a simpler, more seamless, and more streamlined enrollment system for all children's health and health insurance programs, and the clear benefits of establishing a single health insurance program for families that covers all children.
Another innovative program, the Child Health and Disability Prevention Program Gateway, allows doctors and clinics who provide health screenings through the program to pre-enroll uninsured children in temporary full-scope Medi-Cal for up to 60 days.
CHCF says the program is notable for its use of an electronic application permitting enrollment transactions from the provider site. Providers enter minimal information (name, address, date of birth, and gross family income) through an Internet or point-of-service interface, and the Gateway program conducts an automated check against the Medi-Cal Eligibility Data System, returning an eligibility determination message to the provider within seconds.
Children without insurance are granted temporary Medi-Cal coverage. In 2006, more than 600,000 children went through the program and were enrolled in temporary Medi-Cal.
CHCF says the gateway policy also includes a second step designed to link children who receive temporary Medi-Cal coverage to continuous Medi-Cal or Healthy Families. As part of the pre-enrollment process, families are asked whether they wish to receive a joint Medi-Cal/Healthy Families application by mail to apply for continuous coverage for their children. They must return the application before the temporary coverage expires to be evaluated for continuing coverage. Program data show a significant drop-off in numbers between families requesting an application and those who return it.
CHCF says evaluation on this point is challenging given the available data. However, most observers agree that many families of eligible children fail to return the joint application because of the extra work it involves and the difficulty in completing the complex paperwork. The program, the report says, has demonstrated the power of an automated file clearance system and the limitations of a two-step application process.