States take steps to keep Medicaid-eligible children enrolled

Children on Medicaid often lose coverage during recertification, because a parent never received a renewal form or notification of the need to renew, didn't understand what to do with them, didn't send in information in time, didn't show up at a scheduled appointment, or didn't send in or bring in complete documentation.

"A number of children are losing coverage at renewal because family income has exceeded Medicaid eligibility limits, but the child is not referred to or signed up for the SCHIP program," adds Lisa M. Duchon, PhD, a senior consultant at Health Management Associates in Washington, DC.

Automation is an answer

States are trying various approaches to make it easier for parents to keep their children covered through a renewal or recertification period. "They are automating processes and improving coordination between Medicaid and SCHIP, simplifying forms, and making more contact with parents," says Dr. Duchon. "Many states have also lengthened the time between renewals from six months to one year."

Improved coordination between programs, especially through electronic information sharing and the use of Internet enrollment and re-enrollment, looks to be an effective way to help keep children enrolled in programs for which they're eligible, she says.

"Once these kinds of system changes have been made or implemented, they're hard to undo," says Dr. Duchon. As renewals become more automated, the burden of documentation can shift from the client to the program, and that also should help children stay enrolled, she says.

"Administrative efficiencies and information technology tools are critical components of states' efforts," says Patricia MacTaggart, lead research scientist and associate professorial lecturer in the department of Health Policy at George Washington University in Washington, DC. "Health information technology is not the answer. But it is a significant tool that allows states to get to their answer."

System coordination ahead

States are moving toward more system coordination and automation to remove barriers, says Dr. Duchon. Some examples:

• Creating an electronic interface between Medicaid and SCHIP that allows data to be automatically transferred between programs if a child is ineligible for one program. Also, client information is integrated with Food Stamps.

• Pre-populating renewal forms with all prior information about a child except for the family's current income.

• Introducing electronic application and renewal processes, and allowing electronic signatures.

• Creating a universal enrollment and renewal form for SCHIP, Medicaid, and Food Stamps.

• Adding features to eligibility systems to prevent wrongful terminations.

Simplification is key

"Simplification" is the key to states' efforts to keep eligible children enrolled in Medicaid/SCHIP, says Ms. MacTaggart. Here are some things that states are doing:

No longer requiring face-to-face interviews.

This provides the opportunity for access to applications and eligibility via the web at provider sites, community centers, schools, libraries, and even homes. Many low-income families and working poor find it difficult to enroll at local offices for Medicaid or SCHIP, says Kentucky Medicaid Commissioner Elizabeth Johnson. "The reasons vary, and may include not being able to leave work and transportation issues," she says. "However, the result is the same—many eligible families and children are not enrolling in these benefits."

To address that, Kentucky has eliminated the Face-to-Face Enroll-ment requirement, and now allows applications to be mailed in. Applications also are available online to download and mail in.

Using electronic verification systems for proof of citizenship.

"Basic barriers to eligibility, such as verification of citizenship, are being reduced in states like Arkansas and Massachusetts, that have used Medicaid technology dollars to create electronic verification systems for proof of citizenship," says Ms. MacTaggart.

Use of passive renewal processes.

States are simplifying the process by allowing renewals by mail, phone, and fax, shortening forms, reducing verification requirements, extending continuous eligibility to one year, and allowing expedited reviews, says Dr. Duchon.

Reducing the frequency of renewal.

"This is a helpful strategy for families, as is reducing the amount of documentation required to renew," she says. "However, it's possible that tighter budgets could roll back some of these latter efforts—for example, a shift back to six-month renewal."

Contact Dr. Duchon at (202) 785-3669, ext. 15 or, Ms. MacTaggart at (202) 530-2337 or