Better outreach is key factor in increasing coverage of kids

In sharp contrast to adults, the number of uninsured children declined by 800,000 during the first 12 months of the recession, from December 2007 through December 2008, according to a December 2009 report from the Washington, DC-based Kaiser Commission on Medicaid and the Uninsured, "Protecting Children During the Recession: Spotlight on State Health Coverage Efforts." Outreach efforts by state Medicaid programs are a big reason why.

In 2008, New York state's Department of Health (DOH) launched its Connections to Coverage campaign, a multi-strategy outreach initiative to promote health insurance for all of New York's uninsured children and teens. It consisted of a media campaign, enrollment events, and community partnerships.

The media campaign included television and radio commercials, billboards, posters and bus shelter signs, newspaper advertising, and other educational and promotional materials. "The message of the campaign was crafted to educate families about the availability of coverage for all uninsured children and teens, and to put a human face on those who participate in the programs," says Judy Arnold, director of the Division of Coverage and Enrollment.

Children seen in the television commercials and print advertising were actual program participants. In addition to the media campaign, DOH partnered with cultural institutions, such as the Bronx Zoo, the New York Aquarium, and the Children's Museum of Manhattan, and businesses such as Price Chopper, a supermarket chain located in upstate New York, to conduct special enrollment events.

"These enrollment drives not only brought enrollment into the community, but also provided an opportunity to generate local media coverage of the programs," reports Ms. Arnold. At enrollment events held at cultural institutions, families applying for public health insurance received free admission.

Since January 2008, New York has witnessed a steady increase in children's enrollment.

Enrollment of children in Medicaid and Child Health Plus, New York's Children's Health Insurance Program (CHIP), grew by 130,000 children between January 2008 and July 2009. More than 102,000 of these children have been enrolled since New York expanded Child Health Plus in September 2008.

"These gains in enrollment are a result of New York's efforts to expand coverage, simplify enrollment and retention, and aggressively promote the availability of coverage through its outreach and public awareness initiatives," says Ms. Arnold. "The decline in the economy has likely also contributed to the growth in enrollment."

Currently, New York provides health care coverage to more than 2 million children. Nearly 1.7 million children are covered by Medicaid and another 390,000 by Child Health Plus, representing over 40% of the state's children.

"Many of these children come from working families, some of which believe they are not eligible simply because they work," says Ms. Arnold. "Others have parents with low literacy levels, speak English as a second language, or lack an understanding of the importance of health insurance and the need for primary care."

DOH partners with health and human service providers, community organizations, school districts, faith groups, and others that serve children and families to implement outreach strategies in target counties and neighborhoods. "These community partners identify uninsured children and parents served by their program and link them to application assistance in their community," says Ms. Arnold. "Providing more targeted, local outreach efforts are effective. DOH continues to enroll the hardest-to-reach populations."

New outreach option

Beth Morrow, staff attorney for The Children's Partnership's National Health Program in Washington, DC, notes that extensive outreach has been done since the passage of CHIP, "all of which has been valuable. Nevertheless, 5 million eligible but uninsured children have not been reached through those traditional outreach methods," she says. "Thus, it is wonderful that states can now use new techniques and outreach tools such as Express Lane Eligibility."

Express Lane Eligibility allows a state to identify income-eligible children who are not enrolled in Medicaid or CHIP, by using the eligibility information that families have already submitted to the government for tax purposes or to apply for another need-based program.

After a child is identified, the application process is simplified, because information and findings from other state need-based programs and tax returns are used. Thus, it's more likely that a family will complete the application process.

"It allows a state to simplify renewal procedures, and even to do renewal without contacting the family, and in that way improve retention and eliminate churning," says Ms. Morrow. "States can improve coordination among public need-based programs and harness the value of cross-agency data-sharing. This can increase the productivity of other outreach efforts as well."

Contact Ms. Morrow at (718) 832-6061 or bmorrow@childrenspartnership.org.