States making smart use of technology with enrollment

States have achieved substantial progress in streamlining Medicaid enrollment and renewal processes for children, but have achieved less progress in this area for adults, according to Samantha Artiga, MHSA, a principal policy analyst at Kaiser Family Foundation (KFF) in Menlo Park, CA.

Nearly all states have eliminated interview and asset test requirements for children applying for Medicaid and the Children's Health Insurance Program (CHIP), as noted in the KFF's January 2011 brief, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011.

While an increasing number of states had adopted presumptive eligibility and 12-month continuous eligibility for children, according to the report, for parents, seven states still required an interview at application, five required one at renewal, and more than half applied an asset test.

"Continued streamlining of procedures and increased alignment of procedures between children and adults will be important for successfully enrolling newly eligible individuals in a timely manner, and will facilitate the integration of enrollment for Medicaid and Exchange coverage under health care reform," says Ms. Artiga, one of the report's authors.

Innovative technology use

States are increasingly using technology in innovative and cost-effective ways to improve application, enrollment, and renewal procedures, reports Ms. Artiga.

For example, in 2010, a growing number of states began using electronic data matches to obtain or verify information at enrollment and/or renewal, she says.

For example, in 2010, twenty-nine states adopted the new option to verify citizenship status by relying on an electronic data match with the Social Security Administration, according to the January 2011 report. Also, six states implemented Express Lane Eligibility initiatives that enable states to use a finding of income and other eligibility criteria for another public assistance program as evidence of eligibility for Medicaid or CHIP, adds Ms. Artiga.

Thirty-two states now offer an electronic Medicaid application, says Ms. Artiga, while 14 states offer online renewals. "A few states, such as Wisconsin and Oklahoma, have developed more robust online systems with application and account management capabilities," she says. "These are more reflective of the enrollment systems envisioned and required under reform."

Prepare for expansion

States need to continue to streamline enrollment and incorporate technology into their Medicaid and CHIP eligibility systems to be ready for the coverage expansions in 2014, explains Ms. Artiga, to meet the requirements for an integrated, streamlined, technology-supported enrollment system for Medicaid, CHIP, and Exchange coverage.

"The federal government has taken several steps to support states in this area," says Ms. Artiga. For instance, she says, enhanced federal funding is offered for the development and operation of state Medicaid eligibility and payment systems that meet specified standards, and guidance has been issued to help states design and implement the information technology infrastructure outlined.

In February 2011, adds Ms. Artiga, the U.S. Department of Health and Human Services awarded innovator grants to Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a consortium of New England states to create models of information technology systems for operating state-based exchanges that can be shared with other states.

"Many states will need to make large-scale upgrades and improvements to their Medicaid eligibility systems that will require significant lead time," says Ms. Artiga. "It is important to begin efforts now."

Contact Ms. Artiga at (202) 347-5270 or