What Can States Do to Prevent Medicaid Declines Related to Welfare Reform?

Finding and Enrolling Children

•• Develop Medicaid-only application forms for regular Medicaid and Medicaid expansions under CHIP (M-CHIP) and make them available at district or local offices as an alternative to long, combined applications for welfare, food stamps, and Medicaid.

— Keep forms simple; ask no more than needed to determine eligibility and gather basic demographic information.

— Keep third-party documentation requirements to a minimum.

— Inform families of the choice between the Medicaid-only form and a longer form covering more programs.

•• In states that try to divert people from applying for welfare, process the Medicaid portion of a combined welfare-Medicaid application independently and make Medicaid applications available.

•• Accept Medicaid applications by mail without requiring a face-to-face interview.

•• Offer assistance filling out application forms and answering questions about Medicaid at convenient times and places. Offer:

— toll-free help lines staffed during convenient hours;

— outstationed eligibility sites with state workers who can make eligibility determinations and with community workers who can help with preliminary processing;

— convenient office hours at local or district offices (on at least some weekdays, open early or late, and always stay open over the lunch hour);

— minigrants to community groups for innovative application assistance initiatives.

•• Provide application materials and assistance in Spanish and other languages spoken in the community.

•• Adopt "presumptive eligibility" for children to provide Medicaid while the application is being processed.

•• Offer education to the community about the wide availability of Medicaid and CHIP — even for two-parent working families.

•• Enlist the help of community–based groups in providing outreach — particularly to immigrants, minorities, and other underserved populations.

•• Monitor denial rates and revise procedures if a high percentage of Medicaid and CHIP applications are being denied for procedural reasons.

Retaining Children on Medicaid

Adopt 12-month continuous eligibility for children.

Simplify redetermination procedures.

Make sure computer systems do not automatically terminate Medicaid when cash welfare is cut off.

Before terminating Medicaid assistance, comply with legal requirements to review all families losing cash welfare to see if they are eligible for other Medicaid categories, including:

— transitional Medicaid for the entire family;

— children’s Medicaid;

— Medicaid expansions under CHIP (also review eligibility under separate insurance programs, stand-alone CHIP programs);

— "medically needy" coverage for the entire family.

Reprogram computers to do as much of the review as possible automatically.

Update termination notices to clearly reflect current Medicaid policy.

Require supervisory approval before authorizing any welfare-related Medicaid terminations until computer systems are working smoothly.

Assure that if families are sanctioned under welfare work rules, children do not illegally lose Medicaid.

Take advantage of options to offer families moving from welfare to work continued Medicaid coverage:

— extend the time for transitional Medicaid;

— raise income thresholds by using liberal income disregards in regular Medicaid and M-CHIP;

— eliminate asset tests in Medicaid.

Educate families, vocational service providers, and other contractors about the continued availability of Medicaid when families leave cash welfare.

Design quality control pilot studies to test the effectiveness of state systems for retaining Medicaid when families lose cash welfare.

Source: Families USA. "One Step Forward, One Step Back." Washington, DC; October 1999.